I would vote to banish the motor symptoms. I feel self-conscious when I get up to walk at a social gathering and my first steps make me appear drunk.


Ann

Paula and I just heard a Dr. Irene Richard speak at the Fox Rountable meeting in Cleveland. She is doing extensive studies on PD and its relationship to depression. (See the last Fox Research publication she is interviewed about "attitude" in Parkinson's). I am thinking now about people I know who committed suicide who had EARLY stage Parkinson's - one sacrifice is one too many in my opinion. Biochemical causes (an imbalance of neurotransmitters such as serotonin is known to affect the processing of thoughts and emotions).


Paula - if you can't move - you DO get depressed - but now they think depression PRECEDES Parkinson's. May sound strange, but I would rather not move than have the depression. Can you think of people who made a positive out of their handicaps? (Helen Keller - Christopher Reev, etc). Read this recent story: http://mentalhopenews.blogspot.com/2...ttered-by.html

Our minds are not separate entities from our bodies - we have to study and treat the whole body to eradicate or check this illness. The mind is powerful - VERY powerful. When my depression is in check, my attitude improves along with my movement. I am convinced that mental associated illnesses with PD may be part of the cause or at least a strong indicator of the degree of severity of the disease.

Boann - you have to check with Psychological and Psychiatric databases to find the body of research on depression and cognitive difficulty, insomnia, psychosis, anxiety, etc. All of these non-motor symptoms are not medication side effects.

Here are some areas being studied that links PD and depression:
* Identify structure and function of cortical areas, subcortical structures, and tracts implicated in the etiology of mental disorders.
* Identify neurotransmitters associated with mental disorders, pathways of synthesis and degradation, associations with brain structures and tracts, and roles of neurotransmitters in mental disease.
* Understand components of individual CNS neurons, including cell membranes, cellular content, the action potential and mechanisms of electrical and chemical cellular transmission.
* Understand major cell receptor types, composition, and function.

I believe the reason we can't find info readily on PD and depression is because they usually clump behavioral studies and have a title like, "Depression and neurological illnesses." Check out some specifics like neurophysiology, neuropharmacology, neuroendricinology, etc. Add to that synthesis, biosynthesis, degradation of all the chemicals involved in "movement disorders" (acetyline, dopamine, seritonin, norepinephrine, and so forth.

** Somebody needs to do a meta analysis of the body of literature and put "Parkinson's" in the title!**

maybe they have???? I have this theory that is genetic studies, or ways to measure chemical deficiencies BEFORE an illness were to occur, gene therapy to alter its course or even proper psychological/psychiatric intervention may be preventative measures. That's not a bizarre theory. When I have time I'll look up some of this stuff - maybe somebody out there wants to help out.

Peg

I don't see it as a debate -- it's an individual thing. Depression is debilitatimg if you have it.

The answers given to boann by researchers are disturbing tho and I am a cynic.

paula

Paula - you said

"While I'm glad they are discovering new things about the illness, if it delays a treatment or leads researchers astray. . . "

How can researchers treat or cure if they don't know what they are dealing with? The problem of emerging "sub groups" in PD is huge for clinical trials - it may be why trials fail if the trial population is diluted with people who don't even have the same disease.

How can they not explore these new avenues? The hard truth is that it may be too late for us. But it's the truth.

I battled depression for a decade or more prior to dx with early PD, and I mean EARLY. My motor symptoms were extremely mild (left foot dragging slightly, some balance problems, slight tendency to stoop at the end of the day, slight bradykinesia), and they still are. What blew me out of the water was the effect sinemet had on my depression! I was already on two antidepressants (went through several trying to find the right combination) when the neuro prescribed sinemet to check out "possible PD". It was the best antidepressant of any I had previously tried. I really don't think the relief of my mild motor symptoms had that much to do with the dramatic way that the "cloud" lifted.
I took medical leave prior to dx because the depression made it impossible for me to function as a teacher and researcher. It had gotten so bad that my department head asked me to resign my tenured faculty position. Instead, I was able to keep my job by taking several months of leave under the care of two great professionals. It was during that period in 2001 that I began sinemet and confirmed the PD dx. When I returned to work, my department head was delighted with the change in my affect and effectiveness.

Bottom line: nonmotor symptoms nearly did me in. Perhaps if my motor symptoms were more severe I would see it differently. Whether it is DM neuroprotection or a sinemet honeymoon (or a combination of the two), I thank God for it!

Robert

Right now I'd vote for the motor problems. I don't feel I have any depression, although people including my nerologist keep asking me if I am. I'm more frustrated with myself than anything because of my declining mobility. I was an extremely active person prior to this, and the lack of coordination makes me feel like I'm a brainless twit. My hands and arms do stupid things like hesitating and trembling when the movements should be smooth. From a musical standpoint, this spells disaster for anything I attempt to play.

Even though I didn't make music my career, it's been in my life more than anything else. So having this being taken away is like having my soul being eaten by a monster. So depressed, perhaps I am and I don't realize it. Discouraged yes. I can say that's what I am at least right now.

John

carey,

They don't know what they are dealing with - this is true. But we have treatments for depression - and I think I'd rather see a new grad student come along and solve the movement disorder, and hope that it also helps the depression, rather than the other way around - which I don't see any evidence would be likely.

boann's issue produced a hypothetical question. i'm not implying that depression isn't serious with pwp. But as an individual, I am by far suffering more from the motor symptoms. I do agree with boann's challenge to the connection between the two, whether it is a pre symptom or not. Depression could be a pre and continuing symptom in many illnesses. Our bodies are more complicated than we will ever know, and it knows when something is wrong when we don't by the chemical interactions taking place.

Here's a question that just came to me. I wonder if depression is not as big an issue for me because i had already gone through menopause in my 30's before PD diagnosis and obviously have hormone depletion? But on the other hand, estrogen doesn't cure PD; i took replacement for awhile.

paula

Robert, I understand what you are trying to say. But your improvement from sinemet confirms what I am saying. Prozac doesn't cure my motor symptoms. but Sinemet did solve your depression.

Paula - thanks for the clarification - I agree - enough about trying to research and prove a link between depression and PD - if you are depressed, then get treated for depression!

I can't figure out why she is putting so much effort into trying to show that it is NOT a symptom???!!!!

Still, the question remains: just what IS Parkinson's? More questions than answers right now.

motor, no quessttttiiioonn!!!!!!!!!

At this moment, in spite of walking like a drunk and having all over tremor when excited or upset or cold, etc etc, and in spite of my wonky balance, I prefer to keep the motor symptoms because I know what they are. I would dearly love to shed them all and to walk again the way I walked before PD, to eat soup with confidence again, to have my balance back.
But if I would have to give up my short term memory, to give up the mind that makes me me, to lose my happiness to depression in return for physical restoration, it is not worth it, the sacrifice is too large.
The non motor symptoms are sneaky, hidden, frightening. They attack and wound your whole being from the inside.
But later on, if my motor symptoms become paralyzing, I may change my mind.

Which motor symptom would I most like to get rid of.....hard choice, but I choose walking. It has been so long since I could walk well, it would be fantastic to get that back.