Anxiety

[paperchasing]

Severe anxiety tremors. Levodopa not had any effect so stopped after 2-3 months. What is best for the anxiety?

[docjleonard55]

I take Klonopin. Only when needed, like when my tremor gets really strong. It helps.

[Boscoejean]

"The neurochemical changes in PD involving dopamine, norepinephrine, and serotonin might be related to the pathophysiology of depression and anxiety, but this is still not clear."

Neurobiology of depression and anxiety in Parkinson's disease

ncbi.nlm.nih.gov/pmc/articl...

Anxiety and PD could share some underlying biological mechanisms that lead to them occurring at any stage of disease including pre-motor phase. Abnormalities in dopaminergic transmission are associated with anxiety. Striatal dopamine receptor binding was found to be reduced in both nonhuman primate models of anxiety and humans with anxiety disorders. Humans with anxiety disorders also appear to have reduced levels of dopamine uptake in the striatum and reduced level of homovanillic acid in cerebrospinal fluid. Other neurotransmitter systems, including those of nonepinephrine, serotonin, acetylcholine, and γ-aminobutyric acid, may also play a role in anxiety as suggested by the results of animal experiments and pharmacological studies in humans [36, 37]. These neurotransmitter systems interact with dopaminergic system and might be affected in PD patients.

[MarionP in reply to Boscoejean]

Benzodiazepines do help with expanding GABA that's their whole mechanism and appeal. I have noticed that allprazolam tends to relax skeletal muscles a little bit. I use a small dose of clonazepam for sleep but obviously it's a pretty good anxiolytic.

I wonder whether muscle relaxants in small doses might help, I'm talking about the anti-spasmodic muscle relaxants. Haven't seen it talked about very much here and I've not had occasion with my own care to bring it up. Just a thought. Or maybe small doses of both classes. ???

[pdpatient]

I take 10 mg Propranolol. It works in 15 minutes.

[MarionP in reply to pdpatient]

What is the effect specifically? What does it "do"?

[pdpatient in reply to MarionP]

It's very helpful for calming down my localized or whole body tremors that are triggered by dyskinesia or anxiety. It's prescribed off label for both anxiety and dyskinesia. It's originally a blood pressure treatment medicine so I wouldn't take it without having a BP monitor by your side. Low blood pressure is therefore the only major side effect to be careful about because of the dangers of falls.

Hope this helps.

[gomelgo in reply to pdpatient]

So if I have lowish BP I should not try this at home?

[pdpatient in reply to gomelgo]

Yes. You should not. My blood pressure drops down to around 90/65 towards the evening. So I have to be very careful with the medicine. Which is why I take my BP before and after every dose.

At least for me it's worth it to calm down my tremors. Otherwise, it drives me crazy.

[Daisies22 in reply to pdpatient]

Hello,My understanding was that dyskinesia is caused by too much levodopa, as opposed to the PD itself. If this is indeed the case wouldn't adjusting the dose of levodopa reduce your whole-body tremor which you say is triggered by the dyskinesia? This way you will not need to take Propranolol.

I've been on a small dose (10 mg) of Propranolol for about three years but it doesn't help me with my whole-body shaking or my anxiety. I'm not surprised about the anxiety issue as my other anti-Parkinson's medication has as a side effect anxiety!

Did your Neurologist explain to you where the whole-body tremor originates from? I am desperate to at least understand where my shaking comes from.

Thanks in advance for any comments you might have.

D.

[pdpatient in reply to Daisies22]

    Daisies22 , I am at the point where my MDS has given up and can only offer DBS as the solution. Unfortunately I don't want to go that route unless it is the final resort. As long as the drugs work, and as long as I can find antidotes, I figure what is the harm. DBS is being offered as a panacea for all of my troubles and I don't know if I can believe that.

But, you are right on the questions you have asked. Reducing the dosage of Levodopa is the recommended approach but it puts me in an undermedicated situation. Propranolol works like magic and yeah, my wife is reluctant to give it to me because of the low BP issue. I don't want to suffer if I don't have to. I don't know what else to do. As far as I know, what works, works. I can't please everyone.

I have been doing a lot of research and I think that the variability of Parkinson's is greater among YOPD patients. So, our responses will likely be different. The only other medication that works for dyskinesia is Amantadine. Unfortunately, it doesn't do anything for me. I don't know if you have been offered that. Also, 10mg Propranolol is only the lowest dose. I believe that many patients actually need more. Have you discussed the possibility of dosage adjustments with your doctor?

BTW, whole body tremors is dyskinesia in PD. My MDS doesn't like to hear me call it shaking because that conjures up a whole different scenario. Terminology matters😢😂

[Daisies22 in reply to pdpatient]

Thank you, and apologies for my late response.My low blood pressure (usually around 90 over 60) is the reason for the low dose of Propranolol I am on. If I don't take it I get tachycardia courtesy of the Levodopa (around 900 mg per day which I'm trying and failing to reduce). It is such a vicious circle and my Neurologist isn't the most helpful physician I've met.

Re the whole body tremors - all I'm interested in is what triggers them so I could manage them. Unfortunately, I'm not getting a streight answer from Neurology either. Regardless of how many emails I send them the answer is the standard "it's your PD" and "we are not Gods"...

I hope I'm just having a really bad luck with my Neurologist, and other patients have a more positive experience.

Thank you again for writing.

D.

[LAJ12345]

A tiny dose of clonazapam works for my husband

[pdpatient in reply to LAJ12345]

Hi  LAJ12345 I wanted to ask you about the cognitive effect of Clonazepam. I am facing resistance from my psychiatrist regarding the same as she keeps pointing out the deleterious effects on cognition. Has your husband's doctor warned about the same? Or have you observed any?

[LAJ12345 in reply to pdpatient]

Hi, I think as with any drugs there can be side effects if doses are too great. I only give him 1/4 morning and afternoon, and 1/2 at night. He plays bridge to masters level and says his brain is still as good as ever at bridge, it’s just his shaky hand that are an issue (clonazapam helps that a bit).

This amount has been enough to level him out and he doesn’t notice any dulling of his thoughts etc.

On the other hand levodopa at too high doses sends him completely off the wall at nights to the point he doesn’t know where he is or what he is supposed to be doing! And they keep pushing him to take more of it!

I think benzodiazepines have had a bad name as they are addictive. But so are other meds like antidepressants and sleeping pills and levodopa. Also there is a black market for them.

Ask to try it at 0.5mg per day, cut it into quarters, start with 1 x 1/4 at night for a few days. Add another 1/4 in the morning a week later. If you get some improvement stay at that level for a while and see how it feels. It takes maybe a few weeks to level out in your blood. It has a very long 1/2 life so all the tails of previous doses build up eventually to a steady state. That’s why you need to wait a while if you increase it as it will take a while to get to its full effect. The brain issues might arise if you over shoot your ideal dose.

You do get an initial sensation soon after taking it which I think is the addictive part of it, but I think it is the constant low level in your blood that helps long term anxiety.

[pdpatient in reply to LAJ12345]

Thank you so much for your suggestions and insights.

[Deforel_Ch]

You can try Selegiline + phenylalanine (pubmed.ncbi.nlm.nih.gov/642... and/or Lithium Orotate (you can start with 5mg and increase after one week until 45mg if needed), see those words on the "Search HealthUnlocked" field.

[MarionP in reply to Deforel_Ch]

45mg seems like a lot of lithium. Can you explain/elaborate further please? How did you come to the conclusion about that kind of daily range, and for what specific problems are we talking about? Or is that an episode dose range and you might even dose more than once per day, I don't think you specified a lot on what is either episodic or daily consumption, how many episodes per day, or doses per day, and for how many days, occasional, episodic, chronic, what? I'm a little confused. Do you have any guidelines there, and what are they based on?

[Deforel_Ch in reply to MarionP]

Like I said, start with 5 mg per day, wait and see. If your anxiety doesn't improve after a week or two, add 5 mg, and so on. Usually 20 mg per day is enough for most people, but some need more. I did some research online and on healthunlocked.com as well. 45 mg of Lithium Orotate is not a lot as you might think. The dosages of other forms of lithium such as citrate or carbonate that must be monitored are much higher.

[Eryl]

Rhe best for anxiety which will also relieve you Parkinson's is a ketogenic diet.

[Lizzy9]

Hello ~ My HwP has been on the probiotic PS128 Bened Life Neuralli for about 3 months. His anxiety and tremor are greatly reduced. He has better eye contact and is better in conversation. These are things that I’ve seen change so I attribute these improvements to the Neuralli.

He also takes Lithium Orotate. We don’t know if it helps or not. He also takes GABA which does seem to help with his anxiety and tremor.

I hope this helps.

Have a fabulous day!

[gomelgo in reply to Lizzy9]

Looked up the probiotic, thank you. But it's over a $100 per bottle! ouch ...

[Lizzy9 in reply to gomelgo]

Unfortunately you are correct ~ “ouch”.

To me it’s worth it because we are seeing reduced symptoms. We’ve tried soooo many other things that did not help at all.

Good luck and God bless you!

[KiwiLB]

Troscriptions - methylene blue

Has several benefits

[paperchasing]

Thanks for all the helpful comments. I am trying Pregabalin at the moment that has reduced my anxiety and tremors considerably but feel a bit spaced out at present

[st8farm]

Sorry for the lateness of this response. Sometimes the simplest answer is the best answer.

My daughter-in-law has been a nurse at two prestigious hospitals in two major cities in two states. I was suffering from anxiety due to C/L and Parkinson's. She told me that the overwhelming choice of nursing staffs to treat themselves for anxiety was simply 500 mg of Magnesium over the counter or a powdered magnesium drink called CALM over the counter. I tried it and my fearsome anxiety attacks went away with each dose upon ingesting within 15-20 minutes. I began taking it as a preventative and haven't had an anxiety attack for almost 2 years.

Maybe this isn't for everyone but literally hundreds of people have benefited.

Larry