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Anxiety

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Dear Dr. Okun,

 

Why do many people with PD also suffer from anxiety disorder? Is it a cause or an effect of the disease?

 

Thank you,

Richaed

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In many cases anxiety is part of the Parkinson's symptoms (caused by the disease).  Some people have it before they get PD and that may be different.  Some people get it when they wear off their dopamine.  Hope that helps.

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A bit... not sure what you mean by "may be different". Are you suggesting that it is possible for someone to be able to tell the difference between PD anxiety and non-PD anxiety?

 

Regards,

Richard

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If you have a pre-existing anxiety disorder before you got PD that may be very different to treat.

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How do you know when you actually got PD?  I remember symptoms (Micrographia, ect) long before I was ever diagnosed with young onset PD or anxiety. 

 

Thank you and Merry Christmas/Happy Holidays Dr. Okun.

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Usually, or always? I know diagnoses have become quicker and more accurate, but do we actually know the exact cause of PD in each and every patient? What symptom happens first?

Thanks, and regards,

Richard

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Dear Dr. Okun,

 

Happy New Year from one of your biggest appreciators!

 

Re your response...

>> If you have a pre-existing anxiety disorder before you got PD that may be very different to treat.

 

I guess the real question is how many people have been successfully treated by/with this approach? Do you have any statistics to compare?

 

Best Regards,

Richard

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There are not many statistics here, but many of my patients with anxiety and Parkinson benefit from an approach where we bring sinemet doses intervals closer (every 2-3 hours) and we sometimes raise the dose.  If this approach doesn't work we usually look to partner with a psychiatrist for treatment of the anxiety.

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Thank you Dr. Okun,

 

Is it universally agreed that there is a biological factor to anxiety in people with Parkinson's whether or not they were diagnosed with anxiety disorder before or after they were diagnosed with PD?

 

Regards,

Richard in Markham

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Richard, most people believe in the majority of cases the anxiety is from a biological change contributed to by the Parkinson's disease.

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Dr. Okun - 

I have had progressively worsening anxiety over the course  of my disease. 

Timeline:

April 2011 -diagnosed at 45.  Tried many meds.   Tremor dominant. 

Spring/Summer 2017: Dyskinesias from l-dopa .  Couldn't tolerate amantadine (suicidal ideation). Referred for DBS eval.  Also started lexapro for restlessness/agitation. Lexapro helped. 

Oct 2017 - STN DBS in left brian/right body symptoms.   Within 1 month came off all PD meds first, followed by titrating off lexapro too. 

DBS Programming worked from the start. Have had some successful programming tweaks using directional leads for mild hip pain/anxiety.  Some mild stimulatuon induced dyskinesias but able to turn up or down IPG to control.  Overall-very pleased with DBS over PD meds. 

Sept 2018 -   Still off all meds. Feel healthier off drugs but... restlessness/anxiety is slowly coming back again.   Also apathy a bit worse now - harder to do normal activities.   

Anxiety has been for me the worst part of my disease as it progresses. To be more specific on what I feel it is more of a restlessness, agitation, inner tremors or inability to sit still.  Anxiety for me is NOT worrying about bad things happening.   (Clarification- I used to have obsessive thoughts- before DBS, not now.)

Questions:

1.  As I have read through posts sometimes the solution is to reduce time between l-dopa doses to treat off-time anxiety.

How do you and patient decide what is the better option between anti-anxiety meds or reduce time between sinemet doses?

2.  How does anxiety typically progress over the course of Parkinsons disease?   Are there progressive trearments?   

3.  What is the biological cause of anxiety in PD?  Are there treatments based on biology of PD anxiety? 

4.  Can certain foods trigger anxiety?  Foods to avoid? 

Thanks so much for all you do.  I love your forums and helpfulness.  

 

 

 

 

 

 

 

 

Edited by Kaydee
Grammatical error. There are most likely more.

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Great questions.  I generally do not aggressively stop meds after DBS as it can lead to anxiety, depression, apathy and other symptoms....I may try gentle reductions but do it slowly and sometimes restoring meds helps anxiety.

 

As I have read through posts sometimes the solution is to reduce time between l-dopa doses to treat off-time anxiety.

1. How do you and patient decide what is the better option between anti-anxiety meds or reduce time between sinemet doses?

-I almost always optimize Parkinson meds first and move doses closer together and find the right dose as in many cases it is simple wearing off.

2.  How does anxiety typically progress over the course of Parkinsons disease?   Are there progressive treatments?   

-It is highly variable patient to patient but in broad strokes as you wear off between doses this seems to make anxiety symptoms worse.

3.  What is the biological cause of anxiety in PD?  Are there treatments based on biology of PD anxiety? 

-We believe it is a biological change from degeneration of brain regions important to non-motor function.

4.  Can certain foods trigger anxiety?  Foods to avoid? 

-Not sure on that one, but if they do I would think a rare cause.

Thanks so much for all you do.  I love your forums and helpfulness.  

-Totally happy to help.  Also, once I adjust meds and DBS (if you have it) I also consider cannabinoids for anxiety.

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