depression and anxiety

Posted: Fri Apr 10, 2009 10:40 pm Post subject: Anxiety and depression

I have depression and anxiety since I am at adult. I have seen psychiatrist for treatment. I am diagnosed as Parkinson's 2005. Questions: 1. Is my depression may be started before I have parkinson's? 2.I have sideeffect on taking my prescription i.e 1 dosage of Xanax 0.5mg and Prozac 20 at bedtime. Xanas is for my anxiety and Prozac for depression. I feel fresh and engergetic the next day. However I feel tired and dizziness easily in the afternoon after my regular exercise at gym. I have normal blood sugar level. My medication 5 dosages of Requip 2mg and 3 dosages Sinemet CR 50/100 daily. Kindly adviseBack to top
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Wed Apr 15, 2009 8:37 pm Post subject:

I'm not sure that you should necessarily blame your dizziness and fatigue with the drugs. If you experience them more right after you exercise, perhaps you should take it a little easy...either change the time that you exercise, to go to heavy, but you can stretch it a little to pace yourself...? As for your question on depression, here is an exerpt that we wrote about the topic: Depression in Parkinson’s disease is characterized by long periods of sadness or loss of interest and pleasure in almost all activities. The depressed patient feels gloomy, has decreased energy, is constantly fatigued, has poor concentration, difficulty sleeping, and loss of appetite. They can also be preoccupied with guilt, feelings of worthlessness, and hopelessness. Some may have physical complaints (such as poor sleep, loss of appetite, etc). The clinical appearance of depression in Parkinson’s disease often include slowing of motor functions and may result in worse performance of activities of daily living. Depression is very common and can affect up to 50% of Parkinson’s patients (Cummings and Masterman, 1999). Fortunately, only a small percentage (less than 20%) of depressed Parkinson’s patients actually suffer from major depression (Weintraub et al, 2004) . The majority experience minor forms of depression. While depression can result from frustration and a reaction to Parkinson disability, it is increasingly recognized as an intrinsic feature of the illness. The rate of depression does not vary with disease severity. It may even precede the motor symptoms of Parkinson’s disease. Diagnosing depression in Parkinson’s disease can be as simple as asking the patient whether he or she has been feeling sad for some period of time or whether he or she has lost interest in daily activities. However, it can sometimes be challenging as some physical features of depression such as insomnia, weight loss, loss of appetite, and motor slowing are also common features of Parkinson’s disease. Occasionally, depression can be a non-motor manifestation of “wearing-off”. In fact, depression is often under-recognized. Failure to diagnose and treat depression in Parkinson’s disease may result in suboptimal management or ineffective treatment, which can lead to significant disability. The initial approach to the management of depression in Parkinson’s disease involves optimizing dopaminergic medication to improve motor symptoms and minimize motor fluctuations. Dopaminergic medications such as levodopa, dopamine agonists and selegiline also have a mild antidepressant effect. Cognitive behavioral therapy and psychotherapy are often helpful in enhancing the coping mechanism in the Parkinson’s disease patient (Dobkin et al 2007). Family support and counseling may help improve depression in Pakinson’s patients. Selective serotonin reuptake inhibitors (SSRIs) are the most well-tolerated and most commonly used medications to treat depression in the elderly, followed by tricyclic antidepressants (TCA), serotonin norepinephrine reuptake inhibitors (SNRI), monoamine oxidase inhibitors (MAOIs), and even Parkinson’s medication that have selective D3 antagonists properties (such as ropinirole and pramipexole). These will be discussed in detail in Module 5. Patients unresponsive or refractory to medications may respond to electroconvulsive therapy (Moullentine et al 1998) (This therapy is not as bad as it sounds, really. ECT is actually a painless procedure and may even transiently improve motor symptoms of Parkinson’s disease. However, it can cause some memory loss). Repetitive transcranial magnetic stimulation (another painless, non-invasive procedure using magnets placed above the head to “stimulate” areas in the brain) also seems promising and has been recently approved by the United States Food and Drug Administration (US FDA) for the treatment of depression in the general population (Fregni et al 2005). Yours,_________________Hubert H. Fernandez