Parkinson's Disease and Mental Health

Certain mental health problems, like depression and disturbances -- such as hallucinations, delusions, and paranoia -- are possible complications of Parkinson's disease and/or its treatment. But, for most people with Parkinson's disease, depression and mental disturbances can be controlled.

What Is Depression?

Depression is a mood disorder caused by a chemical imbalance in the brain. The term "mood" refers to an emotional state that affects how a person thinks or acts. With depression, a person experiences great sadness. Serotonin, a chemical in the brain, has been associated with depression.

Depression is common in patients with Parkinson's disease. Often, the depression begins years before any of the other symptoms of Parkinson's disease appear.

What Are the Signs of Depression?

Depression can actually increase the physical effects of Parkinson's disease and possibly cause a progression of the disease. If you experience any of the following symptoms for longer than two weeks at a time, you should contact your doctor.

  • Depressed mood
  • An inability to find pleasure in things that were once pleasurable
  • Sleep disturbances (inability to sleep or sleeping excessively)
  • Change in appetite
  • Fatigue
  • Altered level of activity
  • Difficulty with concentration
  • Low self-esteem
  • Thoughts of death

How Is Depression in Parkinson's Disease Treated?

In Parkinson's disease, depression may be treated with psychological therapy, as well as with medications. People seem to do better when they receive both psychological and drug treatments.

There are many antidepressant medications available, each with their own advantages and disadvantages. The choice of antidepressant for patients with Parkinson's disease depends on their overall condition and specific needs. Most people with Parkinson's disease should not take amoxipine (Ascendin) because this medication could temporarily worsen the Parkinson's disease symptoms.

Psychological therapy can help a patient with Parkinson's disease re-establish a sense of self-worth in the face of declining functional abilities. It also can help the person maintain good relationships with caregivers and family members, despite increasing dependency.

What Other Mental Health Issues Are Associated With Parkinson's Disease?

Hallucinations, paranoia, and delusions are all possible side effects of Parkinson's disease treatments. A hallucination occurs when you think something is present when it isn't. For example, you may hear a voice but no one is there. An example of paranoia is when you think someone is following you when they are not. Delusion is when you are convinced something is true, despite clear evidence proving that it is not.


How Are These Mental Disturbances Treated?

The first step is to address any other medical conditions that could produce hallucinations, delusions, or paranoia. Your doctor will check for imbalances in the chemicals of the blood that help control water levels in the body and help with transmitting nerve impulses. He or she may also check your kidney, liver, or lung function, as well as screen for certain infections since these problems could cause mental disturbances. Other medications that you may be using, including over-the-counter drugs, could also be responsible for these disturbances. Be sure to tell your doctor about all medications, including herbal therapies, that you are taking.

Many times, the medications used to treat Parkinson's disease can cause these mental disturbances. Switching to different Parkinson's disease medication can sometimes control these disturbances.

Some people may not be able to tolerate changes in their Parkinson's disease medications without increasing their symptoms. In these cases, it may be necessary to treat the mental disturbances with anti-psychotic medicines. However, there is a risk that traditional anti-psychotic medicines can worsen Parkinson's disease. Fortunately, there are other alternatives. The medication pimavanserin (Nuplazid) was approved specifically to treat the psychosis associated with Parkinson’s disease. Other medications such as Zyprexa, Seroquel, and Clozaril can effectively control hallucinations at low doses without worsening Parkinson's disease symptoms. Clozaril is the least likely to worsen Parkinson's symptoms; but, unfortunately, there is a small chance (about 2%) that your white blood cell (cells that fight infection) count will drop. For this reason, your doctor will likely perform frequent blood tests to make sure your white blood cells stay at a certain level.

If you are feeling depressed or experiencing any of the mentioned mental disturbances, talk to your doctor right away. There is likely a remedy that will make you feel better.

WebMD Medical Reference Reviewed by Neil Lava, MD on June 25, 2016



Cleveland Clinic: "Mental Disturbances Associated with Parkinson's Disease."

National Institute of Mental Health: "Depression and Parkinson's Disease."

National Parkinson Foundation: "Parkinson's Disease: Mind, Mood, & Memory."

american Academy of Neurology: "Screening and Treatment for Depression, Dementia, and Psychosis With Parkinson Disease."


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