Parkinson’s and your mind: mood, worry and thinking changes

Anxiety and depression in Parkinson’s are linked to the same brain changes that cause tremor and stiffness. They are a treatable part of Parkinson’s.

Managing symptoms and facing the unknown can lead to worry about how things might change during the day or over the years.

Parkinson’s can make it harder to stay active and connected, and isolation can add to anxiety.

Grief after a diagnosis is a normal reaction. Depression is different: it lasts weeks or longer and colors everything.

Some signs of depression, like poor sleep and feeling slowed down, are also signs of Parkinson’s. Some experts think depression in Parkinson’s often shows up as frequent, shorter mood changes rather than constant sadness.

Many movement disorder specialists now ask about depression. If yours doesn’t, bring it up.

You could say

• “Could I see a counselor or therapist?”
• “I don’t enjoy things like I used to.”
• “I’ve felt down most days for a few weeks.”

The Parkinson’s Foundation recommends a combined approach: counseling, exercise, social support, and treatment decisions made with your doctor.

As treatment wears off between doses, movement symptoms can come back. Some people feel anxious during these “off” times.

If your worry seems to follow a daily pattern, note the times and share them with your clinical provider.

Working with a trained therapist can help you understand your anxiety and find ways to manage it.

Mindfulness practices and exercise are among the strategies that help manage anxiety in Parkinson’s.

1. Sit comfortably and rest your hands
2. Breathe in slowly for four counts
3. Breathe out for six counts
4. Repeat five times, noticing your feet on the floor

Group conversations and busy places can feel harder with Parkinson’s. Choosing quieter times and a seat near the exit can ease worry.

There are no proven treatments for apathy yet, but structured activities, a regular routine and time with people help.

• Book exercise with a friend so you’re expected
• Join a class or group that meets weekly
• Put small tasks in a calendar with reminders
• Start with five minutes, then decide

Talking with family and friends, or joining a support group, can help you stay engaged and motivated.

A person with apathy is not being lazy or making excuses. Gentle structure and doing things together usually works better than pushing.

Trouble finding the right words is common. A speech therapist can help with language difficulties.

An occupational therapist can help you find ways to adapt and cope with thinking changes.

• Do one thing at a time
• Keep keys and phone in one spot
• Plan harder tasks for your best time of day
• Use a calendar and alarms

Your doctor may suggest seeing a neurologist or neuropsychologist for testing. Mild changes can be found through testing even when they aren’t noticeable day to day.

Illusions and visual hallucinations tend to happen in low light. Good lighting is one of the supportive steps the Parkinson’s Foundation suggests.

Common sleep problems include trouble staying asleep, nightmares or very emotional dreams, and feeling drowsy in the day. Some people act out their dreams.

Mention all sleep changes to your care team. Better sleep can also help mood and thinking.

Some people develop fixed false beliefs, such as jealousy or feeling persecuted. If someone feels threatened, they may become agitated or unsafe. Contact the care team promptly, and call 911 if anyone is in danger.

• “If I look serious, I’m not upset. It’s my Parkinson’s.”
• “My face doesn’t always show it, but I’m really enjoying this.”
• “Parkinson’s makes my voice quiet. Please ask me to repeat if you need to.”

Physical, occupational and speech therapies can help with walking, speech and coping with thinking changes.

Instead of reading their face, ask: “How are you feeling about this?” Their words are a better guide than their expression.

Exercise can ease non-movement symptoms such as depression. People who exercise at least 2.5 hours a week, starting early, have a slower decline in quality of life.

Walking, dancing, yoga, cycling and swimming can all help. Check with your doctor before starting something new.

Support groups can help with living with Parkinson’s, including its effects on mood. Individual or family counseling can help too.

Dance and non-contact boxing classes for people with Parkinson’s are growing. The Parkinson’s Foundation helpline can help you find one near you.

A regular routine, keeping up social contact and avoiding isolation all help with low motivation.

Free help from Parkinson’s information specialists, in English and Spanish, Monday to Friday, 9 a.m. to 7 p.m. ET. They can refer you to local professionals, support groups and wellness programs.

A national organization with information, support groups and local chapters.

Free, confidential support if you are struggling or having thoughts of suicide.

Free, 24/7 support by text, helpful if speaking is hard.

Many countries have a national Parkinson’s organization. findahelpline.com lists free emotional support lines by country.