“It is hard for me to stay positive when you are down and not willing to do something about it.”

This statement was another that arose when I asked Parkinsons Partners to tell me what they wished their loved ones knew. It was endorsed by nearly everyone in the room the night I asked. It was also a topic for frank discussion during the recent Living Well With Parkinson Disease retreat sponsored by the Parkinson Foundation of Western Pennsylvania. Many Partners do find it hard to reach into their own emotional reserves when the person with Parkinsons is struggling with debilitating depression. For many families, this depression leads to depression for the Partner.

Depression has been called the “common cold” of mental health because it is so prevalent in the general population. It is the state that arises when a person is overwhelmed by unremitting stress. It is sometimes expressed as sadness but also commonly appears as difficulty experiencing pleasure (“anhedonia”). A person with depression may ruminate over their problems, withdraw from family, and increasingly feel indifference about living. Moreover, there are physical manifestations such as decreased (or increased appetite), poor sleep, low energy and fatigue that have a direct impact on the quality of life. Although we have made great strides in improving public awareness of depression, for some, there is still a stigma associated with the condition. Many people continue to regard it as a personal failure or weakness rather than a stress-related illness.

It should come as no surprise that so many individuals with Parkinson Disease experience depression. PD dramatically changes the life course of anyone who develops it. Managing a body that is increasingly appears to have a mind of its own is a challenge of the first order. Depression is an understandable reaction to the struggle to accommodate the disease and adjust to the inevitable change in life plans and dreams.

As any Partner can attest, it is almost as hard to watch a person struggle with depression as it is the PD. A depressed individual can be depressing to live with. The Partner can find her or himself struggling to keep positive in the face of a mood disorder that is sapping their loved one’s life energy. If the depression is severe enough, it is easy for the Partner to feel that the person with Parkinsons is unwilling to do anything about it. Certainly it is easy to lose sight of a common paradox- the depression interferes with an individual’s ability to cope with the depression.

Depression feeds back upon itself. It is quite common for an individual with Parkinsons to feel guilty about the demands the disease places on the Partner. This can ratchet up the depressive feelings, leading to a sense of hopelessness that anything can ever be done to change the current circumstances. Watching a loved one become floored by low mood becomes a difficult thing for a Partner to watch. The natural inclination is to coax, nag, berate, and even battle over our loved one’s mood and apparent reluctance to do anything to deal directly with the problem This leads to more guilt and even recrimination. For all involved, there is an increasingly powerful feedback loop that causes each to feel that life is spiraling out of control and that nothing can be done.

The situation need not be hopeless. A consultation with a mental health provider may just be the answer. And it does not need to start with the person who has PD.

For any Partner who is watching both PD and depression attack the quality of life of someone they love, the key is to take care of oneself. It is important to find out if you are also depressed and to learn what you can do to treat the condition. Even if you are not depressed, it is critical that you do not allow your loved one’s condition to sap the quality of your life. You may be responding to both the PD and depression in ways that inadvertently make the situation worse. Identifying unhelpful thoughts, behaviors and interpretations of the present circumstances can go a long way toward making beneficial changes in the relationship. The ideal situation is for everyone in the relationship to get the help they need. My clinical experience is that when even one person makes a change, both partners benefit.

Partners, if you are watching your loved one buckling under depression about their PD, the best way to stay positive is to share your load with someone trained to help you carry it.

Stating this blog’s introduction another way:
“It is easier for me to stay positive when you are down and and I am willing to do something for me.”

Warmest regards,

Paul Short, Ph.D.

This entry was posted on Monday, July 6th, 2009 at 10:14 am and is filed under Parkinson's Partners Blog. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.