Relaxation
Relaxation techniques can be very effective in relieving acute states of anxiety, including therapies such as massage, meditation, breathing techniques, muscle relaxation, yoga, aromatherapy and Tai Chi.
Medication
Anxiety related to motor fluctuations is best managed by adjusting Parkinson’s medications and your doctor may find it necessary to alter your medication regime.
Antidepressant medications can also help. The range is wide and the choice will depend on their benefits and side effects, interaction with other medications and how they suit you as an individual. Most take four to six weeks to be effective but if by eight weeks you feel little or no benefit then your doctor is likely to try others to find one that works for you.
There are three main classes of antidepressants, each of which may be effective but could have certain side effects:
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tricyclic (TCAs) - may worsen Parkinson’s symptoms in some people, namely orthostatic hypotension (lowered blood pressure while standing), dry mouth, constipation and confusion. They are generally not recommended for older or frail people
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selective serotonin reuptake inhibitors (SSRIs) - may cause insomnia, nausea, headache, tremor, agitation and sexual dysfunction. They may not be suitable if you also take selegiline
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monoamine oxidase inhibitors (MAOIs) - only some may be taken as a number interact with other medications.
If anxiety persists, medication may be required for several months, sometimes with a decreased dose over time. Long term use is not usually recommended. When you no longer need to take antidepressants you should reduce the dose slowly to prevent the return of anxiety and rebound symptoms, such as headache and irritability.
Psychological approaches
If medications are not effective, or if anxiety is severe, a psychiatrist, psychologist or psychotherapist can help. This can be particularly effective in more severe cases when used alongside medication. Sometimes it may be useful if your partner or carer is included in consultations. The most effective psychological treatment of anxiety disorders has generally proved to be cognitive behavioural therapy. This involves treating social phobic reactions by confronting the situations which elicit anxiety.
Individual counselling can also help you to recognise worries and underlying issues, and work out a strategy to deal with them.
Electroconvulsive treatment
In the most severe or life-threatening forms of anxiety which do not respond to other approaches, electroconvulsive treatment might be helpful, in which an electrical current is passed through the brain. However, electroconvulsive treatment is not a common treatment for anxiety disorders which occur in Parkinson’s.
Who else can help?
Various trained professionals in the multidisciplinary team may be involved in managing anxiety, including your doctor, a Parkinson’s Disease Nurse Specialist (depending on the country in which you live), a psychiatrist and a counsellor. For more information on the various members of the multidisciplinary team see [link], or ask your doctor who else can help you. In some countries a doctor must refer anyone with Parkinson’s to a counsellor. If you book an appointment with a therapist or counsellor remember to check their qualifications and experience.
There are also many organisations that offer various kinds of emotional support such as telephone help lines, group meetings or practical help. Even if you have close family and friends, sometimes you might want to chat with an outsider and such organisations can be very helpful. Your doctor or a social worker will be able to help you identify such organisations, or you may find contact details in a telephone directory.
