What is anxiety?
Anxiety is experienced as nervousness, worrying,
feeling jittery, having an unsettled mind or inability to stop thoughts that interfere with daily activities or sleep. Anxiety can affect our ability to concentrate, attend to details, and effect our social interactions. Common physiologic changes associated with anxiety include palpitations, racing pulse, sweatiness, jitteriness, dizziness, atypical chest pain, nausea, loss of appetite, muscle tightness (especially in the neck, shoulder and trunk), and headache.
Anxiety can occur from changes in brain regions that influence mood. Anxiety can be present throughout the day, during the medication off period, or surface sporadically as a panic attack. Some people with Parkinson’s describe worsening phobias or anxiety producing situations such as fear of crowded spaces.
What is the association between anxiety and Parkinson’s?
Anxiety can be part of your ‘worries’ about diagnosis, your future, or other life concerns. In addition, anxiety can be a symptom of Parkinson’s. It can be constant or change with your changing movement symptoms. For example, feelings of anxiousness can occur when Parkinson’s medications wear off usually prior to when the next dose is due. Certain movement symptoms can increase or worsen with anxiety, especially tremor and gait freezing. When anxiety is coupled to your movement problems, one problem can worsen the other, like a snowball effect. This is familiar to you if you have tremor as you may have noticed tremor increases at times of stress or anxiety and the increased tremor, in turn, increases anxiety. In addition to tremor, anxiety can worsen off states, dyskinesia, and motor initiation or freezing. Anxiety can cause or worsen restlessness, sleeplessness, fatigue, pain, bladder urgency, and even increase your sensitivity to medicines and their side effects. All in all anxiety can rob you of much needed energy.
What are the treatments for anxiety?
Anxiety is treatable. Treatment can be divided into broad categories as outlined below. Anxiety is best treated by combining many of these therapies and lifestyle changes. If depression co-exists with anxiety treatment will focus on both conditions. Look for more information about these treatments in the Mood and Behavior Tips section as we explore and highlight these overtime.
Lifestyle therapies: Exercise, healthy eating, healthy sleep, creative expressions, experiences with nature, social contact with family, friends and loved ones are very important steps not to be overlooked.
Behavioral counseling: These therapies are administered under the guidance of a psychologist, psychiatrist, counselor, social working or other mental health provider to help us explore our thoughts and feelings. Counseling helps us identify our feelings and find strategies or steps to take to improve reduce our sense of stress and anxiety. Counseling can explore the origins for many of our anxiety. Cognitive behavioral therapy (CBT) explores the many conditioned negative thoughts we may not be aware of that lead to our increased stress and anxiety. Through CBT we can learn to recognize these triggers and replace them with more positive or productive thoughts or strategies that lead to relaxation. Counseling can also explore difficulties or problems in our lives adding to increased stress and anxiety.
Mindfulness and stress reduction: Mindfulness therapy works on the premise that a physiologic balance exists in our bodies between the state of relaxation and stress. More information on this topic is including in the update Harness the power of you relaxation response. Anxiety is increased when this balance shifts toward unchecked stress. Mindfulness therapies include meditation, breath work, guided imagery, hypnosis, prayer and spiritual practices to name a few. These therapies are especially helpful in reducing anxiety given their focus on tapping into the physiologic changes that enhance the relaxation state and reduce the ‘fight or flight stress’ response that leads to physiologic changes in our bodies associated with stress. This can reduce our body’s response to acute and chronic stress, improve general wellbeing, and aid our ability to adjust to life stressors.
Medications: If anxiety is worse at the end of Parkinson’s medicine doses, treating your on-off fluctuations may be needed. Moderate to severe anxiety may need medication. Selective serotonin reuptake inhibitors (common antidepressants) or a category of medicines called benzodiazepines are examples of medications used to treat anxiety. Discuss your symptoms of anxiety with your healthcare provider to identify what treatment strategies are best for you.
Author: Monique Giroux, MD