A conversation about Robin Williams, Parkinson’s, and depression

Like anyone with a funny bone, my heart is heavy at the loss of Robin Williams. I had the privilege of twice seeing him perform live, including a surprise set at the Comedy Cellar in New York. His comedy–pulled from his own, often difficult, life experiences–took his audiences to great heights and sometimes even greater depths. All while evoking laughter, giving his fans both a jolt and a gentle stroke of the soul.

Question: How prevalent is depression among Parkinson's patients?

Answer: Estimates are that 20-40% of Parkinson's patients suffer from some form of depression at any time, and 10-15% of newly diagnosed, untreated Parkinson's patients experience depression, a rate significantly higher than the general population.

We know very little of Robin Williams' specific case, but can you offer insight into how depression affects patients with Parkinson's?

The two simple ways to understand depression, in this case in early Parkinson's disease, are psychologically and biologically. Psychologically, getting a diagnosis of a chronic, progressive neurodegenerative disease is a life-altering event that can overwhelm people. Biologically, the same brain chemicals and regions that lead to motor symptoms in Parkinson's also play an important role in mood regulation.

Could depression be an early sign of Parkinson's?

Yes. Recent research has found that patients with a history of midlife depression are more likely to have a future diagnosis of Parkinson's disease, suggesting that the brain regions and chemicals responsible for mood regulation may be affected before those responsible for motor function. In general, it is becoming clearer that a subset of Parkinson's patients have significant depression or anxiety symptoms at the time of diagnosis.

Are people with severe depression at higher risk of developing Parkinson's?

A diagnosis of depression or antidepressant use is associated with an increased likelihood of future Parkinson's disease. We don't know that depression is an actual risk factor for Parkinson's; it's more likely that it, along with other non-motor symptoms, may be the initial clinical manifestation of Parkinson's disease in some patients.

What can medicine now do to help treat Parkinson's patients who are suffering from severe depression?

For patients with clinically significant depression, there is evidence from clinical trials done recently that a range of antidepressant classes  appear to work in Parkinson's patients with depression, including serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants. In addition, some of the treatments for Parkinson's disease, such as dopamine agonists, monoamine oxidase inhibitors, and deep brain stimulation, may improve mood. Finally, for severe depression in Parkinson's disease, electroconvulsive therapy can be an effective treatment.

What kind of support and services do Parkinson's patients, beyond medication, need to deal with this aspect of their illness?

There have been recent clinical trials showing that psychotherapy, specifically cognitive behavioral therapy, is effective for depression in Parkinson's disease. In addition, educational programs about the nature and course of the illness at the time of diagnosis and support groups thoughout the course of the illness can be helpful in providing education and support to patients.  It's an illness that affects not only the patient but the entire family, so including loved ones and caregivers in any interventions can be helpful.  It's important that patients realize that there is significant research ongoing to improve our understanding and treatment of Parkinson's disease, and patients newly diagnosed with the disease can expect to benefit not only from current treatments but from advances that will be made in coming years.

You don't need to have Parkinson's yourself to get involved and do some good. Take a tip from Robin Williams. As his wife said in her statement:

Robin spent so much of his life helping others. Whether he was entertaining millions on stage, film or television, our troops on the front lines, or comforting a sick child — Robin wanted us to laugh and to feel less afraid.

Since his passing, all of us who loved Robin have found some solace in the tremendous outpouring of affection and admiration for him from the millions of people whose lives he touched. His greatest legacy, besides his three children, is the joy and happiness he offered to others, particularly to those fighting personal battles.

Robin's sobriety was intact and he was brave as he struggled with his own battles of depression, anxiety as well as early stages of Parkinson's disease, which he was not yet ready to share publicly.

It is our hope in the wake of Robin's tragic passing that others will find the strength to seek the care and support they need to treat whatever battles they are facing so they may feel less afraid."

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