ABSTRACT
Anxiety and depression are among the most common neurobehavioral symptoms of Parkinson’s disease (PD), yet often go unrecognized in clinical practice (1). Shulman et al. (1) observed that anxiety and depression detected by symptom inventories was undetected by neurologists in more than half the cases. Furthermore, in comparison to the proportion of parkinsonians with depressive symptoms, relatively few are prescribed antidepressants (2). The importance of diagnosing and treating anxiety and depression cannot be overstated, given that mental health symptoms in general (3), and depression in particular, profoundly impact the parkinsonian’s quality of life (4-6). Early and successful treatment of depression is imperative because this condition is associated with depression in the caregiver (7) and diminishes the caregiver’s quality of life (8). Depression exacerbates cognitive impairment (9-14), increases the risk of dementia (15,16), and is associated with excess functional disability (17-19) and more rapid disease progression (20). Indeed, depression may be a risk factor for PD and one of the earliest signs of the disease, preceding motor symptoms by several years (21-24). This chapter reviews depression and anxiety disorders in PD. Each section examines incidence and prevalence, phenomenology and diagnostic issues, potential causes, and treatment.
