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. 2001 Feb;77(904):89–93. doi: 10.1136/pmj.77.904.89

Parkinson's disease and anxiety

K Walsh 1, G Bennett 1
PMCID: PMC1741918  PMID: 11161073

Abstract

There has been a recent surge of interest in the subject of anxiety in patients with Parkinson's disease. Up to 40% of patients with Parkinson's disease experience clinically significant anxiety. This anxiety may be a psychological reaction to the stress of the illness or may be related to the neurochemical changes of the disease itself. Antiparkinsonian drugs may have a role in the pathogenesis of the anxiety. The anxiety disorders in Parkinson's disease patients appear to be clustered in the panic disorder, phobic disorder, and generalised anxiety disorder areas. The degree of comorbidity between anxiety and depression in patients with Parkinson's disease is in excess of that found in patients without the disease and anxiety in combination with depression may represent a specific depressive subtype in Parkinson's disease. As yet, there is no trial evidence as to the treatment of anxiety in patients with Parkinson's disease.


Keywords: Parkinson's disease; anxiety disorders; panic disorder

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Selected References

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  1. Berlan M., Rascol O., Belin J., Moatti J. P., Rascol A., Montastruc J. L. Alpha 2-adrenergic sensitivity in Parkinson's disease. Clin Neuropharmacol. 1989 Apr;12(2):138–144. doi: 10.1097/00002826-198904000-00010. [DOI] [PubMed] [Google Scholar]
  2. Berrios G. E., Campbell C., Politynska B. E. Autonomic failure, depression and anxiety in Parkinson's disease. Br J Psychiatry. 1995 Jun;166(6):789–792. doi: 10.1192/bjp.166.6.789. [DOI] [PubMed] [Google Scholar]
  3. Bland R. C., Newman S. C., Orn H. Prevalence of psychiatric disorders in the elderly in Edmonton. Acta Psychiatr Scand Suppl. 1988;338:57–63. doi: 10.1111/j.1600-0447.1988.tb08548.x. [DOI] [PubMed] [Google Scholar]
  4. Bonifati V., Fabrizio E., Cipriani R., Vanacore N., Meco G. Buspirone in levodopa-induced dyskinesias. Clin Neuropharmacol. 1994 Feb;17(1):73–82. doi: 10.1097/00002826-199402000-00008. [DOI] [PubMed] [Google Scholar]
  5. Caley C. F., Friedman J. H. Does fluoxetine exacerbate Parkinson's disease? J Clin Psychiatry. 1992 Aug;53(8):278–282. [PubMed] [Google Scholar]
  6. Cash R., Dennis T., L'Heureux R., Raisman R., Javoy-Agid F., Scatton B. Parkinson's disease and dementia: norepinephrine and dopamine in locus ceruleus. Neurology. 1987 Jan;37(1):42–46. doi: 10.1212/wnl.37.1.42. [DOI] [PubMed] [Google Scholar]
  7. Ellgring H., Seiler S., Nagel U., Perleth B., Gasser T., Oertel W. H. Psychosocial problems of Parkinson patients: approaches to assessment and treatment. Adv Neurol. 1990;53:349–353. [PubMed] [Google Scholar]
  8. Fetoni V., Soliveri P., Monza D., Testa D., Girotti F. Affective symptoms in multiple system atrophy and Parkinson's disease: response to levodopa therapy. J Neurol Neurosurg Psychiatry. 1999 Apr;66(4):541–544. doi: 10.1136/jnnp.66.4.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fleminger S. Left-sided Parkinson's disease is associated with greater anxiety and depression. Psychol Med. 1991 Aug;21(3):629–638. doi: 10.1017/s0033291700022261. [DOI] [PubMed] [Google Scholar]
  10. Gold P. W., Goodwin F. K., Chrousos G. P. Clinical and biochemical manifestations of depression. Relation to the neurobiology of stress (1) N Engl J Med. 1988 Aug 11;319(6):348–353. doi: 10.1056/NEJM198808113190606. [DOI] [PubMed] [Google Scholar]
  11. Gotham A. M., Brown R. G., Marsden C. D. Depression in Parkinson's disease: a quantitative and qualitative analysis. J Neurol Neurosurg Psychiatry. 1986 Apr;49(4):381–389. doi: 10.1136/jnnp.49.4.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Henderson R., Kurlan R., Kersun J. M., Como P. Preliminary examination of the comorbidity of anxiety and depression in Parkinson's disease. J Neuropsychiatry Clin Neurosci. 1992 Summer;4(3):257–264. doi: 10.1176/jnp.4.3.257. [DOI] [PubMed] [Google Scholar]
  13. Heninger G. R., Charney D. S. Monoamine receptor systems and anxiety disorders. Psychiatr Clin North Am. 1988 Jun;11(2):309–326. [PubMed] [Google Scholar]
  14. Hillen M. E., Sage J. I. Nonmotor fluctuations in patients with Parkinson's disease. Neurology. 1996 Nov;47(5):1180–1183. doi: 10.1212/wnl.47.5.1180. [DOI] [PubMed] [Google Scholar]
  15. Hollander E., Cohen L., Richards M., Mullen L., DeCaria C., Stern Y. A pilot study of the neuropsychology of obsessive-compulsive disorder and Parkinson's disease: basal ganglia disorders. J Neuropsychiatry Clin Neurosci. 1993 Winter;5(1):104–107. doi: 10.1176/jnp.5.1.104. [DOI] [PubMed] [Google Scholar]
  16. Iruela L. M., Ibañez-Rojo V., Palanca I., Caballero L. Anxiety disorders and Parkinson's disease. Am J Psychiatry. 1992 May;149(5):719–720. [PubMed] [Google Scholar]
  17. Jiménez-Jiménez F. J., Tejeiro J., Martínez-Junquera G., Cabrera-Valdivia F., Alarcón J., García-Albea E. Parkinsonism exacerbated by paroxetine. Neurology. 1994 Dec;44(12):2406–2406. doi: 10.1212/wnl.44.12.2406. [DOI] [PubMed] [Google Scholar]
  18. Lang A. E., Quinn N., Brincat S., Marsden C. D., Parkes J. D. Pergolide in late-stage Parkinson disease. Ann Neurol. 1982 Sep;12(3):243–247. doi: 10.1002/ana.410120305. [DOI] [PubMed] [Google Scholar]
  19. Lauterbach E. C., Duvoisin R. C. Anxiety disorders in familial parkinsonism. Am J Psychiatry. 1991 Feb;148(2):274–274. [PubMed] [Google Scholar]
  20. Lauterbach E. C. The locus ceruleus and anxiety disorders in demented and nondemented familial parkinsonism. Am J Psychiatry. 1993 Jun;150(6):994–994. doi: 10.1176/ajp.150.6.994a. [DOI] [PubMed] [Google Scholar]
  21. Litvan I., Cummings J. L., Mega M. Neuropsychiatric features of corticobasal degeneration. J Neurol Neurosurg Psychiatry. 1998 Nov;65(5):717–721. doi: 10.1136/jnnp.65.5.717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Ludwig C. L., Weinberger D. R., Bruno G., Gillespie M., Bakker K., LeWitt P. A., Chase T. N. Buspirone, Parkinson's disease, and the locus ceruleus. Clin Neuropharmacol. 1986;9(4):373–378. doi: 10.1097/00002826-198608000-00004. [DOI] [PubMed] [Google Scholar]
  23. Maricle R. A., Nutt J. G., Carter J. H. Mood and anxiety fluctuation in Parkinson's disease associated with levodopa infusion: preliminary findings. Mov Disord. 1995 May;10(3):329–332. doi: 10.1002/mds.870100316. [DOI] [PubMed] [Google Scholar]
  24. Maricle R. A., Nutt J. G., Valentine R. J., Carter J. H. Dose-response relationship of levodopa with mood and anxiety in fluctuating Parkinson's disease: a double-blind, placebo-controlled study. Neurology. 1995 Sep;45(9):1757–1760. doi: 10.1212/wnl.45.9.1757. [DOI] [PubMed] [Google Scholar]
  25. Mayeux R., Stern Y., Williams J. B., Cote L., Frantz A., Dyrenfurth I. Clinical and biochemical features of depression in Parkinson's disease. Am J Psychiatry. 1986 Jun;143(6):756–759. doi: 10.1176/ajp.143.6.756. [DOI] [PubMed] [Google Scholar]
  26. Mendis T., Suchowersky O., Lang A., Gauthier S. Management of Parkinson's disease a review of current and new therapies. Can J Neurol Sci. 1999 May;26(2):89–103. [PubMed] [Google Scholar]
  27. Menza M. A., Mark M. H. Parkinson's disease and depression: the relationship to disability and personality. J Neuropsychiatry Clin Neurosci. 1994 Spring;6(2):165–169. doi: 10.1176/jnp.6.2.165. [DOI] [PubMed] [Google Scholar]
  28. Menza M. A., Palermo B., DiPaola R., Sage J. I., Ricketts M. H. Depression and anxiety in Parkinson's disease: possible effect of genetic variation in the serotonin transporter. J Geriatr Psychiatry Neurol. 1999 Summer;12(2):49–52. doi: 10.1177/089198879901200202. [DOI] [PubMed] [Google Scholar]
  29. Menza M. A., Robertson-Hoffman D. E., Bonapace A. S. Parkinson's disease and anxiety: comorbidity with depression. Biol Psychiatry. 1993 Oct 1;34(7):465–470. doi: 10.1016/0006-3223(93)90237-8. [DOI] [PubMed] [Google Scholar]
  30. Menza M. A., Rosen R. C. Sleep in Parkinson's disease. The role of depression and anxiety. Psychosomatics. 1995 May-Jun;36(3):262–266. doi: 10.1016/S0033-3182(95)71665-6. [DOI] [PubMed] [Google Scholar]
  31. Menza M. A., Sage J., Marshall E., Cody R., Duvoisin R. Mood changes and "on-off" phenomena in Parkinson's disease. Mov Disord. 1990;5(2):148–151. doi: 10.1002/mds.870050210. [DOI] [PubMed] [Google Scholar]
  32. Montastruc J. L., Fabre N., Blin O., Senard J. M., Rascol O., Rascol A. Does fluoxetine aggravate Parkinson's disease? A pilot prospective study. Mov Disord. 1995 May;10(3):355–357. doi: 10.1002/mds.870100325. [DOI] [PubMed] [Google Scholar]
  33. Nissenbaum H., Quinn N. P., Brown R. G., Toone B., Gotham A. M., Marsden C. D. Mood swings associated with the 'on-off' phenomenon in Parkinson's disease. Psychol Med. 1987 Nov;17(4):899–904. doi: 10.1017/s0033291700000702. [DOI] [PubMed] [Google Scholar]
  34. Nutt D., Lawson C. Panic attacks. A neurochemical overview of models and mechanisms. Br J Psychiatry. 1992 Feb;160:165–178. doi: 10.1192/bjp.160.2.165. [DOI] [PubMed] [Google Scholar]
  35. Regier D. A., Boyd J. H., Burke J. D., Jr, Rae D. S., Myers J. K., Kramer M., Robins L. N., George L. K., Karno M., Locke B. Z. One-month prevalence of mental disorders in the United States. Based on five Epidemiologic Catchment Area sites. Arch Gen Psychiatry. 1988 Nov;45(11):977–986. doi: 10.1001/archpsyc.1988.01800350011002. [DOI] [PubMed] [Google Scholar]
  36. Richard I. H., Schiffer R. B., Kurlan R. Anxiety and Parkinson's disease. J Neuropsychiatry Clin Neurosci. 1996 Fall;8(4):383–392. doi: 10.1176/jnp.8.4.383. [DOI] [PubMed] [Google Scholar]
  37. Richard I. H., Szegethy E., Lichter D., Schiffer R. B., Kurlan R. Parkinson's disease: a preliminary study of yohimbine challenge in patients with anxiety. Clin Neuropharmacol. 1999 May-Jun;22(3):172–175. [PubMed] [Google Scholar]
  38. Routh L. C., Black J. L., Ahlskog J. E. Parkinson's disease complicated by anxiety. Mayo Clin Proc. 1987 Aug;62(8):733–735. doi: 10.1016/s0025-6196(12)65226-4. [DOI] [PubMed] [Google Scholar]
  39. Roy-Byrne P. P., Uhde T. W., Sack D. A., Linnoila M., Post R. M. Plasma HVA and anxiety in patients with panic disorder. Biol Psychiatry. 1986 Jul;21(8-9):849–853. doi: 10.1016/0006-3223(86)90253-2. [DOI] [PubMed] [Google Scholar]
  40. Schiffer R. B., Kurlan R., Rubin A., Boer S. Evidence for atypical depression in Parkinson's disease. Am J Psychiatry. 1988 Aug;145(8):1020–1022. doi: 10.1176/ajp.145.8.1020. [DOI] [PubMed] [Google Scholar]
  41. Siemers E. R., Shekhar A., Quaid K., Dickson H. Anxiety and motor performance in Parkinson's disease. Mov Disord. 1993 Oct;8(4):501–506. doi: 10.1002/mds.870080415. [DOI] [PubMed] [Google Scholar]
  42. Stein M. B., Heuser I. J., Juncos J. L., Uhde T. W. Anxiety disorders in patients with Parkinson's disease. Am J Psychiatry. 1990 Feb;147(2):217–220. doi: 10.1176/ajp.147.2.217. [DOI] [PubMed] [Google Scholar]
  43. Steur E. N. Increase of Parkinson disability after fluoxetine medication. Neurology. 1993 Jan;43(1):211–213. doi: 10.1212/wnl.43.1_part_1.211. [DOI] [PubMed] [Google Scholar]
  44. Suranyi-Cadotte B. E., Nestoros J. N., Nair N. P., Lal S., Gauthier S. Parkinsonism induced by high doses of diazepam. Biol Psychiatry. 1985 Apr;20(4):455–457. doi: 10.1016/0006-3223(85)90048-4. [DOI] [PubMed] [Google Scholar]
  45. Vázquez A., Jiménez-Jiménez F. J., García-Ruiz P., García-Urra D. "Panic attacks" in Parkinson's disease. A long-term complication of levodopa therapy. Acta Neurol Scand. 1993 Jan;87(1):14–18. [PubMed] [Google Scholar]

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