- I DID NOT RETIRE WHEN I WANTED TO.
I ANTICIPATED WORKING FOR AT LEAST 2 OR 3 MORE YEARS
BECAUSE REALLY I ENJOYED WHAT I DID.
WE USED TO GO TO NEVADA OR ARIZONA, AND I USED TO DO
THE ROCK CLIMBING.
WHEN YOU GET THE SHAKES, LIKE I'M GETTING RIGHT NOW,
YOU CAN'T ROCK CLIMB.
IT IMPACTS ALSO IN YOUR SOCIAL LIFE, BECAUSE I USED TO BELONG
TO A COUPLE OF CLUBS WITH MODEL RAILROADING.
WHEN YOU HAVE THE SHAKES, YOU CANNOT PUT A KIT TOGETHER.
SO YOU END UP WITHDRAWING.
- IT'S ESTIMATED THAT ANYWHERE BETWEEN 20% AND 40% OF PEOPLE
WITH PARKINSON'S DISEASE WILL EXPERIENCE DEPRESSION AT SOME
POINT DURING THEIR ILLNESS.
SO AS PART OF OUR ROUTINE CLINICAL CARE, EVERY PATIENT
WITH PARKINSON'S DISEASE COMPLETES SOMETHING CALLED THE
GERIATRIC DEPRESSION SCALE, WHICH IS A 15-QUESTION
"YES OR NO" TOOL THAT WE USE TO TRY TO HELP DETECT DEPRESSION
IN PARKINSON'S PATIENTS.
WHEN MR. KNIGHT STARTED TO COME TO SEE US, WE WERE NOTICING
THAT HIS SCORES ON THE GERIATRIC DEPRESSION SCALE
WOULD VERY MUCH FLUCTUATE.
HOWEVER, ONCE HE STARTED TO REALLY ENDORSE FEELINGS OF POOR
MOTIVATION AND LACK OF INTEREST IN HIS LIFE, THAT'S
WHEN WE DECIDED TO REFER HIM ON TO DR. WEINTRAUB
FOR POSSIBLE TREATMENT OF DEPRESSION.
- OK, MR. KNIGHT.
YOU CAN HAVE A SEAT, AND A NURSE WILL COME OUT AND CALL
YOU SHORTLY.
- OK. THANK YOU. - YOU'RE WELCOME.
- ONE OF THE TRICKY PARTS ABOUT EVALUATING PARKINSON'S
DISEASE PATIENTS FOR DEPRESSION IS THAT THERE CAN
BE OVERLAP BETWEEN THE CORE SYMPTOMS OF PARKINSON'S
DISEASE AND DEPRESSION.
FOR INSTANCE, PARKINSON'S DISEASE PATIENTS BY THE NATURE
OF THEIR ILLNESS OFTEN EXPERIENCE CHANGE IN SLEEP
AND APPETITE, CONCENTRATION, EXPERIENCE SLOWNESS
OF MOVEMENT, AND AMOTIVATION.
THOSE ARE ALSO CORE SYMPTOMS OF DEPRESSION.
- AS THE SYMPTOMS DEVELOPED, I BECAME MUCH MORE WITHDRAWN,
WHERE I DON'T GO OUT THAT MUCH.
AND THE MEDICATIONS ALSO IMPACT YOUR NORMAL DAILY LIFE.
- IT'S DIFFICULT BOTH FOR PATIENTS AND CLINICIANS TO
KNOW SOMETIMES WHETHER TO COUNT THOSE AS SYMPTOMS
OF DEPRESSION OR COUNT THEM AS JUST SYMPTOMS
OF PARKINSON'S DISEASE.
- A LOT OF TIMES WHEN WE HEAR THAT THE PERSON HAS BACKED OUT
OF ACTIVITIES OR IS NO LONGER AS SOCIALLY INVOLVED, WE DO
WANT TO EXPLORE THAT TO FIND OUT, IS IT BECAUSE
OF THE MOTOR SYMPTOMS?
IS IT BECAUSE OF AN EMBARRASSMENT?
OR IS IT BECAUSE OF AN UNDERLYING DEPRESSION OR MAYBE
A COMBINATION OF BOTH?
- PARKINSON'S DISEASE PATIENTS SOMETIMES HAVE LIMITED
AWARENESS OF THEIR OWN SYMPTOMS, AND THAT'S WHY WE
TRY TO INVOLVE INFORMED OTHERS OR CAREGIVERS
IN THE EVALUATION AS WELL.
- IN PARKINSON'S DISEASE, WE'RE FINDING THAT IT ACTUALLY IS
QUITE COMMON FOR THE PERSON TO HAVE SOME FORM OF DEPRESSION
AND NOT REALLY BE COGNIZANT OF WHAT IS GOING ON.
- AM I ACTUALLY DEPRESSED, OR AM I--I PROBABLY AM,
BUT I WOULD USE THE WORD I'M MORE APATHETIC,
LACK OF INTEREST.
- A LOT OF TIMES, FRUSTRATION AND MOODINESS GETS JUST BLAMED
ON HAVING A CHRONIC DISEASE AND TRYING TO COPE WITH THAT,
WHEN REALLY THERE'S A WHOLE OTHER ISSUE GOING
ON WITH EITHER DEPRESSION OR APATHY OR ANXIETY.
SO IT'S VERY IMPORTANT FOR THE CLINICIAN TO KNOW THE RIGHT
QUESTIONS TO ASK TO BE ABLE TO UNCOVER THESE HIDDEN SIGNS
AND SYMPTOMS OF DEPRESSION.
- IT'S VERY FRUSTRATING, AND I GUESS YOU COULD SAY
DEPRESSED THAT THIS IS ACTUALLY HAPPENING TO YOU
AND YOUR PLANS THAT YOU HAD MADE, YOU'RE NOT GOING TO BE
ABLE TO ACCOMPLISH THEM.
[KNOCK ON DOOR]
- MR. KNIGHT.
- HELLO, DOCTOR.
- ONCE I INTERVIEWED HIM AND CONFIRMED THAT HE DID HAVE
MILD DEPRESSIVE SYMPTOMS THAT WOULD WARRANT TREATMENT,
WE DISCUSSED THE AVAILABLE OPTIONS.
ONE MAJOR ROUTE IS TO CONSIDER PSYCHOPHARMACOLOGY OR
ANTIDEPRESSANT MEDICATION.
THE OTHER MAJOR ROUTE IS TO CONSIDER COUNSELING
OR PSYCHOTHERAPY.
AND THOSE TWO CAN BE COMBINED AND OFTEN ARE.
- WHILE ACTUAL SUICIDE IS NOT VERY COMMON IN PARKINSON'S
DISEASE, SOMETHING CALLED SUICIDAL IDEATION OR THOUGHTS
ABOUT, "WOULD I BE BETTER OFF IF I WAS NO LONGER HERE?
"WOULD MY FAMILY BE BETTER OFF IF I WAS NO LONGER HERE?
AM I A BURDEN? HOW CAN I DO THIS?"
WE DO KNOW THAT THAT IS RELATIVELY COMMON.
- YOU HAVE PARKINSON'S, THERE IS NO CURE.
THEY HAVE MEDICATIONS TO WORK ON THE SYMPTOMS, BUT YOU CAN
SEE THAT YOU ALWAYS--ALWAYS GETTING WORSE.
THOUGHTS ARE THERE THAT,
"WHAT'S THE PURPOSE OF ME CONTINUING ON HERE?"
- MOVING FROM THAT POINT TO ACTUAL SUICIDE IS NOT VERY
COMMON, LUCKILY, IN THIS POPULATION.
- I HAVE NO DESIRE TO DO MYSELF IN.
THAT IS NOT A CONCERN.
SOMETIMES I THINK, THOUGH, THAT IF I STOP TAKING MY
MEDICATIONS, WHAT WILL HAPPEN?
MY WORLD HAS GOTTEN SMALLER.
IT HAS SHRUNK.
AND IT'S REALLY THE LACK OF INTEREST OR...I'M NOT SURE
EXACTLY WHAT IT IS, THAT I'M WITHDRAWN OR WITHDRAWING
INTO MY OWN LITTLE WORLD.
- HE'S TRIED TWO DIFFERENT ANTIDEPRESSANT MEDICATIONS,
BUT BECAUSE OF SIDE EFFECTS, OR CONCERNS OVER SIDE EFFECTS,
HE HASN'T REALLY BEEN COMPLIANT AND HASN'T CHOSEN TO
STAY ON THESE DRUGS.
- THE ONLY PROBLEM WITH THE MEDICATION THAT HE PRESCRIBED,
TOSSED ME FOR A LOOP.
I STOPPED TAKING IT.
- IT DOES TAKE SOME TWEAKING.
WE DON'T ALWAYS FIND THE RIGHT DRUG THE FIRST TIME AROUND.
SO WORKING WITH A PSYCHIATRIST OR WORKING WITH A NEUROLOGIST
IS VERY IMPORTANT.
YOU KNOW, GIVING THE DRUGS A COUPLE OF WEEKS.
IF THAT DRUG DOESN'T SEEM TO WORK OR THERE ARE SIDE
EFFECTS, YOU KNOW, WE HAVE A WHOLE SPECTRUM OF DIFFERENT
TYPES OF ANTIDEPRESSANTS THAT WE CAN USE.
- I'D LIKE TO SEE IF WE CAN FORM AN ALLIANCE WHERE WE CAN
GET HIM TO GET TO AN ADEQUATE DOSAGE FOR AN ADEQUATE PERIOD
OF TIME TO REALLY EVALUATE ITS IMPACT ON HIS MOOD.
IN HIS PARTICULAR CASE, IT MAY HAVE A SECONDARY BENEFIT
OF HELPING SOME OF HIS CHRONIC PAIN SYMPTOMS AS WELL.
CLINICALLY SIGNIFICANT DEPRESSIVE SYMPTOMS ARE COMMON
IN PARKINSON'S DISEASE.
THEY CAN OCCUR AT ANY STAGE OF THE ILLNESS.
IT'S IMPORTANT THAT BOTH PATIENTS AND INFORMED OTHERS
BE AWARE OF THAT AND BE WILLING TO DISCUSS
THOSE SYMPTOMS AND ANSWER QUESTIONS WHEN THEY ARE COMING
IN FOR EVALUATION WITH THEIR NEUROLOGIST OR PARKINSON'S
DISEASE SPECIALIST, AND TO ALSO RECOGNIZE THAT WE DO HAVE
TREATMENTS NOW, WHETHER IT'S MEDICATION OR PSYCHOTHERAPY AND
COUNSELING, THAT DO APPEAR TO BE HELPFUL FOR THE TREATMENT
OF THESE SYMPTOMS.