Anxiety and Parkinson's disease

Anxiety is common in patients with Parkinson's disease (PD). Nearly 40% of patients with PD fulfill criteria for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, anxiety disorders (eg, generalized anxiety disorder, panic disorder, and social phobia), and many more have symptoms of anxiety not meeting formal criteria. This anxiety is often present prior to the onset of the movement disorder, usually co-occurs with depression, and frequently becomes worse in patients who develop erratic motor fluctuations. Anxiety in patients with PD is likely to be related to the neurochemical and degenerative changes that accompany PD, as well as to worsening disability. Pharmacologic and psychotherapeutic treatments have not been studied in these patients; nonetheless, clinical experience suggests that a similar approach to that taken in the non-PD elderly may be useful. This approach involves selective serotonin reuptake inhibitors, other newer antidepressants, cognitive-behavioral therapy, exercise, and occasionally benzodiazepines or atypical antipsychotics.