Depression in People with Parkinson’s Disease

By Dr Mizrab Khan MRCPsych Member of the Royal College of Psychiatrists, United Kingdom

Arshya Vahabzadeh, M.D. Resident Psychiatrist, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine Follow @VahabzadehMD

Since April is Parkinson’s Awareness Month, we wanted to discuss its connection to clinical depression.

Parkinson’s and Mental Health

Parkinson’s disease is a chronic and progressive neuropsychiatric condition that affects more than one million Americans, with over 60,000 people being diagnosed every year. People with Parkinson’s often develop physical symptoms such as tremors at rest, stiffness, and a general slowing of movement.

Today, there’s a better understanding of the psychiatric and mental health concerns of people with Parkinson’s disease. Parkinson’s disease affects several parts of the brain connected to control of mood. This may cause depression and other mental illnesses that harm the quality of life of people with Parkinson’s disease.

Depression in People with Parkinson’s

People with Parkinson’s disease often suffer from clinical depression (more than one third of individuals). Depressive symptoms include apathy as well as changes in sleep, appetite, and self-esteem. It’s far more than feeling sad or “blue” after being diagnosed with Parkinson’s. Studies show that clinical depression may even come before the development of physical symptoms of Parkinson’s. Becoming depressed is also thought to be independent of the physical symptoms, with some people with mild Parkinson’s developing severe mood symptoms. Detecting the depression may be more difficult in Parkinson’s disease because there’s an overlap between the signs of depression and the physical symptoms of Parkinson’s.

If someone with Parkinson’s disease is increasingly apathetic with changes in mood, sleep, appetite, or low self-esteem, then he or she should see a doctor for a psychiatric assessment. People with Parkinson’s are at a higher risk of suicidal thoughts and actions, so it’s important to pay close attention to these warning signs and seek a mental health evaluation.

Can Depression in Parkinson’s Disease be Treated?

Yes, just as depression can be treated for those without Parkinson’s, depression in people with Parkinson’s disease can be improved using both psychological and medication treatments. However, a personalized treatment plan should be created, and any antidepressant medication should be prescribed by a physician who is aware of the other medications that are commonly used in Parkinson’s disease. Ongoing research will help determine the best method to treat this depression.  

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Part 2: What I wish I knew when my daughter was first diagnosed with autism

Guest post by Carolyn Chambers

As the mother of a 9-year old daughter with autism (Kellie was diagnosed with autism in January of 2008 at the age of 4), I’ve learned some things through networking and making friends with other parents who have kids with autism. Now I want to share more tips with you.

Just because a school district (or Early Intervention) says that a certain program is most appropriate for your child doesn’t mean that it is. As I mentioned in the first part of my blog post, doing your own research is key. Here’s a helpful website about special education law and advocacy for children with disabilities: http://wrightslaw.com. If you don’t agree with your child’s school recommendations, request independent evaluations to help determine what is most appropriate. 

 

Treat each professional (school and medical) who works with your child with respect and as an integral part of your child’s “team.” If you feel that someone is challenging, find someone more appropriate to join the team.

As you are proactively communicating with your child’s team of doctors and teachers, make sure they are communicating with each other about treatment. Is everyone aware of what the other one is doing? This is especially important if your child responds to something particularly well in a session. Share that information with every team member. This will make your child’s programming much more effective! And, if something isn’t working for your child, be sure to let everyone know that as well.

Use your child’s “quirks” or obsessions as motivators for therapy sessions. My daughter went through a Super Mario phase, so we incorporated Super Mario into her sessions as much as possible which was successful.

Another tip for parents who are married: don’t forget your marriage! You and your spouse need quality alone time whenever possible. Autism can be extremely stressful on a marriage. Often parents get overwhelmed; there is simply too much going on in their day-to-day lives, and “date night” loses priority. This is another reason why connecting with parents who have children with autism is essential. They can recommend child care providers and share their advice for focusing on marriage while raising a child with autism.

While you make time for your marriage, you also need to carve out some “me time.” Time to go out with friends or do something you enjoy by yourself that isn’t autism OR child-related. Maybe that means going to Starbucks with a good book.

Families of children with autism need to budget for out-of-pocket expenses for therapies and treatments, so speaking to other, more experienced parents helped me. Unfortunately, many of the therapies are not covered by insurance. I still have a hard time getting health care benefits for my daughter’s speech therapy, which is what she needs the most. However, there are some creative, legitimate ways to get needed therapies covered and/or reduce your out-of-pocket expenses. Here are excellent resources: http://health.groups.yahoo.com/group/autism_insurance_information and my all-time favorite: www.tacanow.org/family-resources/autism-on-a-budget-series.

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What I wish I knew when my daughter was first diagnosed with autism

Guest post by Carolyn Chambers

Greetings! My name is Carolyn, and I’m the mother of two daughters, Kirsten (10 years old) and Kellie (9 years old). Kellie was diagnosed with autism in January of 2008 at the age of 4. My first marriage ended shortly after my daughter got her diagnosis. I ventured into single mom-hood while navigating through the often overwhelming unknowns of what to do when you have a child with autism. There was no “Autism for Dummies” book back then, though after doing a quick Google search, I see there’s one available now. I ultimately had to figure out how to best help my daughter mostly on my own and began researching, reading, networking, and engaging with other parents as well as picking the brains of the many professionals who I had the honor to work with thanks to autism.

The best parent connection that I made was with a former friend from high school who later became my wonderful and supportive husband! One of our mutual friends advocated that we “reconnect” through Facebook since we both have daughters on the autism spectrum.

Which brings me to one of the top tips I can offer to parents who have recently gone through having a child diagnosed with autism: get connected with other parents, so you can learn from their experiences.

Join a parent support group like TACA (Talk About Curing Autism). Personally, this has been my #1 and what helped my daughter the most. I learned so much from other parents’ advice on best therapy providers, doctors, school districts, behavioral-type of programs, treatments, interventions, problem solving, etc. And, as a bonus, I made some life-long friends through the support groups.

You should also attend autism conferences; that’s where you’re going to discover the newest cutting edge treatments and therapies as well as learn about the latest research in development. It’s your chance to be immersed with experts and professionals (and another opportunity to network with parents!).

But be prepared to be confused with all of the conflicting information and advice that’s out there. Researching and consulting with experienced parents and doctors will prove priceless.

Paying close attention to your child’s diet is another helpful tip I’ve received and wanted to share with you. You are what you eat! Learn about all of the special diets out there that are said to benefit children with autism and ADHD. At the very least, cut out the junk food, processed, and artificial ingredients. This is something all parents and caregivers should do for their kids regardless of an autism diagnosis. Understand how the digestive system is connected to what goes on in the brain. There’s plenty of science-based knowledge out there supporting the importance of nutrition. Be sure to ask other parents about what diets have been most successful for their children with autism.

Be wary of “miracle cures.” The curse of being proactive when it comes to researching possible interventions for your child is being exposed to all the countless “treatments” that make too good to be true promises and drain your wallet. Me being an information junkie, I don’t mind reading about some of these “treatments” with a grain of salt. But before considering any treatment, even the ones that are less “out there,” remember to research them thoroughly and speak with as many parents as possible who have tried that sort of treatment. Any treatment you proceed with should be done under an experienced doctor’s guidance.

I have more tips to share, so, please come back next week to read the second part of my post.

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What to expect for your first visit with your psychiatrist

By David Goldsmith, M.D., & Arshya Vahabzadeh, M.D. Follow @VahabzadehMD
Resident Psychiatrists, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine

Your Psychiatrist’s Training

A psychiatrist is a physician who is specially trained to diagnose and treat people who are experiencing a wide range of issues, from emotional distress to more severe mental health concerns. People may make their first appointment to visit a psychiatrist when they are having difficulties at work, in relationships, or even as a result of medical conditions. These patients could be experiencing many different symptoms including sadness, lack of energy, anxiety, or mood swings. Other symptoms could include problems with sleep, memory, or appetite. In some circumstances, the symptoms may be much more severe and include hallucinations or suicidal thoughts.

Following medical school, a psychiatrist must undergo at least four years of residency training. He/she will spend that time seeing a wide variety of patients with different psychiatric and medical issues. Some psychiatrists may have additional expertise like treating children or people suffering from drug addiction.

Psychiatrists learn to understand and diagnose complex mental illnesses, including schizophrenia, depression, bipolar disorder, and anxiety. As such, psychiatrists are trained to realize that talking about some issues is quite difficult, so they know how to work with patients who can become very emotional or anxious.

Your First Appointment

The first appointment with a psychiatrist is often an initial evaluation, or intake visit, when the psychiatrist will want to get to know you and what difficulties you are experiencing. These appointments may vary in length but are typically between 40-90 minutes. Your psychiatrist will ask you what kind of issues are concerning you, and how are they affecting your life?

You will be asked about a range of symptoms, and how you have tried to cope with them. Your psychiatrist will want to know about any medical conditions you have now or had in the past. He or she will want to know about past visits with mental health professionals. Many medical and psychiatric conditions may run in families, and usually the psychiatrist will ask you about your family’s health history. They will also ask you about your current medications, both for medical and psychiatric conditions.

Once your psychiatrist has asked you these questions, he or she will make a plan with you and may recommend that you see a particular specialist or have some laboratory tests. Your psychiatrist may suggest a style of talk therapy (psychotherapy) or in some instances, suggest a medication to help with your symptoms.

Your doctor will likely schedule another appointment, so that you can discuss how the treatment plan is going and whether your symptoms have improved. It is very important to ask questions about anything you may not understand, or why you are being prescribed a certain medication or type of therapy. Your psychiatrist will be more than happy to answer your questions and explain things to you in more detail.

Tips for Your First Visit

• Write down a list of symptoms that you have been having if you feel you may forget to mention them.
• Bring along any medical or mental health records that you believe are important.
• It may help to bring a list of your medications.
• You can ask a friend or family member to come to your appointment if you feel that they can provide a unique perspective and make you feel less anxious.
• Always feel free to ask questions about the diagnosis and about any treatments offered.

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Raising Awareness for Binge Eating Disorder

By Sarah Johnson, M.D.

What is Binge Eating Disorder?

Binge Eating Disorder involves frequent overeating during a discreet period of time (at least once a week for three months), combined with lack of control and is associated with three or more of the following:

• Eating more rapidly than normal
• Eating until feeling uncomfortably full
• Eating large amounts of food when not feeling physically hungry
• Eating alone because of feeling embarrassed by how much one is eating
• Feeling disgusted with oneself, depressed, or very guilty afterward 

Binge Eating Disorder also causes marked distress and does not occur during the course of another eating disorder, such as Anorexia Nervosa or Bulimia.

What is the Diagnostic and Statistical Manual of Mental Disorders?

The Diagnostic and Statistical Manual of Mental Disorders is used by mental health professionals around the world to help them accurately diagnose psychiatric disorders. The fifth edition of this manual (DSM-5) will be released in May 2013 after 14 years of extensive research studies and input from the best experts in the field.

What is different about Binge Eating Disorder in DSM-5?

Binge Eating Disorder was previously categorized as a “diagnosis for further study.” In DSM-5, it is defined as a unique psychiatric condition with more specific criteria.

Why is it important that Binge Eating Disorder is being recognized as a unique psychiatric condition in DSM-5?

Being recognized as a true mental disorder will raise public awareness of this troubling condition and may help individuals identify themselves as needing support. Increased awareness can lead to increased interest and funding in the research community, so that we may continue to learn more about this disorder and find better treatments. This designation as a “disorder” may also make insurance companies more likely to cover therapy and medications used to treat Binge Eating Disorder. 

What should I do if I think I am suffering from Binge Eating Disorder?

Binge Eating Disorder treatment is complex and individualized. It can include therapy, medications, and addressing other psychiatric conditions or health problems such as obesity that are also occurring. If you think that you, or a loved one, are suffering from this condition, you should contact a mental health professional for diagnosis and treatment recommendations.

How is Binge Eating Disorder treated?

If you decide to see a psychiatrist for treatment of Binge Eating Disorder, he or she will start by asking questions about your medical and psychiatric history and symptoms that you are concerned about. Common components of a treatment plan might include addressing any underlying medical problems such as obesity or high blood pressure and psychotherapy to help with depression, anxiety, or other emotional problems. Medications may also be used if your doctor thinks it is indicated. There is no magic cure for Binge Eating Disorder, and your psychiatrist will work with you to create an individualized treatment plan.

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