8.18.23 Mental Health and Parkinson’s


Presubmitted Questions – please click each box to see answers

Apathy is the biggest challenge. No matter how much I want to do things, I feel an anchor on my feet and hands. It is the most frustrating thing about Parkinson's, to me. Also, I have kind of a cyclical depression that sets in every couple of months.

1. Yes, apathy can be very disabling. It can be extremely challenging to self-motivate or self-initiate even pleasurable and rewarding activities.
Apathy makes things seem more effortful (or not rewarding enough). I would recommend simplifying your life as much as possible. For example, wear more practical clothes, declutter your home environment, break down long and complex tasks into smaller more manageable pieces, and focus on one thing at a time. Set concrete, well-defined goals and have a realistic plan to reach those goals step-by-step. After each accomplished step, reward yourself. Remind yourself of that sense of accomplishment when you feel down.
every couple of months.

How can I overcome the depression enough to maintain my medication schedule more rigidly

Talk to your doctor to come up with the least complex medication schedule, so that you can be compliant more easily.
Try to associate pill taking with enjoyable and rewarding activities.
Give your medication schedule the highest priority and have a plan. For example, set reminders and have your pills with you at all times. When it is time for your pills, stop everything else you have been doing if possible and take your pill.

Depression is the worst part of PD. No one seems to understand how impossible it is to deal with. Apathy, sadness, and depression nothing else can happen.

We advise talking with your PCP and MDS and asking about access to a therapist/counselor.

Is there any evidence to support the benefits of ketamine for dystonia and non mental effects of PD?

Some preliminary evidence for ketamine’s beneficial effects on dyskinesia. Perhaps helpful for other symptoms because of how it works in the brain but need clinical research. We are looking at effects on other symptoms in our trial.

Is Zoloft an antidepressant?

Yes – a class that increases serotonin in the brain. Ketamine targets another neurotransmitter, glutamate.

Please discuss techniques for getting a PWP with apathy to start moving and exercising.

The first step is to formulate the intention loud and clear (“I will start moving/exercising!”) and make a firm commitment to it. The more reasons you can think of as to why you should start exercising/moving the better. Write them down, tell your family and friends. Next step is to come up with a realistic and well-defined plan (what types of exercise, at what intensity, how often, in what setting, etc.). At this point, you should consider consulting a professional (trainer, coach, physical therapist, etc.). Try to remove barriers to your access to exercise. For example, if driving to a gym is a problem, join a virtual exercise class from home. Social interaction makes exercising easier and more fun. So, make sure you have good company! They will also motivate you to keep going. After each exercise session, reward yourself.

What about the mental health of the caregiver, are any neurological teams addressing this or is it just about their patient's mental health?

This is a very important topic. Caring for a person with Parkinson’s can be incredibly challenging physically and mentally. It can lead to caregiver burnout and depression. Unfortunately, our imperfect healthcare system puts too much pressure on caregivers and does not provide enough support. We are trying to address the caregiver concerns at Yale. Please feel free to contact our nurse navigator Meaghan Harkins for more information at Meaghan.Harkins@ynhh.org

What are natural ways to alleviate anxiety

in the moment, deep breathing. Preventative, mindfulness/meditation, exercise, hobbies/groups