Anti-Depressants and PD
 

Are anti-depressants basically a given with PD as it progresses?

Any recommendations?

:Rain 2:

Dear rd42,
I've heard several times that depression is more common in PWP.
Sometimes I wonder whether it can be confused with what I think of as a fairly normal reaction to the progressive nature of P.D. which is sadness (just my opinion.)
Either way I know of many PWP who take anti depressants.
Perhaps someone else can give an answer to it's therapeutic value.
Cognitive behavioural therapy is another option or it can be used in conjunction with anti depressants.
Cheers,
Lee

I dont believe that its a given for everyone..Ive had bouts with depression, but they are situational..Somehow..ultimately we all have to make peace with the fact that we have pd..and that changes accomanied by pd are out of our control, and inevitable..It wont cure pd related depression..but it certainly helps, and gets us through daily living with pd..I just take it one ay at a time..Its manageable that way

Hi, RD42;
Like Lee and Steve, I think the depression is often situational, i.e, simply the emotional effect of the awareness that one has a relentlesly progressive neurodegerative disease. I have taken anti-depressants of various types for about 25 years, as well as 5-6 years of cognitive "talk therapy" with some really good therapists.
Interestingly, once I recieved the PD Dx, I felt confident enough to "graduate" from the theraputic group, even though I still take the Rxs. I think I really still need them to maintain a consistently positive outlook. My wife agrees with this.
Clinical depression and loss of smell sensitivity can precede other PD symptoms by 5-10 years. That was the case for both my older brother and me, at any rate. Fortunately, I can still smell bread baking. MMMMMM!

Depression in Parkinson's
 

While a lot of depression in PWP's is situational, there is a chemical relationship as well. In one of the threads a year or two ago, someone reported (Keith -- was it you?) that dopamine is one of the precursors to seretonin, which is implicated in depression.

My situation sounds a lot like RLSmi's - I've been on antidepresssant & anti-anxiety meds steady since 1992, and periodically before that. I would love to get off of them, but I've tried in the past and the results have been as close to disastrous as I want to get.

My cyclic depressions started when I was 17, and ever since then have been getting deeper, longer and harder to climb out of - the last one lasting 12 years - and I'm stable now only with the aid of pills. 50 years ago, I would be sitting in some cold, mildewy asylum or other at this point. I am convinced that the cyclic clinical depression happened on its own, but by 1992 the fall in dopamine production was already underway, though I was not symptomatic at that time. the PD deficits were starting to affect things, and by 97 showing symptoms (whch I ignored until 2004).

However, all of this is academic, because whatever sets it off, the range of treatments and their degree and length are pretty much the same for both situational and clinical depression. If it is situational, a patient needs to keep track of when things look bright again; it may be possible to cut out some of the meds when you reach that blessed state. Cognitive behavioral therapy works well with situational fdepression, and not as much with clinical depression.

Good luck, hope this is helpful.

Anyway you look at it...
 

Most PWP will need to at least TRY an antidepressant as a result of depressed mood for at least more than two weeks. By this I mean that it takes something very major to put one in the "big ditch" of depression.
And it's all "brain chemistry changes that cause depression. Try to get through this.
http://mindboosters.libraryonhealth....4b3f&chapter=6

It's mostly a lot of biochemistry, which may not be what one needs to hear, but basically the human brain, like all organs , is in a delicate balance with it's environment. When levels of the "neurotransmitters" that are "command signals" for our mood, are either present in too little or too much of the "normal" concentrations, things happen that we can help but notice. Depression in PWP usually hits people like a freight train; people who have had stable levels of the various mood controlling neurotransmitters for years, all of a sudden find themselves thinking gloomy "depressive thoughts", and for no reason, find themselves crying over the drop of a pin. And this includes big strong men and big strong women, as well as those who went through their previous life with the will of George Patton, or the daily tension of a seasoned army doctor, who has done the most incredible things and never flinched, being reduced to a crying, blithering, non-functional self.
True depression has to be real as far as imbalances in neurotransmitters are concerned. A normal person can grieve over a close loved one, intensely for weeks, or longer, and then finding themselves all of a sudden "lifted out" of their down mood and "normalize" again. However, the presence of disease which permanently alters the delicate balance of neurotranmitter synthesis and concentrations in the brain is what triggers "major depression". Major depression varies from minor depression in that people often say that they "have never felt this way for so long , over something that is causing their horribly bad feelings, for such a long time. No amount of "talking it out" works well for major depression, because neurotrasmitter levels cannot "equalize themselves", and thus help in making the person feel better. For someone whom has never experienced major depression, quite frankly, they will "never understand it".
Well, one bad day about 3 years into PD; I felt it. 42 years old; beautiful wife and 3 kids; great job; everything to live for. PD had not yet "crippled my emotions. But then the dark cloud of depression hit; I felt like suicide was the only way "out". So I tried all they had, Prozac, Wellbutrin, Amitryptiline, and nothing worked until I found the rather new to the market "Effexor". THis was the right choice , insofar as it took care of the reuptake inhibition of not only Serotonin, but also weakly at dopamine receptors, but most importantly at Norepinephrine uptake sites (Norepinephrine is made in the brain from dopamine, already in short supply, and is a major mood regulator "neurotransmitter").
Now I do recommend Effexor as a relatively quick acting and very efficaceous,( especially in PWP) but it has it's warts too. These include an awful withdrawal syndrome, so you should either take it for life or go through a very slow down titration, if you later want to try going without it. And men, I think you'll have to ask for a script for Levitra, as it absolutely kills your libido.
Just remember, it is better to take a pill than go for a kill. Antidepressants work! The social "stigma" has almost dissappeared, but patient reluctance to continue the regimen when you are feeling better is rampant. Just like taking Dopa in an attempt to normalize your PD symptoms, because you simply do not have the correct biochemical pathways to make enough of your own dopamine anymore. Other biochemical pathways to other neurotransmitters go "errant" too; and their aren't too many ways yet known how to deal with the very difficult problems that this causes to our mood. Methinks 'nuff said.cs

Anyway you look at it...
 

Most PWP will need to at least TRY an antidepressant as a result of depressed mood for at least more than two weeks. By this I mean that it takes something very major to put one in the "big ditch" of depression.
And it's all "brain chemistry changes that cause depression. Try to get through this.
http://mindboosters.libraryonhealth....4b3f&chapter=6

It's mostly a lot of biochemistry, which may not be what one needs to hear, but basically the human brain, like all organs , is in a delicate balance with it's environment. When levels of the "neurotransmitters" that are "command signals" for our mood, are either present in too little or too much of the "normal" concentrations, things happen that we can help but notice. Depression in PWP usually hits people like a freight train; people who have had stable levels of the various mood controlling neurotransmitters for years, all of a sudden find themselves thinking gloomy "depressive thoughts", and for no reason, find themselves crying over the drop of a pin. And this includes big strong men and big strong women, as well as those who went through their previous life with the will of George Patton, or the daily tension of a seasoned army doctor, who has done the most incredible things and never flinched, being reduced to a crying, blithering, non-functional self.
True depression has to be real as far as imbalances in neurotransmitters are concerned. A normal person can grieve over a close loved one, intensely for weeks, or longer, and then finding themselves all of a sudden "lifted out" of their down mood and "normalize" again. However, the presence of disease which permanently alters the delicate balance of neurotranmitter synthesis and concentrations in the brain is what triggers "major depression". Major depression varies from minor depression in that people often say that they "have never felt this way for so long , over something that is causing their horribly bad feelings, for such a long time. No amount of "talking it out" works well for major depression, because neurotrasmitter levels cannot "equalize themselves", and thus help in making the person feel better. For someone whom has never experienced major depression, quite frankly, they will "never understand it".
Well, one bad day about 3 years into PD; I felt it. 42 years old; beautiful wife and 3 kids; great job; everything to live for. PD had not yet "crippled my emotions. But then the dark cloud of depression hit; I felt like suicide was the only way "out". So I tried all they had, Prozac, Wellbutrin, Amitryptiline, and nothing worked until I found the rather new to the market "Effexor". THis was the right choice , insofar as it took care of the reuptake inhibition of not only Serotonin, but also weakly at dopamine receptors, but most importantly at Norepinephrine uptake sites (Norepinephrine is made in the brain from dopamine, already in short supply, and is a major mood regulator "neurotransmitter").
Now I do recommend Effexor as a relatively quick acting and very efficaceous,( especially in PWP) but it has it's warts too. These include an awful withdrawal syndrome, so you should either take it for life or go through a very slow down titration, if you later want to try going without it. And men, I think you'll have to ask for a script for Levitra, as it absolutely kills your libido.
Just remember, it is better to take a pill than go for a kill. Antidepressants work! The social "stigma" has almost dissappeared, but patient reluctance to continue the regimen when you are feeling better is rampant. Just like taking Dopa in an attempt to normalize your PD symptoms, because you simply do not have the correct biochemical pathways to make enough of your own dopamine anymore. Other biochemical pathways to other neurotransmitters go "errant" too; and their aren't too many ways yet known how to deal with the very difficult problems that this causes to our mood. Methinks 'nuff said.cs

it's not really about depression
 

This is something I have been up to my neck in the last few months and is very complex, so please forgive the shortcuts here.

One of the primary factors, if not THE primary factor, in PD is the exposure of fetus or child to bacterial toxins called LPS during critical windows of development of the neurological and endocrine systems.

This has several lingering effects. One of the critical ones is an imbalance in the relationship between the hypothalamus, pituitary, and adrenal glands (HPA).

This imbalance results in, among other things, chronic elevation of cortisol levels - a chronic stress reaction.

Restoring HPA balance can have major effects in PWP.

Antidepressants are one way to try to do that. But there is a real question as to whether they are the best way. There are many side effects to watch for.

If you are not truly depressed you might look into other stress lowering techniques instead.

What are some ways of restoring this balance?

HPA balance
 

All the non-pharma ways of dealing with stress are worth looking at because the stress response is largely what we are talking about. The old fight or flight thing.

So, exercise, meditation, etc. are all worth considering.