Depression is treatable. Depression is best treated by combining many of these therapies and lifestyle changes. Look for more information about these treatments in the upcoming update section as we explore and highlight these overtime.
Many of us experience the positive mood that can accompany exercise. But does exercise do more than just increase endorphins and wellbeing - does exercise improve depression? Research has found that rigorous exercise can help improve depression. In general rigorous exercise or ‘cardio’ is performed at an intensity that is greater than just an easy or casual workout. Rigorous exercise such as walking, jogging, dancing, bicycling, rowing or aerobics increases heart rate, breathing and perceived sense of exertion. Always check with your healthcare provider before beginning an exercise routine. These tips will help you along the way
· Exercise 5 times a week to establish a consistent habit and effect.
· Try exercise with others such as a friend, partner or even your dog to keep it fun.
· Exercise in nature is fun, inspiring and in itself may improve mood.
Food affects our mood. We even use the term comfort food to describe foods that warm us and ‘nourish out soul’. Researchers are exploring this relationship and research suggests that certain foods impact mood and maybe depression.
· Omega 3 fish oil (such as that found in salmon) can help treat depression and boost the effect of antidepressants.
· Chocolate- Studies suggest that clinically depressed people eat more chocolate than non-depressed people. Whether this is to self-medicate and soothe depression is not yet known.
· Mediterranean diet may reduce the risk of depression compared with standard Western diet
· Dietary intake of B vitamins such as folate, B6 and B12
· Vitamin D- low levels are linked to depression. Whether an increase in vitamin D will improve depression is not yet known.
If you are depressed you may not feel like socializing. Yet being around other people and having a support network to draw from is very important for depression.
- Join a support group and make an effort to attend. You may find other people with similar experiences making it easier to share your feelings.
- Not up to going out- spend quality time with your family, take your dog for a walk or play with your grandchildren.
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 how we feel. Counseling can explore the origins for many of our depressed thoughts. Cognitive behavioral therapy (CBT) explores the many conditioned negative thoughts we may not be aware of that lead to our depressed feelings and more negative thoughts. Through CBT we can learn to recognize these defeating thoughts and replace them with more positive or productive thoughts- in affect reshaping our mood. Counseling can also explore difficulties or problems you may be having in relationships or with family members.
Mindfulness and stress reduction: Mindfulness therapy works on the premise that wellness is enhanced by focusing on ourselves as a complete being including the mind, body and spirit. Mindfulness therapies include meditation, breath work, guided imagery, hypnosis, prayer and spiritual practices to name a few. These therapies can reduce our body’s response to stress, improve general wellbeing, aid our ability to adjust to life changes and add a sense of purpose to one’s life.
Antidepressants can help and may be needed. Parkinson’s is associated with deficiencies in the neurotransmitters dopamine, norepinephrine and serotonin suggesting that depression in Parkinson’s is related to these physiologic changes. Depression, then, is a symptom of the disease in the same way tremor or rigidity is a symptom.
Antidepressants fall into multiple categories and recent studies show that antidepressants can help mild to moderate depression associated with Parkinson’s disease. Studies are small and therefore limited but include the following classes of antidepressants
· Tricyclic antidepressants (-nortriptyline, amitriptyline)- These ‘older’ medicines do have significant side effects including memory problems, dizziness, sedation, constipation, blurry vision, dry mouth, and bladder control.
· Selective Serotonin Reuptake inhibitors (SSRIs) - These medicines increase serotonin levels. Some of the most common side effects include nausea, tremor, and headache.
· Norepinephrine Serotonin Reuptake (Venlafaxine) Inhibitors – increase both serotonin and norepinephrine levels. They are also used to treat pain and fibromyalgia. Most common side effects are anxiety, insomnia, heart rate changes, nausea, tremor, GI symptoms.
· Dopamine medicines- Medicines used to treat movement symptoms may also improve mood according to one study comparing the dopamine agonist pramipexole and SSRI sertraline.
Talk to your doctor about your symptoms of depression and whether medication is right for you. Over the counter remedies such as St John’s Wart are used by some patients but should not be used unless under the care and recommendation of your healthcare provider. Antidepressants should be used with caution and under close supervision when used with certain Parkinson’s medicines such as MAO B inhibitors (see section on Parkinsons medicines for more information).
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Author Monique Giroux, MD
Copyright 2011 Northwest Parkinson's Foundation Wellness Center