Articles

Take a Walk in The Park

04/28/2013

Walking improves stamina, energy, heart health, strength, and balance. As a form of exercise walking may even alter the physical and brain changes that occur with Parkinson’s over time.  Walking can also help the mind and the soul.   Research tells us that exercise including simply just walking, can protect our thinking abilities as we get older and protect from disease…

·        Reduce cognitive decline that can happen with aging

·        Reduce the risk of developing Alzheimer’s disease a form of dementia that attacks memory and thinking skills

·        Reduce the decline executive function in Parkinson’s.  (Learn more about executive function.)

Walking can also be good for our emotions and our soul. We have long known that exercise can help our mood and treat depression.  A walk in the park is like getting a double dose of therapy.

John Muir, a naturalist and nature lover once wrote,

“In every walk with nature one receives far more than he seeks.”

In a time when many of us are flocking to gyms, joining exercise classes or getting on the treadmill to get in ‘their exercise’, we may be missing an opportunity to move and feel well. Researchers evaluating the effect of walking on our mood showed that a walk in the park improved mood more than a similar walk in the shopping mall.  Our environment affects how we feel, think, move and behave.   Think about a walk in the park on a beautiful sunny day and the feeling and experience that comes to mind

·        The fresh air sharpens the senses and clears the mind of clutter

·        The marvel and good natured fun of watching nature

·        The stress dissolving effect of the peaceful calm of a gentle breeze

·        The sense of hope and anticipation that comes with the first spring buds.

·        The reflection of days past and what brings joy to us in life as we watch the sun set

·        The challenge and sure footedness of walking that is gained from walking on uneven ground

·        The chance to slow down, share your walk and connect with a loved one

·        The energizing feel of the sun

·        The joy and reminder that little things like a bird’s song or child’s laughter are important in life

·        The soothing effect of the sun’s warmth on our back

The benefits of nature are available to us all.  The power of exercise in Parkinson’s, healthy aging and emotional wellbeing are undisputed. Enhance this power by taking your next exercise activity outdoors.  Whether you take a stroll in your wheelchair in the park, take a walk around the block or a short stroll in your backyard, the benefit of nature is priceless.

Author: Monique Giroux, MD 

Copyright 2013 Northwest Parkinson's Foundation Wellness Center

Medication Alone Insufficient in Treating Depression in Parkinson's Disease

Copied from The Northwest Parkinson’s Foundation Weekly News Update

National Parkinson Foundation

Sacramento Bee - New findings from the National Parkinson Foundation (NPF) Parkinson's Outcomes Project show that antidepressants alone do not improve depression in Parkinson's disease. Depression was most effectively treated at centers that refer their depressed patients to a mental health professional or social worker. These findings were presented last week during the 17th Annual International Congress of Parkinson's Disease and Movement Disorders in Sydney, Australia, June 16-20, 2013.

In the study, "Approach to Treatment of Depression in Parkinson's Disease," Peter Schmidt, Ph.D., and colleagues examined which approaches to depression care correlated with the lowest prevalence of depression among patients seen at NPF's Centers of Excellence. Patients were treated with antidepressant medications, counseling by a social worker, treatment by a mental health professional, or a combination.

"This work is part of the larger NPF mission: to determine what works best in the treatment and care of Parkinson's with an aim toward slowing the impact of the disease," said Peter Schmidt, Ph.D., lead author of the study and Vice President, Programs at NPF. "This particular study highlights the importance of team care, something NPF has long advocated at its Centers of Excellence. We found the best care is achieved when neurologists coordinate with other health professionals to aggressively fight Parkinson's. In fact, a 'depression team,' consisting of a social worker and a psychiatrist coordinating with the neurologist, yielded the best results."

The study, analyzing 2,423 patients at 10 NPF Centers of Excellence found 1,121 depressed patients (46%), but at the best center only 30% showed signs of depression. Centers prescribed antidepressant medications to between 29% and 63% of their depressed patients, but high-prescribing centers achieved no significant reduction in depression versus low-prescribing centers. Other treatments, however, did correlate with better outcomes.

This work is part of the Parkinson's Outcomes Project, a longitudinal look at which treatments produce the best health outcomes. Started in 2009, the study represents data from more than 6,000 people with Parkinson's disease in four countries.

New Depression Meds Better in Parkinson's

Copied from The Northwest Parkinson’s Foundation Weekly News Update

Crystal Phend

medpage today - Newer antidepressants boost mood in Parkinson's disease patients without worsening motor function, a randomized trial showed.

Over 12 weeks, depression scores fell compared with placebo by 6.2 points with paroxetine (Paxil, Pexeva, P=0.0007) and 4.2 points with extended release venlafaxine (Effexor-XR, P=0.02), Irene H. Richard, MD, of the University of Rochester, in Rochester, N.Y., and colleagues reported online in Neurology.

Both exceeded the 2- to 3-point difference considered clinically meaningful on the Hamilton Rating Scale for Depression (HAM-D) used to measure this primary endpoint in the Study of Antidepressants in Parkinson's Disease (SAD-PD).

Unlike the older tricyclic antidepressants -- which have cardiac, autonomic, and anticholinergic side effects in Parkinson's patients -- both drugs tested in the trial were well tolerated without any impact on motor function.

A prior study done in Parkinson's disease suggested that the older tricyclics might be preferred despite adverse effects and questioned the efficacy of selective serotonin reuptake inhibitors after it uncovered no improvement in depression with paroxetine beyond that with placebo.

The conflicting results may have stemmed from the shorter duration of treatment, higher dropout rate, and strategy used for missing data in that study, Richard's group suggested.

The treatment effects with paroxetine and extended release venlafaxine were convincing and robust, according to an editorial by Joseph H. Friedman, MD, of Butler Hospital in Providence, R.I., and Daniel Weintraub, MD, of the University of Pennsylvania in Philadelphia.

"Most importantly, this study provides level I evidence for an antidepressant treatment effect in patients without dementia with very mild Parkinson's disease," they wrote.

The editorialists cautioned, though, that it's not clear whether the SAD-PD results would generalize to more severely affected Parkinson's patients. The number needed to treat to achieve depression remission was 13 with paroxetine and 24 with venlafaxine because of the high placebo response, they added.

The multicenter trial randomized 115 Parkinson's disease patients without dementia to 12 weeks of treatment with paroxetine or the serotonin and norepinephrine reuptake inhibitor venlafaxine XR at maximum daily doses of 40 mg and 225 mg, respectively, or placebo.

All three groups showed improvements by week 12, with mean reductions in HAM-D scores of 13.0 with paroxetine, 11.0 with extended release venlafaxine, and 6.8 with placebo.

While both active treatments were superior to placebo, the two didn't differ from each other (P=0.28).

For secondary depression outcomes, paroxetine and extended release venlafaxine came out better than placebo on the Montgomery-Åsberg Depression Rating Scale, Beck Depression Inventory II, and Geriatric Depression Scale (all P≤0.01).

But the proportion meeting remission criteria by reaching a HAM-D score of 7 points or less at week 12 did not differ significantly among the groups at 44% with paroxetine, 37% with extended release venlafaxine, and 32% with placebo.

Likewise, the percentage with a response of at least a 50% reduction in HAM-D score at week 12 didn't differ significantly among groups, at 68%, 53%, and 44%, respectively.

The lack of statistical significance on that outcome may have been because of the substantially lower than planned sample size, the researchers suggested.

Total and motor scores on the Unified Parkinson's Disease Rating Scale improved across groups without differences or treatment-related worsening of motor function. Quality of life wasn't affected overall by either antidepressant.

The researchers cautioned that while the two antidepressants appeared similar in effects in the trial, it wasn't powered to make comparisons between the two.

Nor was the trial large enough to look for characteristics of responders.

"Further research aimed at understanding predictors of response, including identification of patients who may respond preferentially to one class of medication versus another, is warranted," Richard's group wrote.

http://www.medpagetoday.com/Neurology/ParkinsonsDisease/32145

NOTE by John Pepper:

I wonder how the effects of EXERCISE would compare with these test results? Would exercise be better for patients than medication?

News in Context: Commonly Used Drugs Improve Depression in People with PD

Copied from The Northwest Parkinson's Foundation Weekly News Update

April 11, 2012

Study of Antidepressants in Parkinson's disease or SAD-PD, a first-of-its-kind study published today in the medical journal Neurology, has found that two common antidepressants ease depression in people with Parkinson’s disease (PD) without aggravating motor symptoms. The drugs tested in the study, led by Michael J. Fox Foundation (MJFF) Scientific Advisory Board member Irene Hegeman Richard, MD, of the University of Rochester, were paroxetine (brand name Paxil) and venlafaxine extended release (brand name Effexor XR).

Richard’s team, which included investigators from 20 different university sites throughout North America, performed a three-month double-blind, placebo-controlled clinical trial for depression, funded by the National Institutes of Health. They found that those taking either drug experienced a significantly greater improvement in symptoms related to depression versus those taking a placebo pill.

MJFF spoke with Richard and with Maurizio Facheris, MD, MSc, associate director of research programs at MJFF to gauge what the study results could mean for people living with PD and depression.

NOTE: The medical information contained in this article is for general information purposes only. The Michael J. Fox Foundation has a policy of refraining from advocating, endorsing or promoting any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment decisions related to Parkinson’s disease and any other medical condition be made in consultation with a physician or other qualified medical professional.

MJFF: Let’s begin with the basics: Why a study on depression in Parkinson’s? Is treating depression in people with PD different than treating other forms of depression?

IR: PD is associated with changes in brain chemistry and patients with PD may be on a number of other medications that affect brain function. For these reasons, there were concerns that antidepressant medications may not work the same as they do in someone who does not have PD.

MJFF: What causes depression in PD?

IR: In general, we do not think that depression in PD is simply a reaction to having a chronic neurological condition. We believe that it may be due to the underlying changes in brain chemistry and circuitry from the disease itself. Evidence for this includes the fact that depression sometimes starts before patients even develop motor symptoms.

MF: Most antidepressants focus on serotonin, one of the brain’s neurotransmitters. If dopamine is like the motor oil to keep the body’s systems controlling movement running smoothly, then serotonin is like the motor oil for a person’s mood. The brain’s serotonin and dopaminergic systems are closely related, and so when a person’s dopamine level goes down (the primary cause of the motor symptoms of PD), so too does his or her level of serotonin. Therefore it is not at all surprising that people with PD might experience depression.

MJFF: Tell us about the study’s findings.
IR: This is the largest clinical trial evaluating antidepressant medications in Parkinson’s disease to date. Many physicians, including myself, have long prescribed antidepressants for those with PD, but there have always been questions about their efficacy and possible side effects, including the potential to make motor symptoms worse. This study seems to begin to put these questions to rest.

We tested antidepressants from two different classes of drugs: Paroxetine is a selective serotonin reuptake inhibitor (SSRI) and venlafaxine is a serotonin and norepinephrine reuptake inhibitor (SNRI). We found that both were significantly more effective than a placebo pill in treating depression, as measured by the Hamilton Rating Scale for Depression, a tool used by clinicians to detect the presence and severity of symptoms of clinical depression. Those taking paroxetine showed a 59 percent improvement on the scale; venlafaxine a 52 percent improvement; placebo only 32 percent.
The other really good news from the study was that on the whole, medications were well tolerated and participants didn’t experience worsening of their motor symptoms from taking the drugs.

MJFF: How have physicians treated depression in people with PD to date?

IR: Physicians have used a variety of antidepressant medications to treat depression in PD. But prior to this study, there was little evidence on which to base decisions. Tricyclic antidepressants (TCAs) are an older class of drugs that are effective in people with PD, but that have a lot of side effects. SSRIs, which were the next class of available antidepressant drugs, were considered to be effective and better tolerated than TCAs in the general population. A few studies of SSRIs involving people with PD had been done in the past, but questions remained regarding their effectiveness. There were also concerns that they might worsen motor symptoms.

The newest class of antidepressants, the SNRIs (which, like the older TCAs affect both norepinephrine and serotonin) have been shown to be effective and well tolerated in depressed patients who don’t have PD but they had never been studied in patients with PD. So we included one SSRI medication and one SNRI medication in the study. Again, the study found that both were more effective than placebo and were generally well tolerated. The study wasn’t, however, designed to compare the drugs against each other.

MJFF: What are next research steps that might follow from the SAD-PD results?

IR: This study says to the community that ‘we already have medications available to treat depression in people with PD, and we can use them.’ We should be more confident prescribing these drugs moving forward.

But we hope to learn more, in particular, about those people in the study who did not respond to the medications tested. How can we predict who will respond to antidepressants, and what can we do for these patients? We didn’t test this in SAD-PD.

MF: It’s always useful for clinicians to have real study results to refer to. SAD-PD confirms two drugs that are useful in PD. Future studies could focus on other antidepressants that doctors might prescribe.

MJFF: For those who might be depressed, what would you recommend that they do?

IR: Unfortunately, many people are reluctant to admit that they are depressed since there can be a stigma attached to depression. Some people even view it as a sign of weakness and something that they can ‘get over.’ It is important to realize that depression is a part of the disease and isn’t something that one can ‘will away.’ I firmly believe that seeking out treatment is a sign of strength: People who acknowledge that they are suffering from depression and proactively look to do something about this should be commended. They will likely experience significant relief when their depression is treated.

MF: It’s important to seek out help to reverse the often vicious circle of depression. When you feel blue, you are less likely to go out, and this can be seriously detrimental to people with PD if it prevents them from staying socially connected or from exercising to help improve their motor symptoms.

If you are experiencing depression, speak openly about it with your neurologist. Depression can manifest itself in a variety of ways that may not always be obvious to you, such as loss of appetite, difficulty sleeping, fatigue, irritability, and/or anxiety. Caregivers are also good at helping to identify changes that might be taking place that you may not notice in yourself; if your spouse or other close connection mentions changes in your mood or personality, take it seriously. Depression can be deadly when it goes untreated.
 

Depression Takes a Toll on Parkinson's Patients

Copied from The Northwest Parkinson’s Foundation Weekly News Update

Kathleen Doheny

WebMD - For many people with Parkinson's disease, depression affects quality of life more than the symptoms such as shaking, according to new research.

"At least 50% of people with Parkinson's have depression," says Michael S. Okun, MD, national medical director of the National Parkinson Foundation and professor of neurology at the Center for Movement Disorders at the University of Florida, Gainesville.

That was a main finding of the Parkinson's Outcomes Project, a report released today by the National Parkinson Foundation.

"The big news is how large of a role depression plays in Parkinson's disease, how under-diagnosed and under-treated it is," says Joyce Oberdorf, CEO and president of the foundation.

The impact of depression on the health of people with Parkinson's is nearly twice that of movement problems, the researchers found.

About 1 million people in the U.S. and more than 4 million worldwide have the disease. It is marked by tremors and difficulty with walking, movement, and coordination.

Tracking Parkinson's Patients

Beginning in 2009, the researchers evaluated the care of more than 5,500 patients, ages 25 to 95. They went to 20 Centers of Excellence in the U.S., Canada, Israel, and the Netherlands.

About 9,000 clinic visits were included.

The researchers looked at information about medications, referrals to specialists, and rates of depression and anxiety, among other information. The study will be ongoing.

Based on the results, the researchers made some recommendations.

Depression & Parkinson's Disease Details

Mood disorders are common among people with Parkinson's, the researchers found. Besides widespread depression, anxiety is common.

"We have become more acutely aware over the last few years that these non-movement factors are impacting people's quality of life," Okun says.

Doctors should screen people with Parkinson's for depression at least once a year, the foundation says. Patients are encouraged to report mood changes to their doctors. Family members are also encouraged to accompany them to doctor’s visits and to discuss any changes in patients’ mood.

Treatment with medications and talk therapy, as well as getting regular exercise, can help, according to the researchers. "People's quality of life can significantly improve," Oberdorf says.

It's important to realize, Oberdorf says, that the depression is part of the disease, a chemical phenomenon. "It's not, 'Oh, I have Parkinson's disease and I'm depressed,'" she says.

The depression, she and others say, is related to changes inherent in the disease, such as a decline in the brain chemical dopamine. It helps control the brain's reward and pleasure centers.

Tracking Parkinson's Disease: Other Findings

After depression, mobility issues affected a patient's health status the most, the researchers found.

Mobility problems can affect balance, walking ability, and everyday tasks.

Exercising more than 2.5 hours a week is linked with fewer mobility problems and less difficulty in doing everyday activities, according to the researchers.

While all the centers were considered expert at caring for Parkinson's disease patients, the care itself varied, the research found.

There were different referral rates, for instance, to physical, occupational, and other therapists.

Depression & Parkinson's: One Man's Story

Jeff Mackey of Melrose, Fla., is one of the 50% of Parkinson's patients who knows all too well about depression.

The 60-year-old Episcopal priest was diagnosed with Parkinson's disease five years ago, after noticing a hand tremor first thought to be harmless.

He had struggled with mild depression starting in his teen years, he says. It was kept under control, sometimes with low doses of medication, he says.

But when his neurologist diagnosed Parkinson's, he also told Mackey the depression had gotten worse.

Mackey is now on a mood stabilizer and another drug for the depression. "My mood now is much higher; it's stable," he says. "I am able to kind of float above the depression."

Depression still brings him down a day or two a month -- much less than before, he says. "It's gone from almost constant to rare," he says.

Parkinson's Patients' Challenges: Perspectives

The study findings, especially those about depression, ring true with neurologists who treat people with Parkinson's.

"I am not surprised at all by the depression findings," says Michele Tagliati, MD, director of the movement disorders program at Cedars-Sinai Medical Center, Los Angeles. "It's something we see all the time," he says.

"The depression really colors the experience of these patients in a dramatic way," he says. "It's not the sadness of someone looking in the mirror [and saying, 'I have Parkinson's']. It is an integral part of the disease."

Others agree.

"There is a strong link between psychological symptoms and Parkinson's," says William Buxton, MD, medical director of neurodiagnostics at the UCLA Medical Center, Santa Monica, and associate clinical professor of neurology at the UCLA David Geffen School of Medicine.

"Many patients have generalized anxiety for a year or two before symptoms," he says, citing anecdotal and published reports.

The new report, he says, "reinforces what we know, that Parkinson's is not only a disease that just affects walking and motor function, but impacts a patient's sense of well-being and psychological state."

For patients, he says, "the message ... is to stay on top of how they are feeling emotionally" and to keep their doctors informed.

Depression can affect health of Parkinson’s patients

Copied from The Northwest Parkinson’s Foundation Weekly News Update

Brenda Medina

Miami Herald - Mark Worsdale decided it was time to retire from his 30-year career in business when he was diagnosed with early-stage Parkinson’s disease three years ago.

“I wanted to dedicate more time to my well-being,” said Worsdale, 59. “It is important.”

Worsdale joined ParkOptimist, a group of about 100 members who meet a few times a week at St. Matthew Episcopal Church near South Miami for fitness classes like yoga, tai chi, and dance. ParkOptimist, whose umbrella organization is the National Parkinson Foundation’s South Florida chapter, also conducts a support group for Parkinson’s patients and hosts voice and music therapy classes.

Worsdale said the activities, and the friends he’s made, have made living with the disease easier.

“My only regret is not finding the group earlier, when I was diagnosed,” said Worsdale, who dedicates four to five hours a week to go to group activities, and also exercises at home. “I am doing very well, and I think it is the result of how active I keep myself.”

To date, there is no cure for Parkinson’s disease. But research has shown that diet and fitness play a big part in maintaining a healthy lifestyle, particularly curbing depression, a by-product of the disease.

Parkinson’s disease is a neurological disorder that progresses slowly in most people, usually after age 50, although some patients can be in their 20s and 30s. It occurs when the cells in the brain that produce dopamine — a chemical that helps the brain send signals to control muscle movement — are slowly destroyed.

About one million Americans are diagnosed with the condition; Parkinson’s disease is the second most common neurodegenerative disease after Alzheimer’s.

The disease causes stiffness, trouble with balance, slowness of movement and tremors, said Dr. Carlos Singer, chief of the Movement Disorders Division at the University of Miami Miller School Of Medicine. Other symptoms are lack of sleep, urinary and gastrointestinal problems and fatigue. People with the disease also can contend with depression and anxiety.

“It can be confusing at the beginning for many patients,” Singer said. “It affects their daily lives.”

A bedside examination by a neurologist remains the first and most important diagnosis tool for patients suspected of having Parkinson’s disease, according to the National Parkinson Foundation.

A neurologist will base the diagnosis on a detailed medical history of the patient, an examination of the patient’s ability to perform a number of tasks, and the patient’s response to medication that helps produce dopamine. Singer said that patients often get diagnosed when they start noticing a tendency to drag a leg and tremor of the arms either while resting or while holding an object.

“It starts taking them longer to shave,” he said. “Or it becomes difficult to get dressed, sit at the table to eat, or take a walk.”

Last fall, the National Parkinson Foundation (NPF) released a study showing that depression is one of the biggest factors influencing the health of Parkinson’s patients. Several places in South Florida offer extensive health and fitness programs for people with Parkinson’s.

In addition to the programs at St. Matthew, which cost $25 per year per membership with the National Parkinson Foundation, St. Catherine’s Rehabilitation Hospital, of Catholic Health Service, offers Parkinson’s focus groups in North Miami and Hialeah Gardens.

The Michael Ann Russell Jewish Community Center in North Miami Beach and the David Posnack JCC Fitness Center in Davie also run extensive programs for people with Parkinson’s.

“I encourage Parkinson’s patients at any stage to participate in these kinds of activities,” Worsdale said. “I am not saying it can cure the disease but you are going to look and feel better.”

For those seeking medical intervention, deep brain stimulation, or DBS, may be an option.

But this surgical technique does not slow or retard the progression of Parkinson’s disease, said Dr. Bruno Gallo, who has been the director of DBS Therapy at UM Health System for a decade.

Deep brain stimulation consists of electric wires implanted in the patient’s brain and connected to a brain pacemaker in the chest. The pacemaker sends electrical impulses to certain parts of the brain to stimulate activity in targeted areas affected by the disease.

“I like to set realistic goals of what the treatment can and cannot accomplish,” said Gallo, who explained that some patients seek the surgical procedure hoping the disease goes away. “It does improve patients’ quality of life significantly, much more than maximal medical management can in patients who qualify for therapy."

Depression Takes a Toll on Parkinson's Patients

Copied from The Northwest Parkinson’s Foundation Weekly News Update

Kathleen Doheny

WebMD - For many people with Parkinson's disease, depression affects quality of life more than the symptoms such as shaking, according to new research.

"At least 50% of people with Parkinson's have depression," says Michael S. Okun, MD, national medical director of the National Parkinson Foundation and professor of neurology at the Center for Movement Disorders at the University of Florida, Gainesville.

That was a main finding of the Parkinson's Outcomes Project, a report released today by the National Parkinson Foundation.

"The big news is how large of a role depression plays in Parkinson's disease, how under-diagnosed and under-treated it is," says Joyce Oberdorf, CEO and president of the foundation.

The impact of depression on the health of people with Parkinson's is nearly twice that of movement problems, the researchers found.

About 1 million people in the U.S. and more than 4 million worldwide have the disease. It is marked by tremors and difficulty with walking, movement, and coordination.

Tracking Parkinson's Patients

Beginning in 2009, the researchers evaluated the care of more than 5,500 patients, ages 25 to 95. They went to 20 Centers of Excellence in the U.S., Canada, Israel, and the Netherlands.

About 9,000 clinic visits were included.

The researchers looked at information about medications, referrals to specialists, and rates of depression and anxiety, among other information. The study will be ongoing.

Based on the results, the researchers made some recommendations.

Depression & Parkinson's Disease Details

Mood disorders are common among people with Parkinson's, the researchers found. Besides widespread depression, anxiety is common.

"We have become more acutely aware over the last few years that these non-movement factors are impacting people's quality of life," Okun says.

Doctors should screen people with Parkinson's for depression at least once a year, the foundation says. Patients are encouraged to report mood changes to their doctors. Family members are also encouraged to accompany them to doctor’s visits and to discuss any changes in patients’ mood.

Treatment with medications and talk therapy, as well as getting regular exercise, can help, according to the researchers. "People's quality of life can significantly improve," Oberdorf says.

It's important to realize, Oberdorf says, that the depression is part of the disease, a chemical phenomenon. "It's not, 'Oh, I have Parkinson's disease and I'm depressed,'" she says.

The depression, she and others say, is related to changes inherent in the disease, such as a decline in the brain chemical dopamine. It helps control the brain's reward and pleasure centers.

Tracking Parkinson's Disease: Other Findings

After depression, mobility issues affected a patient's health status the most, the researchers found.

Mobility problems can affect balance, walking ability, and everyday tasks.

Exercising more than 2.5 hours a week is linked with fewer mobility problems and less difficulty in doing everyday activities, according to the researchers.

While all the centers were considered expert at caring for Parkinson's disease patients, the care itself varied, the research found.

There were different referral rates, for instance, to physical, occupational, and other therapists.

Depression & Parkinson's: One Man's Story

Jeff Mackey of Melrose, Fla., is one of the 50% of Parkinson's patients who knows all too well about depression.

The 60-year-old Episcopal priest was diagnosed with Parkinson's disease five years ago, after noticing a hand tremor first thought to be harmless.

He had struggled with mild depression starting in his teen years, he says. It was kept under control, sometimes with low doses of medication, he says.

But when his neurologist diagnosed Parkinson's, he also told Mackey the depression had gotten worse.

Mackey is now on a mood stabilizer and another drug for the depression. "My mood now is much higher; it's stable," he says. "I am able to kind of float above the depression."

Depression still brings him down a day or two a month -- much less than before, he says. "It's gone from almost constant to rare," he says.

Parkinson's Patients' Challenges: Perspectives

The study findings, especially those about depression, ring true with neurologists who treat people with Parkinson's.

"I am not surprised at all by the depression findings," says Michele Tagliati, MD, director of the movement disorders program at Cedars-Sinai Medical Center, Los Angeles. "It's something we see all the time," he says.

"The depression really colors the experience of these patients in a dramatic way," he says. "It's not the sadness of someone looking in the mirror [and saying, 'I have Parkinson's']. It is an integral part of the disease."

Others agree.

"There is a strong link between psychological symptoms and Parkinson's," says William Buxton, MD, medical director of neurodiagnostics at the UCLA Medical Center, Santa Monica, and associate clinical professor of neurology at the UCLA David Geffen School of Medicine.

"Many patients have generalized anxiety for a year or two before symptoms," he says, citing anecdotal and published reports.

The new report, he says, "reinforces what we know, that Parkinson's is not only a disease that just affects walking and motor function, but impacts a patient's sense of well-being and psychological state."

For patients, he says, "the message ... is to stay on top of how they are feeling emotionally" and to keep their doctors informed.

 

New Depression Meds Better in Parkinson's

Copied from The Northwest Parkinson’s Foundation Weekly News Update

Crystal Phend

medpage today - Newer antidepressants boost mood in Parkinson's disease patients without worsening motor function, a randomized trial showed.

Over 12 weeks, depression scores fell compared with placebo by 6.2 points with paroxetine (Paxil, Pexeva, P=0.0007) and 4.2 points with extended release venlafaxine (Effexor-XR, P=0.02), Irene H. Richard, MD, of the University of Rochester, in Rochester, N.Y., and colleagues reported online in Neurology.

Both exceeded the 2- to 3-point difference considered clinically meaningful on the Hamilton Rating Scale for Depression (HAM-D) used to measure this primary endpoint in the Study of Antidepressants in Parkinson's Disease (SAD-PD).

Unlike the older tricyclic antidepressants -- which have cardiac, autonomic, and anticholinergic side effects in Parkinson's patients -- both drugs tested in the trial were well tolerated without any impact on motor function.

A prior study done in Parkinson's disease suggested that the older tricyclics might be preferred despite adverse effects and questioned the efficacy of selective serotonin reuptake inhibitors after it uncovered no improvement in depression with paroxetine beyond that with placebo.

The conflicting results may have stemmed from the shorter duration of treatment, higher dropout rate, and strategy used for missing data in that study, Richard's group suggested.

The treatment effects with paroxetine and extended release venlafaxine were convincing and robust, according to an editorial by Joseph H. Friedman, MD, of Butler Hospital in Providence, R.I., and Daniel Weintraub, MD, of the University of Pennsylvania in Philadelphia.

"Most importantly, this study provides level I evidence for an antidepressant treatment effect in patients without dementia with very mild Parkinson's disease," they wrote.

The editorialists cautioned, though, that it's not clear whether the SAD-PD results would generalize to more severely affected Parkinson's patients. The number needed to treat to achieve depression remission was 13 with paroxetine and 24 with venlafaxine because of the high placebo response, they added.

The multicenter trial randomized 115 Parkinson's disease patients without dementia to 12 weeks of treatment with paroxetine or the serotonin and norepinephrine reuptake inhibitor venlafaxine XR at maximum daily doses of 40 mg and 225 mg, respectively, or placebo.

All three groups showed improvements by week 12, with mean reductions in HAM-D scores of 13.0 with paroxetine, 11.0 with extended release venlafaxine, and 6.8 with placebo.

While both active treatments were superior to placebo, the two didn't differ from each other (P=0.28).

For secondary depression outcomes, paroxetine and extended release venlafaxine came out better than placebo on the Montgomery-Åsberg Depression Rating Scale, Beck Depression Inventory II, and Geriatric Depression Scale (all P≤0.01).

But the proportion meeting remission criteria by reaching a HAM-D score of 7 points or less at week 12 did not differ significantly among the groups at 44% with paroxetine, 37% with extended release venlafaxine, and 32% with placebo.

Likewise, the percentage with a response of at least a 50% reduction in HAM-D score at week 12 didn't differ significantly among groups, at 68%, 53%, and 44%, respectively.

The lack of statistical significance on that outcome may have been because of the substantially lower than planned sample size, the researchers suggested.

Total and motor scores on the Unified Parkinson's Disease Rating Scale improved across groups without differences or treatment-related worsening of motor function. Quality of life wasn't affected overall by either antidepressant.

The researchers cautioned that while the two antidepressants appeared similar in effects in the trial, it wasn't powered to make comparisons between the two.

Nor was the trial large enough to look for characteristics of responders.

"Further research aimed at understanding predictors of response, including identification of patients who may respond preferentially to one class of medication versus another, is warranted," Richard's group wrote.

http://www.medpagetoday.com/Neurology/ParkinsonsDisease/32145

7 Ways to Beat Depression for Seniors

Copied from The Northwest Parkinson’s Foundation Weekly News Update

Huffington Post - Roughly a quarter of people age 65 or older suffer from depression. More than half of doctor's visits by the elderly involve complaints of emotional distress. Twenty percent of suicides in this country are committed by seniors, with the highest success rate belonging to older, white men. According to a recent report in the Journal of the American Geriatrics Society, depression is one of the major causes of decline in the health-related quality of life for senior citizens.
 

Why all the depression? Rafi Kevorkian, M.D. calls them the five D's:

• disability,
• decline,
• diminished quality of life,
• demand on caregivers,
• dementia.

To combat senior depression, then, requires coming up with creative methods to counter the five D's. Here are 7 strategies to do just that, to help people break free from the prison of depression and anxiety in their senior years.
 

1. Separate the illness from depression.
 

Depression in seniors is more complicated to identify and treat than that of younger folks because of all the other illnesses involved. For example, Parkinson's disease directly effects brain chemistry and can exacerbate depressive symptoms. Estimates show that 25 percent of cancer patients are depressed and as many as 50 percent of stroke patients suffer from depression.
 

Karen Swartz, M.D., Director of Clinical Programs at Johns Hopkins, maintains that patients with co-existing depression and chronic illnesses tend to focus more on the physical ailment, and therefore delay or impede full recovery from a mood disorder. Her advise?

"Treat both the depression and the chronic illness simultaneously, setting aggressive treatment goals for both.... Do not settle for substandard treatment results--if one or both conditions is/are not responding to treatment, intensify or switch approaches."

Also be sure there is cooperation and clear communication between your doctor and your mental health provider.
 

2. Watch the drinks.

Did you think teenagers were most at risk for substance abuse? Actually, alcohol and drug abuse are very prevalent among people over age 60, affecting 17 percent of older adults. It's not uncommon for seniors to self-medicate with alcohol and drugs as a way of coping with their loneliness or dealing with chronic pain. Hell, I can't say I blame them.
 

But it's bad, bad news:

1. Alcohol is a depressive and is going to depress you even more (once you come down from the buzz of course).
2. Popping sedatives can be lethal, especially when taken in combination with alcohol.
3. Alcohol and drugs can also interfere with the effects of medications taken for diabetes, heart disease, and other common conditions among seniors.
4. Substance abuse increases the risk of suicide, especially in older men.

In other words, pour with caution.

3. Try Tai Chi.
Because disability and diminished quality of life are two of the D's of senior depression, older people would be smart to invest in some fall insurance--to do whatever they can to prevent falls. The fear of falling is legitimate among the elderly because approximately 33 percent of Americans ages 65 or older fall at least once a year. And when you consider the rates of osteoporosis, arthritis, and weak cardiopulmonary systems among elderly, healing from a fracture isn't so easy.
 

Therefore:

• Take up an exercise program like Tai Chi, a martial art that teaches agility, slow movement, and coordination between body and mind. Tai Chi has been proven to prevent falls among seniors because it builds balance, core strength, and confidence.
• Strength training with either free weights or resistance rubber bands is also beneficial.
• Yoga.

4. Treat any insomnia.
 

Here's an interesting trivia fact from David N. Neubauer, M.D., author of "Understanding Sleeplessness: Perspectives on Insomnia": "As we age, we typically spend less time in the deepest levels of non-REM sleep (Stage 3 and Stage 4) and more time in the lighter levels. Consequently, older people often suffer from fragmented sleep, waking up more often during the night and early in the morning. In response to these changing sleep patterns, many [older] people develop poor sleep habits that compound the problem."
 

Dr. Neubauer reports that 80 percent of people who are depressed, experience sleeplessness, and that the more depressed someone is, the more likely it is that he or she will have sleep problems. And vice versa! So absolutely essential to a senior's depression treatment is addressing any sleep problems and to practice good sleep hygiene: like

1.   Going to bed at the same time every night,

2     waking at the same time in the morning,

3     cutting down on or eliminating caffeine.
 

5. Distinguish grief from depression.

By the age of 65, half of American women will be widows. And in 10 to 15 percent of spouses, the loss of their loved one leads to chronic depression. The questions is: what's normal grief and what's depression? Kay Redfield Jamison, Ph.D., Professor of Psychiatry at the Johns Hopkins University School of Medicine, distinguishes the two in this way:

1     "The sadness of grief usually comes in waves, with varying degrees of intensity and bouts of crying, and feelings of intense sadness, guilt, anger, irritability, or loneliness.

2     A person experiencing grief, however, can enjoy some of life's activities. Grief is generally time limited and resolves on its own.

3     Depression is a more persistent and unremitting sadness."
 

In other words, a depressed person is unable to enjoy life activities, merely slogging through life. She may also start to abuse alcohol or other drugs, experience difficulty eating (or overeating), and suffer from sleep disturbances.
 

6. Carry some photos.

Here's a simple way you can buffer yourself from the beast of depression: carry photos of your loved ones and friends in your wallet. Yep! A new study by UCLA psychologists found that by simply looking at a photograph of their significant others, a group of women reported less pain to the heat stimuli to their forearms than when they looked at pictures of an object or a stranger. Says study co-author Naomi Eisenberger: "The mere reminder of one's partner through a simple photograph was capable of reducing pain. The study fits with other work emphasizing the importance of social support for physical and mental health."
 

7. Make new friends.
 

Even better than photos are actual people! Countless studies have demonstrated that people with strong social networks are more resilient to depression and anxiety, especially in their senior years. And since losing friends and family is part of growing older, it is especially important for seniors to make an effort to meet new people. In my piece "13 Ways to Make Friends," I offer a few suggestions:

1. trying out a book club,
2. volunteering, taking a night class, and connecting with your alumni association.
3. Pysch Central's John Grohol proposes 4 more in his "4 More Ways to Make Friends," Such as:
4. joining a bowling league,
5. getting involved in your church,
6. Making a local restaurant or coffee shop your place to hang out

Making  

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     making a local restaurant or coffee shop your place to hang out.