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depression, anxiety and insomina by Dr.Chew



As I had mentioned earlier, you have been more affected by the non-motor symptoms (insomnia, depression, anxiety) than the motor symptoms of Parkinson’s. Overall, your motor symptoms are well controlled by a combination of effective medications, good exercise program and optimistic attitude.

In fact, with the effective treatment for motor symptoms of Parkinson’s (e.g. medications, brain surgery), I find that managing the non-motor symptoms is much more challenging. Depression and anxiety are very common in Parkinson’s. Most of my patients are on sedative agents and anti-depressants. When I have difficulty managing these problems, I do refer these patients to the psychiatrists.

Another common non-motor symptoms is insomnia. Most of my Parkinson’s patients are on sleeping pills. I am quite liberal in prescribing sleeping pills for Parkinson’s patients because I believe that good quality sleep is important in helping the body to rest and maintaining optimal level of physical activity. Apart from sleeping pills, we should also investigate the underlying causes of insomnia e.g. suboptimal control of motor symptoms at night, coexisting depression and anxiety, etc. As in your case, the following cocktail has help you to have a good quality of sleep;Stilnox (10 mg) 1/2 tablet - helps you to fall asleep quickly (within 15 minutes) and maintains sleep for at least 6 hours.Xanax (0.5 mg) 1/2 tablet - anti-anxiety medication which also helps you to fall asleep.Lexapro (10 mg) 1/2 tablet - anti-depressant and anti-anxiety medication. 

Seroquel (25 mg) 1/2 tablet - even though it is not approved by the FDA, this medication has been used to treat insomnia due to its sedative effect.

Hope you will continue to do well with your medications.

Dr Chew Nee Kong, Kuala Lumpur.

mobility and strength: between people with stroke and parkinson’s



You have brought up a very good point. In Parkinson’s, the muscle power is normal. It is the speed of movement which is affected - Parkinson’s patients are slow. Therefore many Parkinson’s patients can lift up heavy objects (despite being slow). And in your case, I saw how powerful your punches were when you were doing boxing exercise at the California Gym today. Parkinson’s is one of the many brain diseases which affects the basal ganglia, a part in the brain which coordinates body movement.

In contrast, stroke patients have reduced muscle power (paralysis) which prevents them from using the affected limbs to lift up heavy objects. In stroke, the affected part of the brain is the pyramidal system, which is different from the basal ganglia.

Whether it is Parkinson’s or stroke, the body movement is affected, albeit in different ways. The human brain is a very complicated and unique body organ.

Dr Chew Nee Kong, Kuala Lumpur

Sometimes Exercise the best medicine more than the medicine?

http://www.patientslikeme.com/forum/show/41306?post_id=561539#561539

Time line or life expectancy?

http://www.patientslikeme.com/forum/show/42510?post_id=578352#578352

Anyone experience bouts of garbled speech (like your mouth is full of marbles)?

Anyone experience bouts of garbled speech (like your mouth is full of marbles)?

http://www.patientslikeme.com/forum/show/42003?post_id=578984#578984

strength and mobility

http://www.patientslikeme.com/forum/show/42857?post_id=582177#582177

stoop posture

http://www.patientslikeme.com/forum/show/43634?post_id=591947#591947

Worrying:medication or disease progression? FORUM

Joined: 03 Mar 2007Posts: 136Location: Malaysia
Posted: Mon May 11, 2009 7:58 pm Post subject: Worrying: medication or disease progression?>

As parkinson’s patients have to worry the medication of sideeffects on them and the progression of the disease, some patients do not take the medication regulary and accordingly to instruction by doctor, some total denial of the disease by avioding to medication. Some feel anxiety on the progression of the disease by taking medication. This is the non motor symptoms of parkinson’s disease. Are you worrying of the sideeeffect of medication or anxiety on the progression of the disease?_________________to help the PD patients aware the diseases and encourage to set up support groups to educate the patients and their immediate families
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bernard shawJoined: 19 Aug 2008Posts: 281Location: Austria Late UK
Posted: Tue May 12, 2009 5:15 am Post subject: Bern.

I have Parkinson’s for the last twenty five years. I do not worry about taking my medicines. My only worry is that the Sinamet will not cut in on time. Then I know my only solution is to go back to bed and wait for the next tablets session. Bern_________________If your face wants to smile, Let it. If it doesn’t, Make it.

 http://www.patientslikeme.com/forum/show/44254

StargazerJoined: 26 Dec 2007Posts: 139Location: Eastern Washington
Posted: Tue May 12, 2009 5:45 pm Post subject:

Hi Teo and Bern, especially the early morning doses. I take my early morning dose and then go back to bed set the alarm for an hour later and they have kicked in. Now there are a couple of things that can interfere, constipation, not feeling well or actually being sick and good old stress. I most often have a bout with one thing or the other at least once a week. Even at that Bern we are pretty well grounded but our age does that for us we or at least I have developed an attitude. A lady Dr. once told me something is going to get us one way or the other. My thought was not if I can help it……..but no point to worry. Have a great week Teo & Bern Deeann

Requesting for your Views on Observations

Posted: Wed Apr 29, 2009 8:35 pm Post subject: Posted: Wed Apr 29, 2009 8:35 pm Post subject: Requesting for your Views on Observations

Dear Doctor I would like to share the following experiences with you :- Firstly, I notice that I get overly “excited” about many issues, some of them quite trivial. When I am faced with any issues, I get upset very quickly, losing my temper in the process. I also feel very sensitive to many issues that can be quite normal for everybody. And when I have such feelings, I get the urge to be very tensed up and I fel the need to air my views repeatedly, which can go on for days, until the issue is settled in my mind. I feel his tremendous pressure within myself to let my views out. In the event that I keep it in, I will get very moody and unsatisfied. I will lose my temper unnecessarily and scold the ones surrounding me. I noticed that my children, particularly my son, and some of my daughters, carry this thread in their behaviour. They can be quite unreasonable and have the tendency to explode in the face of the most trivial of issues. I also recollect that my mother exhibit similar behaviour. Is this a symptom of Parkinson’s Disease, particularly in my case. Or could “genetic” cause be an answer here, in the sense that my behaviour is inherited from my family members. Secondly, I notice that being a PD patient, my shoulder and neck muscles are stiff, thereby impeding the motions of my arms. I have difficulty in swinging my arms while walking, which is quite natural for people who are not suffering from PD. The swinging of the arm is actually to counterbalance the movement of walking. In order to compensate for the lack of movements in my arms, I notice that I stoop with my chest and head forward to balance myself while walking, and also to force some movements into my arms. I notice that a lot of other PD sufferers are walking in a “stoop” manner as well. I would like your input and comments on my observations on the above. Teo Kim Hoo
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Tue May 05, 2009 7:52 pm Post subject:

The stoop and the walk are common in PD and I suggest physical therapy and a regular exercise routine. For the irritability/anger/moodiness I would suggest an evaluation by a psychiatrist as this could be PD related non-motor symptoms, but also could be bipolar or other psychiatric disorder. There are many treatment options so you should seek a diagnosis._________________Michael S. Okun, M.D.
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Anonymous
Posted: Wed May 06, 2009 4:55 pm Post subject:

Regarding the stooped posture you recommend physical therapy. Does therapy reverse this posture or, if not, what purpose does it serve?
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sun May 10, 2009 7:18 pm Post subject:

It may or may not reverse the stooped posture (this is one of the most difficult symptoms to treat in PD). But PT could prevent further decline, could make your truncal muscles stronger, and help with balance even if the posture remains stooped. Yours,_________________Hubert H. Fernandez
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Tue May 05, 2009 7:52 pm Post subject:

The stoop and the walk are common in PD and I suggest physical therapy and a regular exercise routine. For the irritability/anger/moodiness I would suggest an evaluation by a psychiatrist as this could be PD related non-motor symptoms, but also could be bipolar or other psychiatric disorder. There are many treatment options so you should seek a diagnosis._________________Michael S. Okun, M.D.
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Anonymous
Posted: Wed May 06, 2009 4:55 pm Post subject:

Regarding the stooped posture you recommend physical therapy. Does therapy reverse this posture or, if not, what purpose does it serve?
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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Sun May 10, 2009 7:18 pm Post subject:

It may or may not reverse the stooped posture (this is one of the most difficult symptoms to treat in PD). But PT could prevent further decline, could make your truncal muscles stronger, and help with balance even if the posture remains stooped. Yours,_________________Hubert H. Fernandez
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Dear Mr Teo

Dr Okun has already answered your question. Anxiety disorder and depression can be inherited, just like your Parkinson’s.

As you have mentioned earlier, you had already been diagnosed to have depression since you were in your 20’s. In your case, what happened was that the pre-existing depression and anxiety disorder were aggravated when you started having the motor symptoms of Parkinson’s (about ten years ago).

In fact, you are currently more disabled by your non-motor symptoms (depression and anxiety disorder) than the motor symptoms of Parkinson’s. This is why I am inclined to advise you to continue taking Lexapro as long as possible.

Dr Chew Nee Kong, Kuala Lumpur

 

Is Anxiety Genetic Inheritance or PD Symptom?

Posted: Sun May 03, 2009 6:00 am Post subject:

Posted: Sun May 03, 2009 6:00 am Post subject: Is Anxiety Genetic Inheritance or PD Symptom?

Dear Doctor I notice that I have been suffering from feelings of anxiety and impulsiveness for the pass few years, and this feelings have been particularly strong after I had been diagnosed as having Parkinson’s Disease (PD). I overeact even to the most trivial of things, and I would lose my temper and take it out on my family members. I tend to get very sensitive over every tiny issue that crosses my mind. I get depressed and I have the feeling/urge to express myself over and over again on the issues I have problem with. This results in me repeating the same issues over and over again until my “urge” dies down. Furthermore, when I have this “urge”to express myself, I tend to get very emotional and impulsive, whereby I feel the need to immediately do the things to rectify the situation. I will feel very unsatisfied and unfulfilled if things does not go my way. I noticed that my children, particularly my son and one of my daughters, suffer from anxiety as well, and he/she can be pretty impulsive too. Is my feelings of anxiety/impulsiveness a result of PD? If so, please enlighten me on the causes associated with it. Since my son, who is only 36 years old, exhibit the symptoms of anxiety, can it be passed on genetically? For your information, I remember my mother has the same behaviour too.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Tue May 05, 2009 7:57 pm Post subject:

There can definitely be genetic anxiety disorders and other psychiatric disorders like depression or bipolar disease that run in families. This is usually unrelated to PD. Depression, impulsiveness, moodiness, anger, etc. can all be seen as manifestations of PD._________________Michael S. Okun, M.D.

Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Tue May 05, 2009 7:57 pm Post subject:

There can definitely be genetic anxiety disorders and other psychiatric disorders like depression or bipolar disease that run in families. This is usually unrelated to PD. Depression, impulsiveness, moodiness, anger, etc. can all be seen as manifestations of PD._________________Michael S. Okun, M.D.