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.
First published August 14 2014, 6:09 PM