Patients are routinely screened for stress and depression at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders because of the Center’s own ground-breaking research, which provided the first tangible demonstration that life stress accelerates the progression of Parkinson’s disease.
The research, performed in the Gardner Center’s Selma Schottenstein Harris Lab for Research in Parkinson’s, was led by Kim Seroogy, PhD, Lab Director and Professor of Neurology and Rehabilitation Medicine, and James Herman, PhD, Professor of Psychiatry and Behavioral Neuroscience. It was published online last September in the journal Molecular Psychiatry.
“You might assume that it’s obvious that adverse life stress worsens Parkinson’s,” Dr. Seroogy says. “But it had never been explored experimentally.
“It’s not just that the stress is causing someone to feel more emotional, uncomfortable or sad. Stress or depression superimposed on Parkinson’s actually impacts the disease process by worsening the health of brain cells. Parkinson’s involves the death of dopamine-producing cells inside the brain, and stress makes dopamine cells die faster and causes more of them to die. That’s the take-home message.”
It is a message that is starting to resonate with physicians.
“Until recently, many Parkinson’s doctors didn’t treat for depression when patients came in,” Dr. Seroogy says. “It wasn’t entirely their fault, because many symptoms of depression – such as slowness of movement and loss of facial expressions –– are masked by the symptoms of Parkinson’s. People chalked it up to a symptom of Parkinson’s, when actually it was a symptom of depression.”
“Untreated depression may be making the Parkinson’s symptoms appear worse than they truly are,” says Alberto Espay, MD, a movement disorders specialist and Clinical Research Director at the Gardner Center. “Our profession is not doing as good a job as it could be in vigorously screening for and treating depression in Parkinson’s. At the same time, every line of evidence suggests that this is a ‘low hanging fruit’ in terms of providing an opportunity to improve overall function and enhance quality of life.”
In editorial commentary published in CNS Neuroscience & Therapeutics, researchers from China acknowledged the Gardner Center research and concluded that “targeting stress-related disorders and preventing stress-enhanced PD [Parkinson’s disease] exacerbation will be important in clinical management of PD patients at all stages.”
“Depression can be as disabling as the more commonly recognized motor symptoms of Parkinson’s disease,” adds Fredy J. Revilla, MD, Medical Director of the UC Gardner Center. “Research in this area is needed in order to improve the quality of life of our patients.”
In addition to yielding valuable information, the research by Drs. Seroogy and Herman illustrates the value of small pilot projects.
The research team began with a $14,000 pilot grant funded by the Sunflower Revolution Encore, a private fund-raiser hosted by Melody Sawyer Richardson in 2005. The team was further supported by a $50,000 grant from the Davis Phinney Foundation and $20,000 from the Parkinson’s Disease Support Network of Ohio, Kentucky and Indiana.
Data acquired from these early rounds of small studies was ultimately used to secure a $1.7 million grant from the National Institutes of Health, enabling the team to conduct an in-depth study that produced meaningful results.
Drs. Seroogy and Herman and their team members performed their research with rodents that 1) were given a lesion that modeled Parkinson’s disease and 2) were exposed to random stressors that resulted in their displaying the characteristics of stress-induced depression. The scientists discovered that the lesioned rodents that were exposed to stressors suffered significantly more loss of dopamine cells than the lesioned rodents that were not exposed to stressors. They also showed that chronic stress alone did not cause a loss of dopamine cells.
Dr. Seroogy cautions that treating depression with anti-depressants will not cure Parkinson’s, which is a progressive disease. However, treatment with proper anti-depressant medication does have the potential to prevent acceleration of the course of Parkinson’s disease.
— Cindy Starr