“One [thing] I have learned is to live for the day and the moment rather than looking back to the past or worrying about the future. I also have discovered that it is best to live within my limitations—to step back and take things easy if I’m having a bad day. Otherwise I only find myself frustrated and don’t gain anything by it.”
—GEORGE C., PWP
Many people ask if it’s normal for someone with Parkinson’s to experience anxiety. The answer is yes! It is absolutely normal for someone with Parkinson’s to experience anxiety. In fact, paranoia, fear, and anxiety are all emotions that can be experienced by people with Parkinson’s.
Anxiety can be a symptom of PD that results from a loss of dopamine, norepinephrine, and serotonin nerve cells, or it can be a reaction to PD. And there are so many reasons to feel anxious. The minute you get diagnosed with this disease, there are things to be anxious about.
People with PD may experience anxiety in various ways, including feeling fearful, worrying constantly to the point where it can’t be controlled, and having various physical symptoms such as muscle tension, heart palpitations, sweating, and shortness of breath.
My mom struggled with anxiety and fear and wondered whether her loss of confidence in her ability to walk and do everyday activities was partially to blame.
In order to be treated, you need to find the source of the anxiety. Anxiety is often the main symptom of depression, so it’s important to find out if you are suffering from depression so you can be treated for that.
Anxiety often accompanies off periods when a person with PD is experiencing immobility. It can be severe, and the anxiety and immobility will feed off each other, making both worse over time.
To help manage this anxiety you first need to have it diagnosed, and then you should have your antiparkinsonian medications reviewed and adjusted to minimize your off periods (reemergence of symptoms). It’s important that you be educated about the link between anxiety and the off period and reassured that even a long off period will eventually resolve.
If you have PD and experience long off periods, you may find that taking 0.5 mg of lorazepam as needed under your tongue makes your anxiety more manageable. Talk to your doctor if you think you may need or want this.
Having PD is not much different than having any other disease, in that oftentimes being proactive and finding out more about it helps.
Sometimes anxiety leads to a panic attack. A panic attack is an outburst of anxiety that can be triggered by many things. It can last for a few seconds or a few hours. During a panic attack, you may feel things like shortness of breath, clammy sweat, irregular heartbeat, dizziness, faintness, and feelings of unreality.
A panic attack can be triggered by many things, such as a fear of dying, fear of going insane, breathlessness, sweating, chest discomfort, choking, and dizziness. A panic attack can sometimes look like a heart attack, and you need to make sure that it isn’t.
In many people panic attacks happen only in certain situations, and they may be linked to PD meds, in particular levodopa. For instance, panic attacks almost always occur during an off period, when levodopa has worn off and symptoms may not be well controlled. When a panic attack occurs during this time, its intensity parallels the difference in mobility between the off (symptoms not under control) period and the on (symptoms under control) period. In these people, treatment should be directed toward decreasing the fluctuations.
In some people, panic attacks may happen throughout the day, regardless of whether they are on or off. Serotonin reuptake inhibitors, a type of antidepressant, are also useful in treating panic attacks.
Additionally, some people may experience an inner restlessness and inability to keep still. This condition is called akathisia (discussed in chapter 18), and though it’s common in Parkinson’s, it should not be mistaken for anxiety.
Because anxiety goes hand in hand with depression, it would make sense then that treating depression could play an important part in treating anxiety.
There are quite a lot of available treatments for people who suffer from anxiety including medications, exercise, social activities, counseling, and support groups. Below is a list of available drugs that treat anxiety. (Yikes! Some of these drug names are pretty long. Your doctor will know more about them. Ask about which drugs would be best for you.)
• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors
• Nonselective monoamine oxidase inhibitors (Note: Increased risk for hypertension when taken with levodopa)
• Benzodiazepines (Note: High dosages can worsen parkinsonian symptoms)
• Busiprone
Remember: Anxiety is a common nonmotor symptom of Parkinson’s, not simply a reaction to being diagnosed with the disease. If you feel anxious, don’t hesitate to talk to your doctor about it.