Mental disturbances with Parkinson’s disease: depression, hallucinations and compulsive behaviour

This section discusses depression, changes in memory and intellect, hallucinations and compulsive tendencies. These are not by any means conditions which occur only in people with Parkinson’s disease but they are of interest here because they appear to be intimately tied up with the use of dopamine and dopamine agonist drugs used in Parkinson’s disease and their treatment.

A very difficult symptom to unravel in this respect is depression. Some people feel sure that their depression was caused by Parkinson’s disease and that the drugs used to treat the Parkinson’s symptoms also helped to remove their depression. Philip was certainly surprised and pleased to find that the severe depression he had attributed to the problems he was having with a painful hip joint disappeared once he started on anti-Parkinson’s medication so that he no longer needed to take an antidepressant. Elisabeth compared her depression to an iron cloak and described how it was affected by her medication: ‘I tried to get rid of it by taking increased amounts of medication and when it worked it was as if the iron cloak just slid off my shoulders’.

Humphrey’s psychotherapist suspected that the depression he had could be related to his other…

Age at interview 57

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Age at diagnosis 54

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Karen accepts that depression goes with the disease but feels that the only way to come to terms…

Age at interview 45

Gender Female

Age at diagnosis 39

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Others were less convinced and attributed their depression to other things in their lives (see Early symptoms of Parkinson’s disease) but the most common feeling was that it is depressing to have Parkinson’s disease and that is why they were depressed. Rex said that he sometimes felt sorry for himself but that his wife was very good at encouraging him to snap out of it. Ruth felt desperately unhappy when she was first diagnosed, thinking that the disease would progress rapidly. In time she realised that it was not doing so and she also met other people with Parkinson’s who helped her to realise that life could go on.

Ruths depression, panic attacks and paranoia were a reaction to being diagnosed with Parkinsons…

Age at interview 56

Gender Female

Age at diagnosis 47

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Peter describes learning to handle the times when he is feeling down.

Age at interview 72

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Age at diagnosis 67

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People with Parkinson’s disease sometimes worry that there may be a connection between the kind of destructive process that causes it and the changes occurring in Alzheimer’s disease. Several people described having difficulty finding words, though some of them felt it probably had as much to do with their age as with their Parkinson’s. A few mentioned testing themselves by doing crosswords.

Having done some research on the internet Brian feels confident the changes he notices are to do…

Age at interview 77

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Age at diagnosis 63

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Fred emphasises that his thought processes are ok, it just takes a long time to express them.

Age at interview 70

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Age at diagnosis 65

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David says his problem finding the right word is not due to his memory failing.

Age at interview 54

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Age at diagnosis 48

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Another curious symptom which again seems to be both part of the illness and to be connected with the medication used are hallucinations. On the whole these seem not to be of particularly disturbing visions. In some cases the person having them was not altogether sure whether they had really happened. Helen thought she had seen a large rat while she was in bed but something about it convinced her later that it hadn’t actually been a real rat. Philip sometimes felt there was someone standing behind him while he was working at his computer.

Andrew has had many hallucinations in which he sees his late wife.

Age at interview 74

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Age at diagnosis 55

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Jeans hallucinations were very clearly related to her medication as she discovered after she was…

Age at interview 72

Gender Female

Age at diagnosis 64

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Side effects of medicines for dementia and compulsive behaviour

Compulsive behaviour amongst people with Parkinson’s disease is linked to medication use. The problem can arise with both dopamine and with dopamine agonist drugs (see Dopamine receptor agonists). Such effects are now listed in the information issued with the medication but this is relatively recent. In some cases the risk had been explained to people prescribed the drug, but by their very nature these disorders involve secretive behaviour so that people tended to deny the problem when questioned by their doctor.

Joe experienced a kind of compulsive behaviour which seemed to him excellent till he was warned…

Age at interview 64

Gender Male

Age at diagnosis 43

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Elaines partner has commented that she is shopping a lot.

Age at interview 44

Gender Female

Age at diagnosis 43

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Helen’s compulsive shopping turned into secret online gambling with disastrous consequences.

Age at interview 39

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Age at diagnosis 33

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Ginas doctor asked if she had noticed anything unusual like gambling but she denied it. By the…

Age at interview 49

Gender Female

Age at diagnosis 42

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Davids first dopamine agonist caused hypersexuality. When he was changed to another type he…

Age at interview 54

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Age at diagnosis 48

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Richard admitted that he had become uncharacteristically promiscuous since taking a dopamine…

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A striking feature for all these people caught up in compulsive behaviour was that it disappeared when they were taken off the offending medication or the dose was greatly reduced. An intriguing aspect of this is their experience that while on the drug, and behaving in a way that they would never have done otherwise, they were turned into someone who they cannot recognise in themselves. As Helen said, ‘I don’t even think about it now, it’s unbelievable how you can be so obsessed with something and then it just stops. And how can a drug do so much to change somebody and if I hadn’t owned up to it, you know, I’d have got into terrible, terrible trouble and I would have just become more of this person that wasn’t me really.

David fears that a drug could so manipulate his identity that he is willing to forego certain…

Age at interview 54

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Age at diagnosis 48

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In spite of this David gives a word of advice to people reading this.

‘The agonists are very good at controlling symptoms but do have many more side effects in my opinion than levodopa based drugs do. The ones I’ve described are extreme and really quite rare. I wouldn’t want anybody to worry about that too much. Be aware of it but, you know, don’t be concerned because it’s quite rare. I mean I through my website I know thousands and thousands of people in the UK with Parkinson’s and it’s only about two or three people who’ve suffered the same way I have. So it is really quite rare.’

Owning up to the compulsive behaviour was the most difficult thing for them to do but as they all agree the best thing they ever did.

Helen couldnt at first own up to her secret gambling; it was a huge relief when eventually she did.

Age at interview 39

Gender Female

Age at diagnosis 33

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Redefining yourself

'You don't want the Parkinson's to define who you are' (Sharon) They may feel sure that in themselves they have not changed, but physical features...