Robin Williams' Death
STORYLINEFull coverage of the life and death of actor Robin Williams, who died from apparent suicide on August 11, 2014 at the age of 63.
Dan Steinberg / Invision/AP
'Perfect Storm': Parkinson's Disease May Worsen Depression
A
push from Parkinson’s disease could have put Robin Williams at risk of a
“perfect storm” of depression, medical experts said Thursday.
Williams’ wife said the comedian was battling the early stages of Parkinson’s
along with the mood disorder when he took his own life, and health
experts say the two are closely linked. Parkinson’s, it turns out, can
produce depression even in those who have never suffered from it before.
“I think it makes
absolute sense that if you have a pre-existing depression and you get a
disorder that by itself has a tendency to cause depression and you also
just learned you have the disorder, it creates the perfect storm,” said
Dr. Jeff Bronstein, a professor of neurology and director of the
movement disorder program at the University of California, Los Angeles.
The news caught many off guard, including Michael J. Fox, who has been living with Parkinson’s disease for decades.
A diagnosis with the disease can be traumatic.
That’s partly because
many people have preconceived ideas about Parkinson’s that are “far more
grim and dire than reality,” Bronstein said. “The majority of people
with Parkinson’s are walking around without telling anyone. You only see
the small fraction who are not doing well. And people identify them
with the disease.”
While people can develop
Parkinson’s disease as early as their 20s, the majority are diagnosed
in their early 60s, Bronstein said. “And then they live essentially a
normal lifespan,” he added. “In the early stages, the majority live well
and without significant disability.”
Although the disease is
best known for its deleterious effects on the nerve cells that produce
dopamine, a neurotransmitter that facilitates movement, Parkinson’s also
affects a host of other chemical messengers, including serotonin and
norepinephrine, which may explain why patients are more likely to
develop depression.
The good news is that
Parkinson’s-related depression responds well to currently available
antidepressants that pump up the amount of serotonin and norepinephrine
circulating in the brain, said Dr. Irene Richard, a professor of
neurology and psychiatry at the University of Rochester Medical Center
and a science adviser to the Michael J. Fox Foundation for Parkinson’s
Research.
The bad news: Often
doctors and even patients themselves do not recognize the depression.
It’s just too easy to say that the patient is down because of the
diagnosis, Richard said. Further, Parkinson’s and depression have
overlapping symptoms, such as a blank facial expression and a monotone
voice, she explained.
When it comes to
suicide, there isn’t any data suggesting that Parkinson’s patients are
at higher risk than others, experts said. However, Williams did fall
into a group with one of the highest suicide rates in the world:
Suicides among white, upper-middle-aged men has jumped by more than 50 percent in the last decade, according to the Centers for Disease Control and Prevention.
“It’s not uncommon for Parkinson’s patients to have death and suicide ideation. But the traditional view is that suicide is less common among them than in the general population, possibly because of personality changes that make patients adverse to taking risks.”
One
thing researchers do know is that people with a history of depression
are likely to develop Parkinson’s-related depression before they start
having motor symptoms, said Dr. Daniel Weintraub, an associate professor
of psychiatry at the University of Pennsylvania School of Medicine.
However, it’s usually a motor symptom, such as unexplained tremor, that
brings patients in to the doctor’s office, he said.
Studies have shown “that
it’s not uncommon for Parkinson’s patients to have death and suicide
ideation,” said Weintraub. “But the traditional view is that suicide is
less common among them than in the general population, possibly because
of personality changes that make patients averse to taking risks,” he
said.
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