Thank you for the podcast.

With reference to the symptoms of depression having a negative impact quality of life in Parkinson’s disease, is that not the nature of depression? Is there a suggestion that there is some difference between the impact of depression in Parkinson’s and its impact in other contexts?

With reference to depression as a symptom, it is a little unclear from the podcast whether it is always a symptom:

“what we think is that depression in Parkinson’s disease is not a reaction to the illness, it is actually a part of the underlying illness…”

or only sometimes a symptom:

“we actually think that depression in some patients may be a part of the underlying disease.”

Since it seems unlikely to me that it is always a symptom, I think this theory must be that it can be a symptom *or* a reaction.

Then the question becomes is there a difference between depression as a symptom and depression as a reaction. And it seems from Dr. Richard’s response that’s there is no discernible difference. If that is the case, then why is a potential difference noteworthy in any way? if they can’t be told apart, they can’t be treated differently.

Are there any efforts underway to determine whether or not there is a treatment relevant difference between depression as a symptom of, and depression as a reaction to Parkinson’s disease?

And given that the symptoms of depression in Parkinson’s are the same as the symptoms of depression in other contexts, what is it that has made us question whether or not standard depression therapies work in Parkinson’s?

And as far as studies showing that people with arthritis have lower rates of depression in people with Parkinson’s, the first study I stumbled across comparing depression rates among those with Parkinson’s to those with arthritis found no difference between the two:

“As with previous studies, the patients with Parkinson's disease scored significantly higher than normal controls on various self-ratings of depression and anxiety but, in this study, did not differ from those with arthritis. Qualitatively, both the Parkinson's disease and the arthritis groups had depression characterised by pessimism and hopelessness, decreased motivation and drive, and increased concern with health.” (Gotham, et al., J Neurol Neurosurg Psychiatry. 1986 Apr;49(4):381-9.)

Also, I wonder how long arthritis therapies work on average, and how long people live with the disease on average. I also wonder if arthritis therapies have side effects with the potential to negatively impact everything from one’s ability to perform everyday tasks, like drinking a glass of water, or working, to one's ability to socialize comfortably.