Is depression part ofPD

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Approximately 50% of people with PD suffer from depression. In some, depression is the first symptom of PD. People with PD may suffer from an endogenous depression, a depression unrelated to any external event. Such depressions are part of the chemical imbalance underlying PD, and some studies have shown that the PD drug Mirapex can also act as an anti-depressant in some people with this kind of biochemical depression, even if they don't have PD. People with PD can also suffer from an exogenous depression, a depression related to external events such as job loss, retirement, or knowledge of a relative with advanced PD with fear of becoming as disabled as the relative. In some people, depression is associated with anxiety, and in some, the anxiety is so overwhelming that agitated depression is a result. Depression is sometimes associated with a sleep disorder: an inability to fall asleep at night, prolonged sleeping during the day, or a combination of both. In some, depression is associated with a passive, quiet, and withdrawn state and can be treated in several ways and will depend on some of the associated factors described previously here.

How do you know if you're depressed? Sometimes trying to determine whether you're depressed or whether you have PD or both is difficult. Someone with PD who has a sad, poker face, a soft, weepy voice, and a stooped posture (bent as though bearing the weight of the world on his or her shoulders) may appear depressed when he or she is not. Conversely, a depressed person who moves slowly, speaks softly, and walks stooped over may appear to have PD when he or she does not. You may be depressed if during the past week you have cried for no apparent reason; have felt sad, helpless, or guilt stricken; had difficulty sleeping at night or have slept all day; have felt anxious, fearful, uncertain, or worried for no apparent reason; have lost interest in your work, hobbies, family, or friends; and have began to drink alcohol heavily.

The Depression Questionnaire (Table 2) may help you determine whether you're depressed. The questionnaire is modeled on the Hamilton Depression Scale and has not been validated as a test; rather, it is meant as a teaching guide. If during the past week you have had one of the following symptoms on 4 or more days, select "Yes"; if you have not, select "No."

If you answered yes to 10 or more questions, then you are probably depressed. If you answered yes to 15 or more questions, then you are depressed. Discuss this with your spouse, family, minister, and doctor. If you have thought of ending your life, seek help immediately.

Treatment of depression starts with a frank discussion between you and your family about why you're depressed. The discussion should then involve your doctor. Treatment may consist of counseling, behavior modification, or psychiatric analysis. Antidepression drugs may be prescribed. The selective serotonin reuptake inhibitors (SSRIs)—Celexa, Paxil, Prozac, and Zoloft—are the most commonly prescribed antidepression drugs. They raise the levels serotonin in the brain. Low levels of serotonin are associated with

100 Q & A ABOUT PARKI

N S O N D

S E A S E

Table 2 Depression questionnaire

1. I feel sad.

Yes

No

2. I feel discouraged.

Yes

No

3. I feel blue.

Yes

No

4. I feel like I'm a failure.

Yes

No

5. I often feel isolated.

Yes

No

6. I feel sick.

Yes

No

7. I feel guilty.

Yes

No

8. I feel like I'm being punished.

Yes

No

9. I feel disappointed in myself.

Yes

No

10. I hate myself.

Yes

No

11. I blame myself for bad things that happen.

Yes

No

12. I cry a lot.

Yes

No

13. I feel irritable.

Yes

No

14. I don't care about what is happening around me.

Yes

No

15. I don't care about other people.

Yes

No

16. I can't make decisions.

Yes

No

17. I feel unattractive.

Yes

No

18. I can't work.

Yes

No

19. I can't fall asleep.

Yes

No

20. I can't stay awake.

Yes

No

21. I feel tired.

Yes

No

22. I have no appetite.

Yes

No

23. I don't care about sex.

Yes

No

24. I worry about everything.

Yes

No

25. I feel ashamed.

Yes

No

depression and anxiety. The SSRIs take at least 2 to 3 weeks to work. Side effects include fatigue, weight gain, and loss of sex drive, although they are less common in SSRIs than in other classes of anti-depression drugs. Wellbutrin increases brain dopamine levels in all regions of the brain, not just the ones that PD impacts. It is helpful in the apathetic depression of PD. Side effects include agitation and rarely seizures.

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