Antidepressants have many uses beyond what their labels may say that they do. Some of the beneficial side effects are well documented and everyone knows about them. But sometimes medications, and not just antidepressants, are prescribed by doctors for off-label usage that is not approved by the FDA. And sometimes, researchers in the course of conducting their studies stumble upon these beneficial side effects. One such beneficial side effect has been discovered in the anti-depressant usage of Parkinson's patients.
What is Parkinson's?
Parkinson’s disease is a neuromuscular degenerative disorder that affects motor abilities. The average age of a Parkinson’s diagnosis is somewhere around the age of sixty, though at times those that are younger will also be diagnosed with the disease. Cases such as those are known as Early Onset Parkinson’s Disease.
Most people don't realize how much they use their muscles. Everything that is done requires use of the muscles, from speaking to simply sitting and stretching your legs. There are three types of muscles: smooth, cardiac and skeletal.
Skeletal muscle is the type of muscle that can be felt, think biceps and seen if someone flexes that bicep. When we exercise to build muscle, this is the type of muscle that we build. They’re called skeletal muscles because they attach all over the skeleton. Skeletal muscles are paired for use, one muscle will move bone in one direction, while its pair will move the bone in the opposite direction. Unlike cardiac muscle which is shares contraction force, skeletal muscle can and will contract voluntarily, specifically the millions of tiny striated muscles in the body that are known as sarcomeres. Skeletal musculature is the type that is involved with the degenerative aspects of Parkinson's.
Patients with an undiagnosed condition may start to notice things such as slight tremors or trouble grasping and holding on to objects, they may have tremors in the chin or lips along with uncontrollable twitching in the limbs mainly the legs. Smaller handwriting that crowds a page is usually a sign of Parkinson’s as well, along with a loss of smell, and increased mobility issues. There may be freezing also of the facial muscles and the arms and legs, as well as a decrease in the blink rate.
By far the most common indicators for Parkinson’s are a resting tremor, bradykinesia and rigidity of musculature which will begin on one side of the body a gradually migrate to the other side, eventually encompassing both regions of the body.
Because the disease progresses quite slowly, it’s easy to catalog the advancement of symptoms with the aim of predicting how close you may be to the day that a fall occurs. Working closely with a physical therapist can help with many of the unanticipated results or reasons for a fall.
The Emotional Component of Parkinson's
Aside from the motor components of Parkinson’s, there are numerous other non-motor symptoms that patients can and will experience over the course of their disease. Many include oral and sometimes skin care issues, but by far one of the most serious that can contribute greatly to a hastening of disease symptoms is depression.
Particularly if the patient was active before the onset of life altering disease complications, depressive symptoms can manifest faster. The lack of ability to move as they used to or speak as well in order to express themselves will take a toll on the previously articulate. Facial rigidity that cause drooling while being unable to feel it can also be a source of embarrassment for many. Patients may begin to isolate themselves and withdraw from social situations, and research has shown that patients that tend to self-isolate and suffer from depression experience a quickening of their symptoms.
Many Parkinson’s patients do and should seek help for their depressive symptoms and what researchers are now seeing in relation to certain prescribed medications, is a delay in the most severe of motor symptoms. The most commonly prescribed therapy for treating depression in Parkinson’s patients is Levodopa. Levodopa is naturally occurring chemical within the body and is a precursor of dopamine. The synthetic form of Levodopa is transported to the brain, where it is then converted into dopamine by the body thus raising the dopamine levels of the body which theoretically slows the progression of the disease much more than without this therapy.
Researchers found that when patients took a certain class of antidepressants known as tricyclics which are a class of antidepressants that bind to receptor sites differently. This discovery is significant because the disease often lowers the level of dopamine available for use by the body. By studying the brains of mice, they found that patients that were on tricyclics for depression early within the early stages of the disease, had a longer period of time before they needed to begin Levodopa therapy.
Their findings also suggested that the buildup of alpha-synuclein protein to be significantly less in the same mice. Although this protein is found abundantly in the neurons of the human body, but researchers have yet to find in what way it is beneficial the body. However, the protein is a significant pathological hallmark of Parkinson’s disease and can be found in clumps in the brain being the primary components of Lewy Body, which are abnormal deposits of proteins. These abnormal deposits, particularly in the brain affect the chemical production and distribution of these chemicals that can cause changes in mood and behaviors as well as causing mobility issues. The belief is that a better understanding of the hows and whys of alpha-synuclein clumping will lead to better and more effective treatments and even a cure for Parkinson’s.
At all costs, the non motor symptoms of the disease should be addressed and taken care of, particularly depression. It’s unknown if starting a regimen of antidepressants without experiencing depression symptoms are a process that will be advocated for in the hopes of halting the progression of the disease even further. But because of the slow progression and the fact that the disease presents much later in life, most patients manage to live a full life with Parkinson’s.
Yes, things will change and new routines and accommodations will have to be made for this new chapter in life, but there is no reason why a Parkinson’s diagnosis should stop one from living their lives to the fullest.