From the Guidelines
For patients with Parkinson's disease and anxiety, selective serotonin reuptake inhibitors (SSRIs) are the preferred initial treatment due to their efficacy and minimal impact on Parkinson's symptoms. When considering medication for anxiety in Parkinson's disease, it's crucial to weigh the benefits against potential risks and interactions with other medications. According to 1, physician-prescribed SSRIs or anxiolytics should be chosen based on side effect profiles, interactions, response, patient age, and preference. Key considerations include:
- Starting with low doses of SSRIs such as sertraline (25-50mg daily) or escitalopram (5-10mg daily) to minimize side effects and assess tolerance.
- Monitoring regularly for adherence, side effects, and adverse events, as recommended by 1.
- Considering short-term interventions for acute anxiety episodes, which may include benzodiazepines like lorazepam (0.5-1mg as needed), but using them cautiously due to risks of dependence and cognitive impairment.
- Exploring alternative options like buspirone (starting at 5mg twice daily) for patients who cannot tolerate SSRIs or have specific concerns about side effects.
- Incorporating non-pharmacological approaches, such as cognitive behavioral therapy, mindfulness, and regular exercise, to provide a comprehensive management plan for anxiety in Parkinson's disease.
From the Research
Medication Options for Anxiety in Parkinson's Disease
- Bromazepam has been found to be effective for anxiety in PD, but its usage is limited due to the potential risk of confusion and falls 2.
- Selective serotonin reuptake inhibitors (SSRIs) have shown promise in treating anxiety in PD, although most studies have been uncontrolled and had anxiety outcomes as secondary measures 2, 3.
- Buspirone has been studied as a potential treatment for anxiety in PD, but tolerability concerns have been raised, and its efficacy is still uncertain 4.
- Tricyclic antidepressants have been reported to be beneficial in treating anxiety in PD, but with modest effect sizes and potential additional side effects 3.
- Benzodiazepines are not recommended for treating anxiety in PD due to the increased risk of falling, although one study suggested that they may not significantly impair motor and nonmotor symptoms in PD patients 2, 5.
Considerations for Treatment
- Cognitive and behavioral therapies, with or without pharmacotherapy, have demonstrated efficacy and should be considered as a treatment option 2.
- A targeted and individualized multimodal approach, utilizing psychotherapeutic interventions along with pharmacologic therapies, may be beneficial for managing anxiety in PD patients 2.
- Decreasing off-periods is important for managing anxiety in patients with motor fluctuations, and L-Dopa has been shown to improve anxiety in these patients 3.
- The presence of comorbid depressive disorders and motor fluctuations can impact treatment outcomes and should be taken into account when developing a treatment plan 6.