As I have written before, Parkies are at high risk for anxiety disorder. This is not merely because we’re reacting in fear to our diagnosis, but because PD changes the chemical structure of our brain in a way that naturally brings on anxiety and its partner-in-crime, depression. As one article that I read noted, researchers found higher rates of anxiety in people with Parkinson’s than in comparable people with multiple sclerosis.
However, as my own doctor pointed out, anxiety is treatable. She told me this during a recent visit when I admitted that I didn’t see how I could manage all the anxious stress I was under. At the same appointment, she checked my blood pressure and was shocked at how high it was. I think the two were related.
So what I’d like to do now is research and review – for my benefit as well as yours – what Parkies can do to lessen our anxiety levels.
(1) Medication
My neurologist had me visit a psychiatrist for two sessions. He listened to what was making me anxious, then tweaked my meds; basically he added more clonazepam and is monitoring my nortriptyline levels. He is now following up via emails to ascertain whether the change in meds is helping. This process is ongoing and I hope it works.
(2) Psychological Therapy
A Parking Suns reader sent me a 2015 article entitled “Cognitive Behavior Therapy for Depression and Anxiety in Parkinson’s Disease.” (Click to download!) It lays out many ways Parkies might give themselves over to depression and anxiety, then suggests a course of 8-12 one-hour sessions to help you out of your rut.
The article has a paragraph-long description of one person with PD that I’ll copy-and-paste here; maybe you’ll see yourself in part of it:
“Bill was a 73 year old retired shopkeeper who presented with symptoms of generalized anxiety disorder and depression. He had watched his best friend die of end stage PD one year prior to his own diagnosis of PD. Understandably, he became anxious the same future awaited him when he received his diagnosis. Bill became depressed and stopped doing the activities that gave his life meaning and pleasure such as photography. He believed that his PD would prevent him doing photography well and thus he gave away all of his equipment as he thought “my life is over because of my PD” and “I am going to have to stop doing this sooner or later so may as well get the pain over with now”. Bill also reported isolating himself due to embarrassment over his motor symptoms, for example worrying he would spill food and drinks. He stopped attending a music club with his friends and also reduced his interest in buying music to share. Bill also stated that since his wife had died five years ago he had started to go out and meet with friends, but since his diagnosis of PD had withdrawn from his friends, felt more lonely and was missing her more. He reported depressive rumination about his PD and hopelessness about the future. Bill also worried about being depressed, and that he was losing his identity and was “weak”. He was worried he would get to the “point of no return” with his PD and as a result avoided doing many things where his symptoms would be noticeable, and became hypervigilant about his symptoms looking for the start of the “end”. Bill also reported thinking “I am incompetent and can do nothing at all” and “I am completely not able to function, my life is over”. [pg. 445-446]
The article’s authors suggest that a Parkie’s mood can improve even though the physical progression of the disease continues unabated. They propose a therapy model that in 8-12 sessions does the following:
First few sessions: Break the cycle of negative thoughts about being physically impaired because you have PD. If possible, bring in your caregiver to work out ways you and the caregiver can support each other.
Middle sessions: Delve into the PD diagnosis as if it was a grieving process. Recognize all that you can still do, and conduct your own experiments to show yourself that you are still up to the task on many fronts. For example, in the article, the patient Bill had stopped eating out with friends because he thought (a) he would spill lots of his food and drink, and (b) his friends would laugh at him. When he finally accepted an invitation to dine out, he found he spilled only a little bit of his drink and his friends didn’t notice.
The middle sessions also have you keep thought diaries. To quote from the article: “Thought diaries are useful in challenging negative PD related specific cognitions and cognitive biases. Thought diaries are used to challenge any negative cognition the individual with PD is experiencing as it is these negative cognitions which are seen as maintaining depression and anxiety disorders in PD.”
Final sessions: Learn to be your own therapist by (a) continuing to keep thought diaries and (b) conducting your own behavior experiments. By the way, Bill apparently returned to his hobby, photography.
(3) Physical Exercise
What better site to check out on this than the Davis Phinney Foundation? (OK, there’s Rock Steady, too….) Click here for the Davis Phinney article “How Exercise Can Ease Anxiety in Parkinson’s.”
The opening paragraph states: “Not only can anxiety result from the brain changes brought on by Parkinson’s, but worries about off-times, changing symptoms, as well as questions and fears about the future, can all lead to anxiety.”
According to the Phinney article, exercise offers multiple benefits for Parkies:
- It appears to slow the disease’s progression for many people.
- It reduces or eliminates physical symptoms such as tremoring and stooped posture.
- You feel great afterwards because of the endorphins coursing through your body.
- It improves your cognitive ability.
- It reduces your anxiety levels.
- It reduces your anxiety levels.
Yes, I said it twice.
I can speak from experience about this. Before I work out at the gym, I’m often in a grouchy, anxious mood, and I feel stressed out. After practically any workout – treadmills, free weights, yoga/stretching, stationary bike, swimming – I feel calm and upbeat.
And last summer, each time I swam in long distance, open water swim races (e.g., click!), I emerged from the water feeling immortal.
(4) Stay Social…
…even though at first you may not feel like it. (See #2 above. See also poem below.)
(5) Do Something You Love
This is my own, personal suggestion. For example, I love writing sonnets, even though I’m not good at it. But I enjoy the challenge and feel terrific when I sense the poem is “done.”
Here’s a sonnet that I wrote; it covers both (4) and (5):
Sun’s Up! Get the Heck Out of Bed!
I wake up in the morning, and I’m tired.
I want to eat and go right back to bed.
My energy’s depleted, and my head
Is silty, sodden, saddened and quagmired.
I have no wish to venture out the door.
I don’t know how I’ll make it through the day.
I’d like to toss the rest of life away,
And not see anybody, anymore.
But somehow, something gets me on a train
Which whisks me down the Hudson to New York.
And with some friends I pick up knife and fork
And eat, and yak, and laugh, and quaff champagne.*
So sleeping more’s a dilatory tactic,
A dumb way to delay all that’s fantastic.
*Actually, prosecco, which is basically Italian champagne.
What creative pursuit turns you on?
Anxiety is one of the many surprise items in Parkinson’s grab-bag of goodies (or should I say “baddies”?). However, this is one symptom you can do something about. You don’t have to suffer with it.
P.S. I didn’t mention meditation as a possible prophylactic against anxiety…mainly because I’m unfamiliar with it. If you want to add something about meditation and mindfulness in the comments section below, be my guest!
