Written By: Debjani Arora | Updated : April 18, 2018 4:56 PM IST
Periods could bring various changes in your mood. Eat well if that is the case. © Shutterstock
When we talk about Parkinson s disease our focus remains in managing the condition, which revolves around helping the person deal with the slower movements or manage involuntary movements or at least help them get a control over the motor movements through medications or surgery. But if you take a closer view of the condition, you will know that just managing the movement disability part is not enough. This is because a disease like Parkinson s, which is a progressive neurodegenerative condition, has its roots deeply seated in the brain, the area which produces the neurotransmitter dopamine. Know about the treatment options available to treat the condition.
Dopamine is secreted from various areas of the brain. It is also secreted in the basal ganglia that control voluntary movements of the body. When there is a dip in dopamine secretion this is when the movements become slow or uncoordinated, a typical feature of the Parkinson s disease. Dopamine is also considered the feel-good hormone that controls the various emotional responses, feelings and moods of a person. This is why people who suffer from Parkinson s disease undergo severe mood swings as the condition progresses. Know what is the difference between Parkinson s disease and Parkinson s syndrome?
We spoke to Dr Pavan Sonar, consultant psychiatrist and sexologist, Mumbai to know more about how mood swings affect Parkinson s patients. Here is an excerpt of the same:
1. How does lack of dopamine affect the mood or mental health of a Parkinson s patients?
Parkinson s disease is caused due to depletion of the neurotransmitter dopamine in the basal ganglia region. This neurotransmitter helps in coordination of various movements and is also responsible for pleasure and happiness. It controls the emotional responses, feelings and moods of a person. In fact, it is the neurotransmitter that makes one behave the way he does with empathy and compassion. Since in a condition like Parkinson s, there is a depletion or consistent decrease in this neurotransmitter people suffering from this condition experiences bouts of sadness, lack of pleasure, gloomy mood or irritability. They might get control over these mood swings when on medication and their physical symptoms are manageable.
But treating a Parkinson s patient with psychotic drugs (for mood swings) or even medications that increase dopamine is tricky and challenging. If there is too much of dopamine release due to medication the patients might tend to show higher mood states like mania or psychosis. This is why the drugs given to Parkinson s patients need to be monitored and titrated carefully.
2. Parkinson s have no cure, so as the condition progresses what are the psychological changes that a patient has to endure?
Some of the most common psychological changes that affect one as the disease progresses are emotional blunting, increasing sadness, high anxiety, loss of emotions and expressions, apathy, memory problems, cognitive deficits, etc. In extreme cases or where the condition has progressed quite far, paranoid psychosis of chronic nature is seen at times.
3. Can going for surgery like the deep brain stimulation help to treat the psychological problems too?
One thing people should understand that deep brain stimulation or DBS is offered to people who don t show very promising results with medications. It is a device that helps to regain some of the control over movements and improves the pace of the motor movements too. In DBS two very fine wires, with electrodes at their tips are implanted into the brain which is connected to extensions that are tunnelled under the skin behind the ear and down the neck. They are connected to a pulse generator or a pacemaker-like device that is placed under the skin or around the chest or stomach area. However, this can only bring about temporary relief in the patients and cannot cure the condition.
Implementation of DBS doesn t mean that the brain will secrete dopamine, but the movements can be controlled with electrically generated impulses. So, when it comes to controlling mood swings it has a temporary effect. DBS cannot modify the disease and induce a curing effect to reverse the mood swings or establish an emotional quotient.
4. What kind of help do these patients need from the caregivers when it comes to dealing with the psychological aspect of the condition?
Utmost important is empathetic understanding. A caregiver should understand that dealing with a Parkinson s patient who is also suffering from mood swings or psychological disorders are not going to be a two-way communication channel. So, a caregiver should expect least in terms of emotional reciprocation. Avoid taunting them. They might not just need emotional support but even physical support to walk or just take medicines. It is necessary to be empathetic towards them. To ensure that the mood swings don t get the better of them talk to a psychiatrist along with your neurologist to know which medications will work to control the mood swings.
5. With medications can mood swings in Parkinson's patients become reversible?
It is unpredictable. As the illness in itself is a degenerative one and the symptoms keep fluctuating. Even the medicines used to treat the condition are known to cause psychological symptoms. It is considered as a progressive degenerative disease. So, in many cases, it may worsen even with best possible treatments. Few patients may attain remission in the mood swing.
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