Serotonin, norepinephrine and dopamine are all chemicals that are involved in regulating mood, energy, motivation, appetite and sleep. In addition, the frontal lobe of the brain, which is important in controlling mood, is known to be under-active in people with Parkinson’s disease. It’s no wonder that Parkinson’s patients may look sad. We have every right – our brain is messed up. But looking sad and feeling sad are two different things.
PD recipients have three strikes against them in the “mood-control” department, the first mentioned in the above paragraph. The second is – sometimes we can wear what is referred to as a ‘masked face’. This is not an optional ‘mask’ they wear, as if going to a masquerade ball, nor is it necessarily due to the possibility of depression being present. No, having a masked face is just one of the gifts that Little Monster (aka PD) gives to us. Because of the disease, the PD patient has no control over the facial muscles that have decided to give in and not hold our smiles anymore. So naturally, because the majority of the public hasn’t a clue what’s going on behind our faces (and some PD’ers I’ve met), our lack of expression can often be (and believe me, it is) misconstrued as a sign that we are sad or depressed. How that assumption saddens and depresses me, because that assumption is not true.
We all have another part of our brain called the frontal lobe. It is a very important place in the brain that helps to control moods. The problem here is that for PD patients, it is known to be under-active, which accounts for the third strike against control over our moods.
I have been asked several times, “Why are you so sad?” or, “Are you depressed?” or, “What’s wrong?” I’m not sad. I’m not depressed. In addition, nothing was wrong until I was asked all those questions and then began wondering that maybe something actually was wrong. Maybe there was something I’m supposed to be sad or depressed over and I just haven’t found out about it yet. A surefire way to get someone feeling low (at least, for me) is to tell him or her how ‘low’ he or she looks. Works every time. It’s called the power of suggestion. Especially if it happens repeatedly.
I was sitting with a friend the other day, listening to her tell me about things in her life. As far as I knew, nothing had changed in my appearance. She then asked, unexpectedly and interrupting herself, “Are you okay? You look like you’re going to cry.”
I was fine. However, then I questioned myself. Was I fine? Why do I look so sad to her? Do I feel sad? Am I going to cry? Should I cry? Is there something to cry about that I missed? Maybe I should cry. How long should I cry? Alas, after a thorough examination of my brain, I concluded that yes, I was fine and I wasn’t going to cry. I didn’t feel sad, but for reasons beyond my control, I looked sad. I chalked that up to Little Monster stealing my smile.
We can try and look on the lighter side of this issue, but for some PD’ers (and others), depression is not only very real but it is a real battle and there isn’t a lighter side for them.
Dr. Anthony Santiago, the world’s greatest Movement Disorder Specialist (at least in Minnesota), once told me that in some PD cases, depression is the patient’s first symptom (surprise!) of having this disease. Through the course of living with PD, it can continue to be a symptom for the reasons stated above, in regards to the chemical make up of our brain. An additional reason as to why a PD patient may experience depression is that the patient is day in day out staring an ugly, chronic illness in the face. That in itself is enough to cause depression for many.
So, what to do?
Make sure you are being optimally treated for PD. If you’re not receiving the correct medications regarding sleepless nights, if you’re struggling with constipation, experiencing fatigue, freezing episodes and more, these can contribute to depression and need to be addressed. That is why you need to discuss anything (that you think may be irrelevant to you or not) with your physician to get the best care. What we think is not associated with PD, may very likely be.
It goes without saying that regular exercise is an important part of being at your best, not only physically, but emotionally and mentally as well. I find that if I’m striving for better health and begin to or increase my exercise, I tend to make better choices when it comes to food. I look at it like – I just walked a while and I’m not eating that yummy cold Chocolate Chip Mint ice cream and cancel out what I just accomplished. (I’ll save it and eat it the next day. Hopefully by then, someone else will have found it and I won’t half to be tempted, but hopefully not.)
It’s a proven fact that if we get up and get going we’ll feel better mentally. Depression means just how it sounds. It depresses the individual within whom it dwells. It saddens them, makes them feel discouraged and disheartened. While this is happening, the individual often focuses on wanting to feel better, to feel something. More often than not, the individual struggling with depression focuses on himself and how bad he may feel. It is an emotional battlefield.
Chip Ingram , former Walk Thru the Bible president, once told a story of a doctor he knew who was treating a patient for depression and that nothing he seemed to be doing was working. The doctor finally told his depressed patient to go to a certain room in the local hospital and read to the cancer patient in there each afternoon. Within a week, his depressed patient’s spirit, emotional well being and mental outlook had improved dramatically. By taking his eyes off himself and putting them on another and getting involved helping other, the once depressed patient realized there were others worse off than himself.
There are many cases of depression that don’t fit neatly or easily into that theory of treatment, some due to chemical imbalances or injuries that are difficult to treat, even with the medications that are available. Sometimes there are just no easy answers for treating depression and since each case is individual and unique, so are the treatments.
If you feel you tend to get depressed at times, or are feeling sad, think about joining a support group, if you haven’t already done so. Start a hobby. Get involved in a recreational or social activity. Dance is becoming more popular and well known for its benefits to PD patients, (in terms of exercise) and is a great way to meet new people. I’ve never met a depressed person who was dancing (or singing).
Many effective and safe medications have been used to treat depression in people with PD. If you haven’t already, discuss your concerns with your doctor and ask if another treatment might suit you better.
Remember, as a PD patient, caregiver, or friend, progress is being made every day towards finding a cure. Until then, get the best treatment you can, tailored to you. Your doctor can only treat you as well as you amount that you are willing to confide in him with what you are experiencing.
Journeying with you – sherri