From the Guidelines
For patients with Parkinson's disease who have anxiety, selective serotonin reuptake inhibitors (SSRIs) are generally considered the best first-line medication option. This recommendation is based on the most recent and highest quality study available, which suggests that physician-prescribed SSRIs or anxiolytics should be chosen based on side-effect profiles, interactions, response, patient age, and preference 1.
Key Considerations
- SSRIs such as sertraline (Zoloft) starting at 25-50 mg daily and gradually increasing to 50-200 mg daily as needed, or escitalopram (Lexapro) starting at 5-10 mg daily and increasing to 10-20 mg daily if necessary, are often recommended because they effectively treat anxiety while having minimal impact on Parkinson's symptoms.
- It's essential to start with low doses and increase gradually to minimize side effects.
- Benzodiazepines like lorazepam can be used for short-term or breakthrough anxiety but should be used cautiously due to risks of cognitive impairment, falls, and dependence.
- Buspirone is another option that doesn't worsen Parkinson's symptoms.
- Certain medications commonly used for anxiety, particularly tricyclic antidepressants and some antipsychotics, should be avoided as they can worsen Parkinson's symptoms by blocking dopamine receptors.
Monitoring and Individualization
- Treatment should always be individualized based on the specific patient's symptoms, medication regimen, and comorbidities.
- Close monitoring for both effectiveness and side effects is crucial, as recommended by the most recent guideline update 1.
- Regular monitoring for adherence, side effects, and adverse events is also necessary, considering the patient's age, preference, and response to the medication 1.
From the Research
Anxiety Medications for Parkinson's Disease Patients
- There are no specific studies that directly compare anxiety medications for patients with Parkinson's disease.
- However, studies on depression in Parkinson's disease patients may provide some insights, as anxiety and depression often co-occur 2, 3, 4, 5, 6.
- Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression in Parkinson's disease patients and may also be effective for anxiety 3, 4, 5, 6.
- Some SSRIs that may be useful for anxiety in Parkinson's disease patients include:
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) may also be effective for anxiety in Parkinson's disease patients, although evidence is limited 6.
- Duloxetine, an SNRI, has been shown to improve depressive symptoms and freezing of gait in Parkinson's disease patients, but its effectiveness for anxiety is unclear 6.
Considerations for Anxiety Medications in Parkinson's Disease Patients
- Clinicians should consider the potential interactions between anxiety medications and other medications used to treat Parkinson's disease, such as monoamine oxidase B inhibitors 4.
- The anticholinergic effect of tricyclic antidepressants and the impact of SSRIs on blood pressure should also be considered 4.
- Extrapyramidal effects of antidepressants, such as worsening of tremor, should be monitored 6.