From the Guidelines
Treatment for generalized anxiety disorder (GAD) in a patient with Parkinson's disease should prioritize selective serotonin reuptake inhibitors (SSRIs) such as sertraline, due to their efficacy in reducing anxiety with minimal impact on Parkinson's symptoms, as supported by recent studies 1. When managing GAD in patients with Parkinson's, it is crucial to consider the potential interactions between antidepressants and dopaminergic therapy.
- First-line pharmacological treatment typically includes SSRIs, with sertraline being a preferred option due to its lower risk of QTc prolongation compared to other SSRIs like citalopram or escitalopram 1.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine or duloxetine are also effective options for treating GAD in patients with Parkinson's disease.
- Benzodiazepines, such as lorazepam, can provide short-term relief during acute anxiety episodes but should be used cautiously due to the risk of falls and potential cognitive effects.
- Non-pharmacological approaches, including cognitive behavioral therapy (CBT), mindfulness practices, and regular physical activity tailored to the patient's mobility level, are equally important for managing GAD in patients with Parkinson's disease. Treatment should be initiated at lower doses than typically used in non-Parkinson's patients and titrated slowly while monitoring for worsening of motor symptoms, orthostatic hypotension, or cognitive changes 2. The choice of an anxiolytic should be informed by the adverse effect profiles of the medications, tolerability of treatment, including the potential for interaction with other current medications, response to prior treatment, and patient preference 2. It is recommended to use a stepped care model to tailor intervention recommendations based on variables such as current symptomatology level, level of functional impairment, presence of risk factors, chronicity of GAD, and response to previous treatments 2. Psychological and psychosocial interventions should be derived from relevant treatment manuals of empirically supported treatments, and the use of outcome measures should be routine to gauge the efficacy of treatment, monitor treatment adherence, and evaluate practitioner competence 2.
From the Research
Treatment Options for Generalized Anxiety Disorder in Patients with Parkinson's
- Pharmacological treatments: + Bromazepam has been found to be effective for anxiety in Parkinson's disease, but its usage is limited due to potential risks of confusion and falls 3 + Selective serotonin reuptake inhibitors (SSRIs) may be effective for anxiety in Parkinson's disease, although there are no controlled studies to support this 3, 4 + Paroxetine and sertraline have been compared in a study for the treatment of generalized anxiety disorder, and both were found to be effective and well-tolerated 5
- Non-pharmacological treatments: + Cognitive and behavioral therapies have demonstrated efficacy and warrant consideration for the treatment of anxiety in Parkinson's disease 3, 6 + Cognitive-behavioral therapy (CBT) has shown promise for treating anxiety in Parkinson's disease, with preliminary evidence suggesting its feasibility and effectiveness 6
Challenges and Gaps in Current Treatment
- There is a significant paucity of treatment data for anxiety in Parkinson's disease, with few controlled studies to guide treatment decisions 3, 4, 7
- Anxiety in Parkinson's disease is often undertreated, with many patients not receiving adequate treatment 4
- More research is needed to establish novel targeted treatment protocols for the management of anxiety disorders in Parkinson's disease 4, 7