Common symptoms associated with Parkinson's
Depression and anxiety are commonly experienced in Parkinson's disease and can occur at any stage, impacting motivation and quality of life.
Key points
- Optimising the dose and timing of Parkinson's medication can improve mood symptoms, particularly where they fluctuate alongside motor 'on-off' periods.
- Counselling and psychological support are commonly used alongside, or sometimes before, medication is considered.
- Untreated depression and anxiety can worsen motor symptoms and overall quality of life, so reporting mood changes to your care team is important.
Next steps:
Depression may include:
- difficulty concentrating
- fatigue or low energy
- feelings of hopelessness or worthlessness
- loss of interest or pleasure in activities previously enjoyed
- persistent low mood, apathy or sadness
- reduced motivation (apathy).
Anxiety may include:
- excessive or persistent worry
- fluctuations with medication (eg worsening as a dose wears off)
- panic attacks
- physical symptoms such as a racing heart, sweating or shortness of breath
- restlessness or feeling on edge.
Mood changes are not always due to Parkinson's disease itself; several other factors should be considered:
- medication effects or interactions
- other medical conditions such as thyroid problems
- reduced facial expression and slower movement, which can sometimes be mistaken as a sign of low mood, even when the mood is unchanged
- sleep disturbance, pain or fatigue contributing to low mood or worry
- social isolation or reduced independence
- the emotional impact of adjusting to a chronic diagnosis.
There is no blood test or scan for anxiety or depression.
Assessment is based on a conversation with your GP or specialist about mood, motivation, sleep and daily functioning, and may be supplemented by a screening questionnaire.
Your care team will also consider other factors, such as pain, sleep problems or medication timing.
- Optimising Parkinson's medication – because mood symptoms can fluctuate alongside motor 'on-off' periods, reviewing and adjusting the dose or timing of Parkinson's medication is often one of the first and most effective steps, and may improve depression and anxiety even before other treatments are added.
- Counselling and psychological support – counselling can help with coping strategies, adjustment to diagnosis and anxiety management. It is commonly recommended alongside, or sometimes before, medication is considered.
- Non-medicine approaches – maintaining routine, staying physically and socially active and psychological therapies such as cognitive behavioural therapy can be effective, particularly for milder symptoms.
- Antidepressant medicines – commonly used and generally well tolerated. The choice of medicine is individualised based on symptoms, other medications and side-effect profile.
- Regular review – as with other symptoms, the benefits and side effects of any medicine used for mood should be reviewed regularly with your care team.
When to consider specialist review
Speak with your neurologist or GP if:
- low mood or anxiety is new, persistent, worsening, or affecting daily life or relationships
- if you notice mood changes fluctuating with your Parkinson's medication timing.
When to seek urgent help
Seek urgent medical attention if you or a family member:
- is having thoughts of self-harm or suicide
- if low mood or anxiety worsens suddenly and severely.
Call Emergency 000, present to your nearest Emergency Department or contact your GP or specialist urgently. These changes need prompt assessment rather than waiting for a routine review.
Common patient questions
Not necessarily. While it's understandable to feel low after a diagnosis, depression in Parkinson's disease is also linked to changes in brain chemistry associated with the condition itself. It can occur independently of how someone is coping physically.
Anxiety and depression can sometimes fluctuate with Parkinson's medication timing, particularly worsening as a dose wears off. This should be discussed with your neurologist, as adjusting the timing of your medication may help.
Most antidepressants can be used safely alongside Parkinson's medication, though your doctor will consider potential interactions and individual factors when choosing a medicine.