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Psychiatric Symptoms and 
Parkinson's Disease

Many people know Parkinson’s disease as a movement disorder that causes tremor, stiffness, slowness, and walking difficulty. 

 

However, Parkinson’s disease can also affect mood, motivation, thinking and memory, sleep, behavior, and perception. In fact, some people with Parkinson’s disease find that these symptoms affect quality of life as much as—and sometimes more than—the movement symptoms themselves.

 

Changes in brain function caused by Parkinson’s disease can directly cause psychiatric symptoms; they are not just a reaction to the stress of living with a chronic neurologic illness. Medications used to treat Parkinson’s disease can also affect mood, behavior, and thinking. In many people, a combination of brain changes, stress, and medications can all play a role in these symptoms.

 

Parkinson’s disease often affects movement, thinking/memory, and emotions simultaneously. Thus, effective and safe treatment needs to take all these areas into account in order to help you feel, think, and function as well as possible.

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On this page:

 

Common non-motor symptoms

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Parkinson’s disease affects much more than just movement. Common non-motor symptoms include:

  • Depression

  • Anxiety

  • Loss of motivation or initiative

  • Fatigue

  • Sleep problems

  • Trouble thinking as clearly or as quickly as before

  • Difficulty concentrating

  • Memory problems

  • Seeing or hearing things that aren’t really there

  • Paranoia or difficulty distinguishing what’s real and what isn’t 

  • Changes in personality or behavior

  • Impulse control problems

 

Some people experience relatively mild symptoms, while others develop difficulties that significantly affect independence and day-to-day functioning.

 

Mood, motivation, or thinking: which is it?

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Many motor and non-motor symptoms of Parkinson’s disease overlap with one another and can be difficult to interpret. If you have Parkinson’s disease you may notice the symptoms personally, but sometimes family members or friends see the changes first. 

 

For example, you might smile less often, participate less in conversations, spend more time sitting quietly, and others may comment that you seem less interested in activities than before. This can happen for many different reasons. You may have depression, and know you are feeling sad and down. You may be experiencing apathy, which is a loss of motivation caused by neurologic changes from Parkinson’s disease—apathy is NOT laziness, though sometimes people can misunderstand it as such. You may be dealing with cognitive changes that make it harder to keep up with conversations and activities. Parkinson’s disease may also make it physically harder for your face to show emotion, even when you are feeling perfectly happy inside. Or, you can have a combination of these reasons.

 

You may notice that your mood, anxiety, and thinking and memory change throughout the day as your movement symptoms change—these non-motor symptoms, just like your movement, may get worse  right before it is time for your Parkinson’s medications, and get better after you take them. This is known as the “on-off” phenomenon.

 

Because psychiatric, cognitive, and motor aspects of Parkinson’s disease can overlap, symptoms that initially appear straightforward are often quite complex. Understanding the causes of your symptoms is important because different causes may require very different treatments.

 

Depression

 

Depression is one of the most common psychiatric symptoms in Parkinson’s disease. Symptoms can include sadness, trouble feeling happy, hopelessness, fatigue, irritability, loss of interest in activities, and social withdrawal.

 

Depression in Parkinson’s disease is more than simply a reaction to living with a chronic illness. Parkinson’s disease itself affects brain systems involved in mood regulation. Depression can also worsen cognitive symptoms, fatigue, and overall functioning.

 

Anxiety

 

Anxiety is very common in Parkinson’s disease. People can find themselves worrying about anything and everything, feel anxious in social situations,  have panic attacks, or experience a sense of nervousness and unease that just won’t go away.

 

For some people, anxiety becomes much worse when Parkinson’s medications wear off between doses. You may notice your anxiety gets really bad right before it is time to take your medication, and then you feel much better once the medication kicks in.

 

Loss of motivation is not always depression

 

Parkinson’s disease cause a decrease in activity levels and loss of motivation, which is called apathy. 

  • Apathy can involve:

  • Loss of motivation

  • Impaired ability to show emotions 

  • Spending much of the day inactive

  • Difficulty initiating activities independently

  • Less interest in hobbies or social interaction

 

Apathy frequently causes much more distress to family members than to the person who has it. Loved ones may feel hurt, frightened, or confused by what seems like emotional withdrawal or loss of interest in relationships and daily life. Families sometimes worry that the person is depressed, giving up, being lazy, or no longer cares about other people.

 

Apathy is caused by changes in brain systems involved in motivation and starting activities—not by a deliberate choice, laziness,  or not caring. While apathy can look like depression from the outside, people experiencing apathy often don’t feel sad or down—they may report feeling perfectly fine.

 

Understanding apathy can help reduce guilt, frustration, and misunderstandings. It can also help families develop strategies to encourage activity and participation, rather than misinterpreting apathy as rejection, avoidance of responsibilities, or lack of affection.

 

Hallucinations, strange beliefs, and unusual experiences

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People with Parkinson’s disease may sometimes see or hear things that are not really there, particularly later in the illness.

 

People may see children, animals, visitors, or other figures that are not actually present. Early on, people typically recognize that these experiences are not real; however, over time, some individuals may start to believe in them.

 

Some people also develop delusions, which are false beliefs or strange ideas that they cannot be talked out of. For instance, people may worry that strangers are entering their home, that someone is stealing their possessions, or that their spouse is cheating on them. 

 

While often scary and upsetting, these symptoms do NOT mean the person is “going crazy” or has a new mental illness like schizophrenia. Rather, these symptoms can occur because of the Parkinson disease itself, the medications used to treat it, medications used to treat other conditions, or a combination. 

 

Some people with Parkinson’s may know perfectly well that the images they are seeing cannot really be there—for instance, seeing dogs run through the house when they do not own any pets and realizing this is logically impossible. In these cases, just understanding how these images relate to the Parkinson’s disease and that it is not a mental illness, can significantly reduce stress and worry. 

 

On the other hand, when the person experiencing hallucinations and delusions believes they are real, this can cause tremendous fear and distress for the patient and major stress for families and caregivers. In some cases, untreated hallucinations and delusions can become one of the most disabling aspects of Parkinson’s disease, even when movement symptoms remain relatively manageable.

 

Thinking and memory changes

 

Parkinson’s disease can affect thinking and memory in different ways. You may notice that while you can still do all your daily activities and responsibilities, these things require more effort and take longer than before.

 

Common cognitive symptoms include:

  • Slowed thinking

  • Difficulty multitasking

  • Problems planning or organizing activities

  • Difficulty shifting attention from one task to another

  • Trouble concentrating

  • Memory problems

  • Difficulty finding words

  • Difficulty judging distances or navigating unfamiliar places

 

These symptoms are not always caused by Parkinson’s disease alone. Depression, anxiety, sleep disorders, medication side effects, pain, fatigue, and other medical problems can worsen cognitive functioning; treating these problems can often significantly improve thinking and memory.

 

Sometimes people who have had Parkinson’s disease for many years develop more significant problems with thinking and memory, to the point that they can no longer manage their daily lives without help. Even in these cases, medications that help cognition, stopping medications that make cognition worse, and cognitive rehabilitation can often meaningfully help functioning. 

 

Impulse control problems and medication-related behavior changes

 

Occasionally, medications used to treat Parkinson’s disease can cause significant changes in behavior.

 

These behavior changes may include:

  • Compulsive gambling

  • Excessive shopping

  • Excessive or socially inappropriate sexual behaviors

  • Repetitive activities

  • Overuse of Parkinson’s medications

 

Understandably, these behavior changes can cause serious problems with finances, relationships, and social interactions, and can even sometimes lead to legal troubles.

 

Often family members notice the problem more easily than the person with the behavior changes; sometimes this can lead to embarrassment, arguments, blame, and guilt—particularly when no one realizes the changes are related to medications.

 

Our approach to Parkinson’s disease

 

Parkinson’s disease can cause psychiatric, neurologic, and cognitive changes that often overlap and affect each other in complex ways. Effective treatment depends on understanding the cause of your symptoms: for instance, if you find it hard to engage in life the way you used to, this may reflect depression, fatigue, thinking/memory changes, motor symptoms, medication side effects or medication wearing-off, or some combination of these factors. 

 

As a neuropsychiatrist, Dr. Byars uses her combined training in psychiatry, neurology, and  cognitive disorders to fully assess symptoms and functioning and to work with you to achieve your goals. 

 

Depending on the situation, treatment may include:

  • Medications

  • Talk therapy

  • Strategies to increase healthy activities such as exercise, good sleep, and social connection

  • Family education and support

  • Coordination with your neurologist, therapist, rehabilitation clinician, and PCP 

 

Family involvement

 

If family members or caregivers are involved in your healthcare, we’re happy to work with them as part of your team. 

 

Sometimes family members may notice changes that are difficult for the person with Parkinson’s disease to fully recognize or describe; especially if Parkinson’s disease has significantly affected thinking and memory, or if hallucinations and delusions are a problem.  In these cases, family observations are very helpful in understanding what is happening and developing an effective treatment plan.

 

There is hope

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Psychiatric symptoms in Parkinson’s disease are common, real, and important. They deserve the same attention and thoughtful treatment as movement symptoms. 

 

Effective care for psychiatric aspects of Parkinson’s disease can help you get back to feeling like yourself and living your life again. Even when symptoms cannot be eliminated completely, meaningful improvement in quality of life is very possible.

 

If you are wondering if specialized care for psychiatric symptom of Parkinson’s disease may be helpful for you or a family member, we’re happy to talk through your situation and help you think about next steps. 

 

You can schedule a free 15-minute phone call to help you decide whether BayLight Psychiatry is the right fit for your needs.

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