Depression in Parkinson’s Disease

Overview

What is depression?

Depression is a medical problem. It causes long-lasting, overwhelming feelings of sadness or hopelessness. A person with depression may have trouble:

  • Enjoying activities they once liked.
  • Taking care of themselves properly.
  • Working.

What is Parkinson’s disease?

Parkinson’s disease is a neurological disorder that affects your nervous system (brain). It can cause:

  • Issues with balance and walking.
  • Tremor (shaking).
  • Stiff muscles.
  • Slow movement.

People with any chronic (long-term) disease may experience depression. These diseases can trigger strong feelings about symptoms, physical limits and the possibility of death.

People with Parkinson’s disease often have similar reactions. But the ties may run even deeper, as Parkinson’s disease may directly cause depression. That’s because Parkinson’s affects chemicals in your brain. These changes can lead to mood disorders like depression, anxiety and apathy (lack of motivation or drive). Depression can also intensify other Parkinson’s symptoms — speech and movement can slow even further, or forgetfulness can worsen, for example.

How common is Parkinson’s depression?

Depression is very common when it comes to Parkinson’s disease. Up to 50% of people with Parkinson’s disease experience depression.

Symptoms and Causes

How can Parkinson’s disease cause depression?

For many people, the challenges of Parkinson’s disease are enough to cause depression.

But scientists believe that depression in Parkinson’s might also come from changes to certain chemicals in the brain:

  • Dopamine.
  • Norepinephrine.
  • Serotonin.

Those chemicals help control your:

  • Appetite.
  • Energy.
  • Mood.
  • Motivation.
  • Movement.
  • Sleep.
  • Thinking skills.

What are the symptoms of depression in people with Parkinson’s disease?

The symptoms of depression vary from person to person. They may include:

  • Crying a lot.
  • Feeling cranky or irritable.
  • Feeling sad, helpless, hopeless, worthless or guilty.
  • Feeling tired almost all the time and having less energy.
  • Having problems with sleep — too much sleep, too little sleep or insomnia (trouble falling or staying asleep).
  • Poor attention or concentration.
  • Losing interest in activities you once enjoyed.
  • Losing interest in eating or taking care of yourself.
  • Moving or talking too slow.
  • Thinking a lot about dying or wishing to die.

When do symptoms of depression start with Parkinson’s?

Parkinson’s disease starts changing your brain well before diagnosis. That means some people experience depression for a while without knowing the cause. Others may not feel depressed until later in their Parkinson’s treatment.

It’s also possible to get Parkinson’s and never experience depression.

Diagnosis and Tests

How is depression diagnosed?

There aren’t any tests to confirm depression. If you have signs of depression, reach out to your healthcare provider. They’ll talk with you about your symptoms, how long you’ve had them and how much they interfere with your life.

Your healthcare provider may also review your Parkinson’s medications with you. This’ll help make sure that:

  • Your medications aren’t causing depression symptoms.
  • Your medications are managing your Parkinson’s disease symptoms as much as possible.

What are the challenges to diagnosing depression in people with Parkinson’s disease?

It can be difficult to tell whether a symptom is actually caused by depression or the physical effects of Parkinson’s disease. For example, Parkinson’s disease causes muscle weakness, with symptoms that may seem like depression:

  • Downcast eyes.
  • Flat expression.
  • Lack of visible emotions.
  • Slow speech.

Parkinson’s can also cause apathy, which can look like depression, with symptoms like:

  • Loss of interest in previously enjoyable activities.
  • Flat expression.
  • Losing interest in eating or taking care of yourself.

Similarly, other symptoms can come from either Parkinson’s disease or depression:

  • Fatigue or less energy.
  • Low sexual function.
  • Trouble sleeping.
  • Weight loss.
  • Memory loss.

Management and Treatment

How is depression treated in people with Parkinson’s disease?

Depression can make the symptoms of Parkinson’s disease worse. It’s important to identify and treat depression as soon as possible.

Several strategies can improve your mood and your movement. They’re much more effective when used together. Treatments for depression when you have Parkinson’s include:

  • Medications: Many medications can help treat depression. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most common type prescribed to people with Parkinson’s disease. Your healthcare provider can recommend the right medication for your particular needs.
  • Psychological therapy: Counseling, or talk therapy, can help you manage the emotional challenges that come with Parkinson’s disease. For example, cognitive-behavioral therapy (CBT) can help you unlearn negative thoughts and behaviors. Instead, you’re encouraged to focus on positive emotions and actions. CBT can help you understand your self-worth, maintain your relationships and solve problems. Support groups, in person or online, can also provide emotional therapy.

There’s increasing evidence that regular exercise and leading a healthy lifestyle also helps lessen feelings of depression in Parkinson’s disease. Check with your doctor about the types of exercise you can do safely without injuring yourself. Eat a well-balanced diet, limit alcohol and don’t smoke, as well.

Prevention

Can I prevent depression with Parkinson’s disease?

You may not be able to prevent depression over the entire course of Parkinson’s disease. Still, several strategies can help you delay or control the symptoms of depression:

  • Eat well-balanced, healthy meals.
  • Exercise several times a week.
  • Take all of your medications as they’re prescribed.
  • Take part in activities so you don’t feel alone or isolated.

How can I notice depression symptoms earlier?

The earlier you notice and report symptoms of depression, the earlier your healthcare providers can help you. Consider the following:

  • Ask a friend or family member to look out for any changes in your mood, since you might not notice.
  • Bring a loved one to your appointments. They can contribute to conversations about your mood.
  • Ask a healthcare provider to screen you for depression at least once a year. Many questionnaires and tools are able to identify depression.
  • Talk with your healthcare providers about your mood at every appointment. Mention if your mood has changed since your last appointment or if you have any symptoms of depression.

Outlook / Prognosis

What is the outlook for depression with Parkinson’s disease?

Many people with Parkinson’s disease have depression but don’t get help for it. They may not notice their symptoms, or may think the symptoms are unavoidable with Parkinson’s.

What they may not realize is that medications, therapy and lifestyle changes can help. Many people find some relief from depression. And that helps reduce their symptoms of Parkinson’s disease.

Living With

Besides treatments, other strategies can boost your mood and increase your self-worth:

  • Ask for help. Remember, depression isn’t a sign of weakness. It’s caused by chemical changes in your brain.
  • Connect with Parkinson’s disease support groups — in person or online.
  • Exercise several times a week.
  • Maintain your hobbies and activities.
  • Schedule fun activities in advance so you have things to look forward to.
  • Identify small tasks you can accomplish each day, such as completing a chore, exercising or calling a friend.
  • Take part in social activities so you don’t feel isolated.
  • Try complementary therapies, such as music therapy, relaxation techniques, massage, acupuncture and meditation.

When should I talk to my healthcare provider?

Talk to your healthcare providers about your mood at every appointment. Talking about it regularly will prompt you to open up. And it will help your healthcare providers notice symptoms of depression early so they can provide care.

If you start to think about hurting yourself, call a healthcare provider immediately. You can also call the National Suicide Prevention Lifeline at 800.273.8255. This hotline connects you to a national network of local crisis centers for free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.

In an emergency, call 911.

A note from Cleveland Clinic
Depression from Parkinson’s disease isn’t a sign of weakness or something you have to live with. It’s related to chemical changes in your brain, and treatments can help. Talk to your healthcare provider about your mood, especially if you feel down for weeks at a time. Several strategies can help you feel better. You can still take part in things you enjoy and better manage the symptoms of Parkinson’s disease.

Last reviewed by a Cleveland Clinic medical professional on 12/20/2020.

References

  • American Parkinson Disease Association. Depression in Parkinson’s. (https://www.apdaparkinson.org/what-is-parkinsons/symptoms/depression/) Accessed 12/20/2021.
  • American Parkinson Disease Association. Depression and Parkinson’s disease. (https://d2icp22po6iej.cloudfront.net/wp-content/uploads/2017/02/APDA1709-Supplement-Depression-D4V1.pdf) Accessed 12/20/2021.
  • Marsh L. Depression and Parkinson’s disease: current knowledge. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878671/) Curr Neurol Neurosci Rep. 2013; 13: 409. Accessed 12/20/2021.
  • Michael J. Fox Foundation for Parkinson’s Research. Depression and Anxiety. (https://www.michaeljfox.org/news/depression-anxiety) Accessed 12/20/2021.
  • Parkinson’s Foundation. Depression. (https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Depression) Accessed 12/20/2021.

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