Symptoms and lifestyle Anxiety and Parkinson's I f you have Parkinson’s you may suffer from anxiety, either because of worrying about living with the condition or because of possible changes in brain chemicals. This information sheet describes anxiety and how it can make you think and feel. It also looks at steps you can take to help reduce anxiety, and at what treatments are available. What is anxiety? Anxiety is a feeling like fear. It is a natural reaction when faced with a situation we find threatening or difficult. Usually, anxiety disappears when the situation changes, or if we get used to the situation or go away from it. But some people become anxious for long periods and for no clear reason. This can make life difficult and may stop you from doing the things you want to. Main symptoms of anxiety Anxiety causes changes in your mind and body. If it goes on for a long time it can affect your work and social life. People with anxiety may experience some of the following: •• fear •• constant worry •• tension Physical symptoms can happen when you’re feeling fear, tension or worry. They may include: •• sweating •• pounding or racing heart (palpitations) •• feeling breathless •• dizziness •• trembling •• indigestion •• nausea and stomach cramp •• a pale face and dry mouth •• muscle pain •• restlessness •• need to go to the toilet frequently When anxiety and panic carry on for a long time you may start to feel that life is hopeless. These feelings may affect your ability to carry out everyday activities. “ My husband is a laid-back person, but lately he suffers panic attacks when out of his comfort zone. He hates being in crowded places, such as noisy restaurants, and generally doesn't like being anywhere that he feels he can't get out of if he needs to. ” Jenniferchristine, from our online forum Sometimes, anxiety can exist with the symptoms of depression. The symptoms of depression range from feeling sad and miserable for long periods, to losing the will to live. Find out more: see our information sheet Depression and Parkinson’s. Types of anxiety There are three main types of anxiety, though these can overlap. Many people will experience more than one type. •• Generalised anxiety disorder (GAD). This is when you experience excessive and uncontrollable worrying most of the time about every day events in your life. •• Panic attacks. These are short periods of sudden, intense feelings of fear. They often happen in situations that are likely to make you feel anxious, and are accompanied by a racing heart, sweating and shortness of breath. Some people think these symptoms are the signs of a heart attack or that they are going to die, and they rush to the hospital for help. The intensity of a panic attack peaks after around 10 minutes, then the symptoms start to fade. •• Phobia. This is when you feel frightened of something that is not dangerous, nor would it usually make other people feel scared. For example, agoraphobia is the fear of going out where there are other people. How does anxiety affect people with Parkinson’s? If you have Parkinson’s, anxiety may come from worrying about living with the condition. It may also be related to changes in brain chemicals. Some people with Parkinson’s have anxiety that happens when they are ‘off’. The ‘off’ period happens when a dose of medication wears off before the next dose is due, and your movements are less under control. If you go ‘off’ and have difficulties moving, it can make you feel anxious or even have a panic attack. It is important to be able to recognise the symptoms of anxiety, so it can be treated as soon as possible. 2 Ways to unwind In the majority of cases, anxiety can be treated. Simple measures such as making time to relax are helpful. You can learn how to do this by reading a book or listening to a CD. There may also be relaxation classes in your area. Your local Parkinson’s UK information and support worker will have details of these. It can also help to avoid too much caffeine (found in tea, coffee and some fizzy drinks), and alcohol, especially late in the evening, as these can make some of the physical symptoms of anxiety worse. “ Anxiety stopped me in my tracks last year, so I had sessions of cognitive behaviour therapy. While it didn’t ‘cure’ my anxiety it certainly helped me to recognise the symptoms of an attack so I could try to do something about it. ” Djemm, from our online forum You can help combat stress and release anxiety through regular exercise. Other ways to ease anxiety include: Yoga Yoga is a gentle exercise that aims to improve flexibility, strength, balance and breathing. There is some evidence that yoga could help with anxiety and stress. Massage Many people find that having a massage helps them to relax, but it is not suitable for people with certain health problems, such as a history of blood clots or bleeding disorders, fractures, open or healing wounds, skin infections or weak or broken bones. Acupuncture Acupuncture is part of traditional Chinese medicine. Although there is no clear evidence that it can reduce anxiety, some people find it helpful. T’ai chi T’ai chi is a combination of slow and gentle exercises and meditation. There is no clear evidence that it reduces anxiety but it may have psychological benefits. Find out more: see our booklet Complementary therapies and Parkinson’s. Changes to Parkinson’s medication You may find that when your movement symptoms are better controlled by medication, your anxiety improves. For example, if your anxiety symptoms increase when your medication is working less well, before the next dose is due (when you are ‘off’), it may improve with changes to Parkinson’s drugs that make ‘on’ periods last longer. Even if you don’t have ‘on’ and ‘off’ periods, you may still have generalised anxiety if your Parkinson’s symptoms aren’t properly treated. Again, changes to your medication may help. Always speak to your specialist or Parkinson’s nurse about any adjustments to Parkinson’s medication. 3 Talking and counselling Sharing your worries and fears with a trusted friend or family member can help reduce anxiety. Talking to other people with Parkinson’s can also help, as you share your experiences and find out how others cope with similar problems. Parkinson’s UK has local groups across the UK. Visit parkinsons.org.uk/localgroups to find your nearest group. You can also talk to other people with Parkinson’s online at parkinson’s.org.uk/forum, or be put in touch with someone who has been similarly affected through the peer support service - see page 5 for details. If you prefer to speak to a professionally trained counsellor, ask your GP for information (many surgeries have counsellors attached to their practice). There are also counselling organisations that can give you information and details of private counsellors, including the British Association for Counselling and Psychotherapy. The mental health charity Mind has a guide, Making Sense of Counselling. This explains what counselling is, how it can help, what it involves, the types available and how to find a counsellor. There is a small charge for this booklet. Details about helpful organisations are given on pages 5 and 6. Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (sometimes called ‘talking’ therapy or CBT) can be very effective in dealing with anxiety. It works by changing ‘unhelpful’ everyday thoughts and behaviours that can lead to feelings of anxiety or make anxiety worse. Cognitive behavioural therapy can take place in groups or individually with a therapist, who may be a clinical psychologist, psychiatrist or specially trained nurse. It usually involves a course of weekly sessions. You can also find cognitive behaviour therapy (CBT) courses online or use computer programmes, such as ‘FearFighter’, which may be available through your GP. Talk to your GP or other healthcare professional for advice. There are also a number of self-help CBT books that are recommended by the NHS and Health Service for people with anxiety. Many of these are available at your local library via the ‘Books on Prescription’ scheme. Again, ask your GP for advice or check the More information and support section. Medication for anxiety At present, there is no evidence on whether or not the symptoms of anxiety in people with Parkinson’s can be treated effectively with medication. But your GP or specialist may discuss this option if severe anxiety is affecting the quality of your day-to-day life. The most common medications used to treat anxiety in these circumstances are antidepressants. These may improve both anxiety and depressive symptoms. Other types of anxiety medication may be considered, but your GP or specialist will discuss with you what is best for you. How can family, friends and carers help? Anxiety can be a difficult problem to live with. It can affect everyday activities, such as going out or socialising. If anxiety symptoms start to significantly affect someone's quality of life, then a family member, friend or carer should try to encourage them to speak to their GP, specialist or Parkinson’s nurse. They may be referred to a mental health specialist who may recommend treatment. Helping a person with Parkinson's to practise relaxation techniques regularly can also help. 4 More information and support Parkinson’s nurses Parkinson’s nurses provide expert advice and support to people with Parkinson’s and those who care for them. They can also act as a liaison between other health and social care professionals to make sure your needs are met. Parkinson’s nurses may not be available in every area, but your GP or specialist can give you more details on local services. Information and support from Parkinson’s UK You can call our free confidential helpline for general support and information. Call 0808 800 0303 (calls are free from UK landlines and most mobile networks) or email [email protected] We also run a peer support service if you’d like to talk on the phone with someone affected by Parkinson’s who has faced similar issues to you. The service is free and confidential – ring the helpline and they will match you with a peer support volunteer. Our helpline can also put you in touch with one of our local information and support workers, who provide one-to-one information and support to anyone affected by Parkinson’s. They can also provide links to local groups and services. Our website has information about your local support team and how to contact them at parkinsons.org.uk/ localtoyou. You can find details of our local groups and your nearest meeting at parkinsons.org.uk/localgroups You can also visit parkinsons.org.uk/forum to speak with other people in a similar situation on our online discussion forum. Useful contacts Anxiety UK 0844 477 5774 [email protected] www.anxietyuk.org.uk British Association for Behavioural and Cognitive Psychotherapies (BABCP) Visit the website to find a therapist near you. www.babcp.com Mind 0300 123 3393 [email protected] www.mind.org.uk For information on counselling visit www.mind.org.uk/help/medical_and_alternative care/making_sense_of_counselling 5 No panic This charity offers telephone mentoring and recovery groups for people suffering from anxiety disorders. 0800 138 8889 www.nopanic.org.uk Northern Ireland Association for Mental Health 028 9032 8474 www.niamh.co.uk Royal College of Psychiatrists For mental health resources and information. www.rcpsych.ac.uk Scottish Association for Mental Health 0141 530 1000 [email protected] www.samh.org.uk Thank you Thank you very much to everyone who contributed to or reviewed this information sheet: Alison Rose, Lead Movement Disorder Nurse Specialist, County Durham and Darlington Foundation Trust Dr Richard Brown, Professor of Neuropsychology and Clinical Neuroscience, Institute of Psychiatry, London The Royal College of Psychiatrists (rcpsych.ac.uk), which allowed us to use information from its leaflet, Anxiety, panic and phobias Thanks also to our information review group and other people affected by Parkinson’s who provided feedback. 6 Anxiety and Parkinson's (2013) If you have comments or suggestions about this information sheet, we’d love to hear from you. This will help us ensure that we are providing as good a service as possible. We’d be very grateful if you could complete this form and return it to Resources and Diversity, Parkinson’s UK, 215 Vauxhall Bridge Road, London SW1V 1EJ. Or you can email us at [email protected]. Thanks! Please tick...  I have Parkinson’s. When were you diagnosed? ...............................................................................................................................................................  I’m family/a friend/a carer of someone with Parkinson’s  I’m a professional working with people with Parkinson’s Where did you get this information sheet from?  GP, specialist or Parkinson’s nurse  Parkinson’s UK local group or event  Our website  Information and support worker  Ordered from us directly  Other ............................................................................................................................................... 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Parkinson’s UK Free* confidential helpline 0808 800 0303 Monday to Friday 9am–8pm, Saturday 10am–2pm. Interpreting available. Text Relay 18001 0808 800 0303 (for textphone users only) [email protected] parkinsons.org.uk *calls are free from UK landlines and most mobile networks. How to order our resources 0845 121 2354 [email protected] Download them from our website at parkinsons.org.uk/publications We make every effort to make sure that our services provide up-to-date, unbiased and accurate information. We hope that this will add to any professional advice you receive and will help you to make any decisions you may face. Please do continue to talk to your health and social care team if you are worried about any aspect of living with Parkinson’s. References for this information sheet can be found in the Microsoft Word version at parkinsons.org.uk/publications Last updated February 2013. Next update available February 2015 FS96 © Parkinson’s UK,February 2013. Parkinson’s UK is the operating name of the Parkinson’s Disease Society of the United Kingdom. A charity registered in England and Wales (258197) and in Scotland (SC037554).