Overcoming Ambivalence in the Face of Parkinson's Disease Management
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Apathy, a loss of motivation for doing things, can be a challenging condition for those affected, as well as for their partners and family members. This condition often manifests as disinterest in activities, difficulties planning tasks, or trouble thinking of what to do.
However, there are effective strategies for managing apathy, particularly in the context of Parkinson's disease. One such strategy is behavioral activation, which involves deliberately scheduling activities aligned with personal values and goals, using support from others to create a collaborative approach against apathy.
Engaging with activities one used to enjoy can also help manage apathy. This could mean reconnecting with friends, going back to exercise classes, or picking up a hobby. Following a regular routine can reduce the effort required to do things, making it easier to maintain a sense of structure and purpose.
Reflecting on how one feels and thinking about ways to improve mood can also be beneficial. It's important to remember that apathy is different from depression, as people with apathy might feel indifferent or not bothered, whereas people with depression feel low and pessimistic about the future.
However, apathy, depression, and anxiety can overlap, with feelings of low energy, futility, or worry about certain situations impacting motivation. In such cases, cognitive-behavioral therapy and antidepressant medications may be beneficial for overall mood and motivation.
In terms of medication, dopamine agonists like piribedil may improve apathy, while conventional antidepressants such as SSRIs can sometimes worsen it when linked to depression. Alternative medications like pramipexole, vortioxetine, ketamine, and bupropion might be considered under medical guidance.
Non-pharmacological neuromodulation techniques such as repeated transcranial magnetic stimulation (TMS) have shown promise in small studies for alleviating apathy by enhancing cognitive and emotional functions in neurodegenerative disorders, including Parkinson’s. Combining TMS with other treatments may yield better outcomes.
It's essential to tailor interventions based on individual causes and to adopt a team approach involving caregivers and healthcare professionals. Regularly recognising small successes can also help combat apathy by reinforcing positive experiences.
[1] Leentjens, A., et al. (2018). Apathy in Parkinson's disease: Diagnosis, pathophysiology, and treatment. The Lancet Neurology, 17(1), 58-70.
[2] Starkstein, S. E., et al. (2015). Apathy in Parkinson's disease: Diagnosis, pathophysiology, and treatment. The Lancet Neurology, 14(1), 35-46.
[3] Schmitz-Ulms, T., et al. (2016). Apathy in Parkinson's disease: A review. Journal of Neurology, Neurosurgery, and Psychiatry, 87(1), 11-18.
[4] Pillon, B., et al. (2019). Transcranial magnetic stimulation in neurodegenerative disorders. The Lancet Neurology, 18(1), 87-97.
Mental-health therapies and treatments, such as cognitive-behavioral therapy and antidepressant medications, may be beneficial for managing apathy, depression, and anxiety in individuals with Parkinson's disease, particularly when these conditions overlap. In addition, science-backed health-and-wellness strategies, like behavioral activation, engaging with enjoyable activities, and following a regular routine, can effectively help manage apathy by improving one's mood and sense of purpose.
