Depression

For people with Parkinson’s disease (PD) depression is a common and often disabling symptom, affecting up to 60 percent of people with the disease.
While everyone feels sad from time to time — and while people with PD may experience grief in reaction to a PD diagnosis — depression is different. Sadness is temporary, but depression is persistent, lasting for weeks or longer.
Not only that, depression is a part of PD itself, resulting from changes in the chemistry of the brain. Specifically, PD causes changes in areas of the brain that produce dopamine, norepinephrine and serotonin — chemicals that are involved in regulating mood, energy, motivation, appetite and sleep.
A person may experience depression at any time in the course of PD, even before diagnosis. In addition, the symptoms of depression may come and go throughout the course of the disease.
It’s important to know that depression can intensify both the motor and cognitive symptoms of PD. Researchers have found that people with PD who experience depression begin PD medications for motor symptoms earlier and that treating depression can actually improve both quality of life and movement.
Depression, while common in PD, is often overlooked and undertreated. It is important to be aware of its symptoms, so that if you experience it, it can be treated effectively.

Symptoms

The following are common ways that people with PD experience depression:

• Persistent sadness (lasting for weeks or longer)
• Crying
• Loss of interest in usual activities and hobbies
• Decreased attention to self care (hygiene, medical/health needs, etc.)
• Feelings of guilt, self-criticism and worthlessness
• Increased fatigue and lack of energy; getting out of bed in the morning is a struggle
• Change in appetite/eating habits (either poor appetite or over-eating)
• Loss of motivation
• Complaints of aches and pains
• Feelings of being a burden to loved ones
• Feelings of helplessness or hopelessness
• Ruminations about disability, death and dying
• Sleep difficulties (too little or too much)
• Many people with PD experience depression on its own, others are diagnosed with anxiety — feelings of constant worry — along with it. 
• Similarly, the symptoms of depression can overlap with symptoms of apathy.

Therapies

How can you ease depression in PD? First, share your concerns with your doctor. Many movement disorders specialists now include questions about depression in their exams. If your doctor does not, raise the topic. He or she may recommend medical or nonmedical coping strategies, including the following:

• With your doctor, evaluate your PD medications. People with PD who experience uncontrolled “on-off” periods and freezing episodes are more prone to depression so it is important to talk with a doctor to ensure your PD is being treated optimally—both motor and nonmotor symptoms.
• Many commonly-prescribed antidepressants are effective for people with PD. Different drugs work in different ways, and the approach needs to be tailored to the individual. If you or your loved one is currently taking an antidepressant that does not appear to be helping, ask your doctor if a different one may work better. Be aware that some medications for depression may interact with PD medications.
• Consider psychological counseling, in particular an approach called cognitive behavioral therapy. This therapy helps people recognize and change patterns of thought and behavior to ease depression and anxiety.
• Be aware of anxiety, and ensure it is treated, since it is so often diagnosed alongside depression.
• Exercise — walking, yoga, gardening or any exercise that appeals to you can help to ease symptoms of depression.

Tips for Coping with Depression

• Educate yourself about PD and its symptoms, including depression.
• Ask for help — it takes courage, but it also puts you in control of finding a way to feel better and overcome feelings of helplessness.
• Keep an open mind — depression is not a personal failing or a sign of weakness, it is a chemical imbalance in the brain.
• Plan short-term goals that you can achieve on a daily basis — plan to walk, do a chore or talk to a friend. Small accomplishments contribute to a feeling of self-worth.
• Maintain social ties — plan to connect with a friend once a week, or take on volunteer work.
• Plan something to look forward to. Think about things you can do to enhance your quality of life, and plan how to achieve them in small, do-able steps.
• If you have stopped or cut back on leisure activities because of PD, try to resume one that you enjoyed or find a new one.
• Connect with the PD community. Compare notes on coping with depression with members of a PD support group.

Source:  http://www.pdf.org/depression_pd