What is depression?
Depression is a medical illness. Specifically, depression is a mood disorder that is caused by an imbalance, or unevenness, of a chemical in the brain. The term “mood” refers to an emotional state that affects how a person thinks or acts.
With depression, a person generally may feel great sadness or a loss of interest in things he or she used to enjoy. An imbalance of serotonin, a neurotransmitter (chemical) in the brain, has been linked to depression, along with other chemicals, such as norepinephrine and dopamine.
Is depression common?
About 16.2 million adult Americans suffer from what is known as major depressive disorder. The lifetime risk of women developing depression is 70 percent higher than men. Around the world, 350 million people suffer depression. Depression is responsible for the loss of $33 to $44 billion a year in the form of absenteeism, reduced productivity, and medical expenses.
Depression is also common in patients with Parkinson’s disease; an estimated 50 percent have some form of depression. Often, depression begins years before the patient has any of the physical symptoms of Parkinson’s disease (such as tremor, slowness of movement, or problems with walking and balance). This is caused by a decrease in chemicals, such as dopamine, within the brain as Parkinson’s disease begins. Depression in Parkinson’s disease affects quality of life, as much as (and sometimes more than) the movement problems themselves.
What are the types of depression?
There are several types of depression:
- Major depression is a disabling form of depression in which a person has tremendous difficulty performing simple daily tasks. People with this type of depression are often hospitalized if the symptoms are severe and affect the person’s ability to function.
- Dysthymia is a milder and chronic (long-term) form of depression in which patients have sadness, yet are often able to continue with their daily routine.
- Seasonal affective disorder strikes during the winter months.
- Postpartum depression affects women after they have given birth.
- An adjustment disorder with depressed mood is a clear emotional reaction to a negative experience or situation, such as the loss of a loved one or being diagnosed with a severe illness.
- Pseudo-dementia is a type of thinking or mental problem that occurs when a patient is suffering from depression that may look similar to “dementia.”
- Organic depression is caused by chemical or physiological (physical) change in the brain from another medical condition.
Symptoms and Causes
What are the signs of depression?
If you have several of the following symptoms for longer than two weeks at a time, you should contact your doctor:
- Depressed mood
- Loss of interest or pleasure in activities
- Sleep disturbances (unable to sleep, or sleeping for long periods of time)
- Change in appetite
- Excessive fatigue
- Sudden change in level of physical activity
- Difficulty with concentration or making decisions
- Feelings of worthlessness
- Excessive guilt
- Constant low self-esteem
- Thoughts of death
There also are physical signs of depression, which include:
- Downcast eyes
- Slow speech
- Flattened expressions
- Slower movement or fatigue that may be similar to the symptoms of Parkinson’s disease
This often makes it a challenge to diagnose depression in someone with Parkinson’s disease. In addition, depression can actually make the physical effects of Parkinson’s disease worse, so it’s important to recognize and treat these symptoms right away.
Management and Treatment
How is depression treated?
It often is difficult to know how to effectively help a loved one with depression. It is important to have realistic expectations and to give unconditional love. Communication should take place in a positive and honest way. Your loved one may reject attempts to help at first; this is part of the illness. Fortunately, treatments are available and are successful in 90 percent of patients with depression.
Depression may be treated with psychological therapy, as well as with medications. Studies show each treatment is effective by itself, but they are much more effective when used together.
There are many antidepressant medications available, each with its own advantages and disadvantages. The choice of antidepressant for patients with Parkinson’s disease depends on their overall condition and specific needs. Most antidepressants used for treatment in general are effective in those with Parkinson’s disease, although there are some antidepressants that have shown promise in recent studies specifically for Parkinson’s disease.
Psychological therapy can help a patient with Parkinson’s disease regain a sense of self worth while his or her physical and functional abilities are declining. It also can help the person maintain good relationships with caregivers and family members, even while he or she may have to depend on them even more. It also can help the patient focus on more positive approaches to problem-solving.
Electroconvulsive therapy, or ECT, can sometimes be a valuable treatment for depression associated with Parkinson’s disease. ECT is a procedure in which a brief electric stimulation is used to produce a generalized seizure in the patient while he or she is asleep under general anesthesia. However, during the course of ECT, some patients may have difficulty tolerating certain side effects, especially if they already have major muscle aches and/or problems with processing information or memory.
A major advantage of ECT is that it works very quickly (unlike medications that may take several weeks to become fully effective). It is therefore, often reserved for patients with very severe depression or for critical situations.