“We cannot lose hope. We must try to remain positive and live each day with this disorder.” – Frank C. Church
Many people with Parkinson’s Disease will, at some point, experience depressive feelings or even full depression. The treatment for depression is not an exact science. Treatment options around the world vary from talking therapies, alternative and complementary therapies through to the use of prescribed medication.
In the Western world, a combination of talking therapies and prescribed medication would appear to be increasingly used as a targeted approach to addressing the suspected cause and effect of depression; although the treatment options and prescribing regimen appear to vary and it is clear that this area of human illness is not yet fully understood. Research into new methods of treatment are ongoing.
When depressive feelings occur, they can cause confusion and anxiety. Often, we can try to shrug the feelings off in the hope that they are nothing serious but, for people with Parkinson’s, it can be one of the symptoms of Parkinson’s itself and may represent an escalation of the illness.
Depression can cause a variety of very difficult symptoms, for example; a sense of despair, helplessness, powerlessness, a lack of hope, a sense of being ‘stuck’, an overwhelming lethargy, cognitive confusion, behavioural difficulties, a sense of impending doom and an intense self-loathing. Each individual will experience a range of symptoms, unique to them. Symptoms may not just be emotional. People are often surprised by the physical manifestation of symptoms of depression; illness from generally feeling ‘unwell’ through to what might be classed as psychosomatic symptoms of any of a number of physiological illnesses.
There are a number of ways that depression is considered. For example; ‘Reactive’ and ‘Clinical’ Depression. Reactive Depression is often described as a depression where the onset is caused by an event / situation / experience or circumstances that cause a person to enter into a depressed state. Clinical Depression, alternatively, is often described as being something innate within the person who is depressed; caused by their own individual physiological genetic make-up. Cause by an illness such as Parkinson’s can fit into both categories.
A person with depression may already have a strong sense of their emotional state and associated symptoms. They may have been living with the condition for some time and, if they have started to feel the sense of powerlessness, helplessness and hopelessness that are often symptomatic of depression, they may have very low expectations of talking therapies as a successful form of treatment and low belief in any positive outcome of therapy; a belief rooted in their sense of hopelessness.
Another important consideration, is the extent of the depression. For example, is the depression acute or chronic? If it is acute, how frequently do the bouts or symptoms manifest and how long do they last? Can a pattern be identified? If it is chronic, then what is the history of this; how long has this been going on for and to what degrees or levels during that time? For people with Parkinson’s, keeping a record of our mood and feelings can be very useful to take with us for each review with our Neurologist and helpful to any of the medical team supporting us.
It is generally considered that it is easier to effectively treat depression, when the person is experiencing the early stages of its development. Identifying how far into the experience, or the frequency experienced, that a person suffers will help the medic/therapist to determine the most suitable type of intervention.
There are also considerations around the level of the symptoms. For example, there are levels from mild through to major. Mild depression is considered to manifest fewer of the full range of possible symptoms but is also considered to be the beginning of the potential for longer term, more major condition.
In major depression, a professional might expect to find a greater range of symptoms in effect and may also find that the person’s behaviour has started to become that of internalising their cognitive processes and introverting in their behaviours; particularly around social engagement. This is where a person with major depression may gradually reduce contact with friends, family and work colleagues. Some may even stop leaving their home / going out.
Some people may not know they are depressed. Some people may experience their symptoms, the accompanying sense of despair and may develop fears that they are in some way ill; it is not uncommon for people with depression to develop a sense of imminent death or a phobia about an aspect of their health.
Depression carries the hallmarks of feeling like a very serious illness, while being potentially invisible to others. It is often the experience of the person with depression, that they are considered by others to be looking ‘well’ and so are often expected to get on with their life, yet all the while feeling, inside, as though they are a ‘casualty of war’; qualifying them for a bed and treatment or, in worst case scenario – triggering the person to wanting a way out; which is when we identify suicide risk. This is clearly a state of suffering.
I would appeal to anyone with Parkinson’s that feels they may be suffering depression, to reach out for help. Contact your Doctor, Neurologist or any of your support team, tell a friend, tell a family member or your employer. You can seek help anonymously, through services like the Samaritans (UK national emotional crisis support helpline – check in your own country for similar services). Your Doctor may recommend a short period of time on medication and / or a referral to ‘talking therapies’ with a Counsellor or Psychotherapist, for example.
(c) Deano Parsons. 2021.