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AbledConditions - Special Report Banner: Depression | Parkinson's Disease: Robin WIlliams - The Tears Of A Clown. The background shows a black and white photo of Robin Williams crouching on one knee with his hands crossed over his other knee as he looks at the camera with a small smile. There is a candle burning in the foreground.

What Is Depression?

Depression is the term given to a low mood, and feelings of extreme sadness or apathy with an aversion to any kind of physical activity.

Depressed mood may not require any professional treatment, and may be a normal reaction to certain life events, a symptom of some medical conditions, or a side effect of some drugs or medical treatments.

A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition, which may benefit from treatment.

 

TYPES OF DEPRESSION

Depression affects each person in different ways, so symptoms caused by depression vary from person to person. To clarify the type of depression you have, your doctor may add information to your depression diagnosis called a specifier. Specifiers include having depression with specific features, such as:

Anxious Distress:

Unusual restlessness or worry about possible events or loss of control;

Mixed Features:

Simultaneous depression and mania, which includes elevated self-esteem, talking too much, and racing thoughts and ideas;

Melancholic Features:

Severe depression with a profound lack of response to something that used to bring pleasure, associated with early morning awakening, worsened mood in the morning, significant changes in appetite, and feelings of guilt, agitation or sluggishness;

Atypical Features:

Ability to be cheered by happy events, increased appetite, little need for sleep, sensitivity to rejection, and a heavy feeling in arms or legs;

Psychotic Features:

Depression accompanied by delusions or hallucinations, which may involve themes of personal inadequacy or negative themes;

Catatonia:

Includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture;

Peripartum Onset:

Occurs during pregnancy or in the weeks or months after delivery (postpartum);

Seasonal Pattern:

Related to changes in seasons and diminished exposure to sunlight.

 

SYMPTOMS OF DEPRESSION

Although depression may occur only one time during your life, usually people have multiple episodes of depression. During these episodes, symptoms occur most of the day, nearly every day and may include:

Feelings of sadness, emptiness or unhappiness;

Angry outbursts, irritability or frustration, even over small matters;

Loss of interest or pleasure in normal activities, such as sex;

Sleep disturbances, including insomnia or sleeping too much;

Tiredness and lack of energy, so that even small tasks take extra effort;

Changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people;

Anxiety, agitation or restlessness — for example, excessive worrying, pacing, hand-wringing or an inability to sit still;

Slowed thinking, speaking or body movements;

Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that are not your responsibility;

Trouble thinking, concentrating, making decisions and remembering things;

Frequent thoughts of death, suicidal thoughts, suicide attempts or suicide;

Unexplained physical problems, such as back pain or headaches;

For some people, depression symptoms are so severe that it’s obvious something isn’t right. Other people feel generally miserable or unhappy without really knowing why.

 

DEPRESSION SYMPTOMS IN CHILDREN AND TEENS

Common symptoms of depression in children and teens are similar to those of adults, but there can be some differences.

In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.

In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression may occur with other mental health conditions, such as anxiety, eating disorders, substance abuse or attention-deficit/hyperactivity disorder (ADHD).

 

DEPRESSION SYMPTOMS IN OLDER ADULTS

Depression is not a normal part of growing older and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, including:

Memory difficulties or personality changes;

Fatigue, loss of appetite, sleep problems, aches or loss of interest in sex, which are not caused by a medical condition or medication;

Often wanting to stay at home, rather than going out to socialize or doing new things;

Suicidal thinking or feelings, especially in older men.

(Source: MayoClinic)

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What Are The Treatments?

The first step to getting the right treatment is to visit a doctor or mental health professional. He or she can do an exam or lab tests to rule out other conditions that may have the same symptoms as depression. He or she can also tell if certain medications you are taking may be affecting your mood.

The doctor needs to get a complete history of symptoms. Tell the doctor when the symptoms started, how long they have lasted, how bad they are, whether they have occurred before, and if so, how they were treated. Tell the doctor if there is a history of depression in your family.

MEDICATION

Medications called antidepressants can work well to treat depression. But they can take several weeks to work. Antidepressants can have side effects including:

  • Headache
  • Nausea, feeling sick to your stomach
  • Difficulty sleeping and nervousness
  • Agitation or restlessness
  • Sexual problems.

Most side effects lessen over time. Talk to your doctor about any side effects you may have.

It’s important to know that although antidepressants can be safe and effective for many people, they may present serious risks to some, especially children, teens, and young adults.

A “black box”—the most serious type of warning that a prescription drug can have—has been added to the labels of antidepressant medications. These labels warn people that antidepressants may cause some people to have suicidal thoughts or make suicide attempts, especially those who become agitated when they first start taking the medication and before it begins to work.

Anyone taking antidepressants should be monitored closely, especially when they first start taking them.

For most people, though, the risks of untreated depression far outweigh those of antidepressant medications when they are used under a doctor’s supervision. Careful monitoring by a professional will also minimize any potential risks.

Several types of therapy can help treat depression. Some therapies are just as effective as medications for certain types of depression. Therapy helps by teaching new ways of thinking and behaving, and changing habits that may be contributing to the depression. Therapy can also help men understand and work through difficult situations or relationships that may be causing their depression or making it worse.

THERAPY

Several types of therapy can help treat depression. Some therapies are just as effective as medications for certain types of depression. Therapy helps by teaching new ways of thinking and behaving, and changing habits that may be contributing to the depression. Therapy can also help men understand and work through difficult situations or relationships that may be causing their depression or making it worse.

(Source: National Institute of Mental Health)

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What Is Parkinson's Disease?

Parkinson’s Disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time.

Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.

Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in the an area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination.

As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.

The specific group of symptoms that an individual experiences varies from person to person. Primary motor signs of Parkinson’s disease include the following:

Tremor of the hands, arms, legs, jaw and face;

Bradykinesia  or slowness of movement;

Rigidity or stiffness of the limbs and trunk;

Postural instability or impaired balance and coordination.

Scientists are also exploring the idea that loss of cells in other areas of the brain and body contribute to Parkinson’s. For example, researchers have discovered that the hallmark sign of Parkinson’s disease — clumps of a protein alpha-synuclein, which are also called Lewy Bodies — are found not only in the mid-brain but also in the brain stem and the olfactory bulb.

These areas of the brain correlate to nonmotor functions such as sense of smell and sleep regulation. The presence of Lewy bodies in these areas could explain the non-motor symptoms experienced by some people with PD before any motor sign of the disease appears.

The intestines also have dopamine cells that degenerate in Parkinson’s, and this may be important in the gastrointestinal symptoms that are part of the disease.

(Source: Parkinson’s Disease Foundation)

 

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What Are The Treatments?

Parkinson’s disease can’t be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised.

Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important.

MEDICATIONS

Medications can help you manage problems with walking, movement and tremor by increasing your brain’s supply of dopamine. However, dopamine can’t be given directly, as it can’t enter your brain.

You may have significant improvement of your symptoms after beginning Parkinson’s disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms usually can continue to be fairly well controlled.

Your doctor may prescribe medications, which may include:

Carbidopa-levodopa:

Levodopa, the most effective Parkinson’s disease medication, is a natural chemical that passes into your brain and is converted to dopamine. Levodopa is combined with carbidopa (Parcopa, Sinemet), which protects levodopa from premature conversion to dopamine outside your brain, which prevents or lessens side effects such as nausea.

In Europe, levodopa is combined with a similar substance, benserazide (Madopar).

Side effects may include nausea or lightheadedness (orthostatic hypotension).After years, as your disease progresses, the benefit from levodopa may become less stable with a tendency to wax and wane (“wearing off”).Also, you may experience involuntary movements (dyskinesia) after taking higher doses of levodopa. Your doctor may lessen your dose or adjust the times of your doses to control these effects.

Dopamine agonists:

Unlike levodopa, dopamine agonists don’t change into dopamine. Instead, they mimic dopamine effects in your brain.They aren’t as effective as levodopa in treating your symptoms. However, they last longer and may be used with levodopa to smooth the sometimes off-and-on effect of levodopa.

Dopamine agonists include pramipexole (Mirapex), ropinirole (Requip) and rotigotine (given as a patch, Neupro). A short-acting injectable dopamine agonist, apomorphine (Apokyn), is used for quick relief.Some of the side effects of dopamine agonists are similar to the side effects of carbidopa-levodopa, but also include hallucinations, swelling, sleepiness and compulsive behaviors such as hypersexuality, gambling and eating. If you’re taking these medications and you behave in a way that’s out of character for you, talk to your doctor.

MAO-B inhibitors:

These medications include selegiline (Eldepryl, Zelapar) and rasagiline (Azilect). They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO-B). This enzyme metabolizes brain dopamine.

Side effects may include nausea or headaches.When added to carbidopa-levodopa, these medications increase the risk of hallucinations.These medications are not often used in combination with most antidepressants or certain narcotics due to potentially serious but rare reactions. Check with your doctor before taking any additional medications with a MAO-B inhibitor.

Catechol O-methyltransferase (COMT) inhibitors:

Entacapone (Comtan) is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.

Side effects, including an increased risk of involuntary movements (dyskinesias), mainly result from an enhanced levodopa effect. Other side effects include diarrhea or other enhanced levodopa side effects. Tolcapone (Tasmar) is another COMT inhibitor that is rarely prescribed due to a risk of serious liver damage and liver failure.

Anticholinergics:

These medications were used for many years to help control the tremor associated with Parkinson’s disease. Several anticholinergic medications are available, including benztropine (Cogentin) or trihexyphenidyl. However, their modest benefits are often offset by side effects such as impaired memory, confusion, hallucinations, constipation, dry mouth and impaired urination.

Amantadine:

Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson’s disease. It may also be given with carbidopa-levodopa therapy during the later stages of Parkinson’s disease to control involuntary movements (dyskinesias) induced by carbidopa-levodopa.Side effects may include a purple mottling of the skin, ankle swelling or hallucinations.

 

SURGICAL PROCEDURES

Deep Brain Stimulation:

In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and may reduce your Parkinson’s disease symptoms. Your doctor may adjust your settings as necessary to treat your condition. Surgery involves risks, including infections, stroke or brain hemorrhage.

Some people experience problems with the DBS system or have complications due to stimulation, and your doctor may need to adjust or replace some parts of the system. Deep brain stimulation is most often offered to people with advanced Parkinson’s disease who have unstable medication (levodopa) responses.

DBS can stabilize medication fluctuations, reduce or halt involuntary movements (dyskinesias), reduce tremor, reduce rigidity, and improve slowing of movement. DBS is effective in controlling erratic and fluctuating responses to levodopa or for controlling dyskinesias that don’t improve with medication adjustments.

However, DBS isn’t helpful for problems that don’t respond to levodopa therapy apart from tremor. A tremor may be controlled by DBS even if the tremor isn’t very responsive to levodopa.

DBS may provide a sustained benefit to Parkinson’s symptoms persisting for years after the procedure. However, DBS doesn’t keep Parkinson’s disease from progressing.

(Source: Mayo Clinic)

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AbledConditions Photo: The background shows a montage of newspaper front pages reporting the suicide death of Robin Williams. A screen capture of a tweet by British author and journalist Cole Moreton of the Guardian newspaper reads: Looking at a few front pages on Robin Williams today, what the hell happened to the reporting guidelines on suicide? Disgraceful.

The Loss Of Robin Williams Sparks New Dialogue On Addiction, Depression, Parkinson’s Disease & Suicide

 

The breaking news traveled like a tidal wave across all media platforms, and no matter whether you heard it on TV, the radio or in an iMessage or via a tweet, the reaction was a universal feeling of shock and sadness that Robin Williams had died.

The universal presumption was that he must have died from a heart attack or a stroke, although fans who knew about his addiction issues could be forgiven for thinking it might have been a drug overdose.

No one was prepared for shocking, horrible truth that he committed suicide by hanging himself from a closet door and trying, unsuccessfully, to cut his wrists.

Soon, the so-called ‘tears of a clown‘ stained every front page of every newspaper and a confused mix of sadness, loss, compassion and anger replaced the initial shockwave. As the breaking news coverage evolved into a developing story, everyone came to learn of Robin William’s addiction and financial issues, as well as his struggles with Depression and Bi-polar Disorder. The final missing piece of the puzzle came in the revelation from his widow that Williams had recently been diagnosed as being in the early stages of Parkinson’s Disease.

Despite the additional context, the consensus on social media seemed to be ‘what a sad and terrible waste of a talent and what a horrible thing to do to his family’. That was met with a pushback from fans who had either experienced, or knew someone with, addiction issues, Depression and/or Parkinson’s Disease and the challenges they face.

Jamie Masada, founder of the Laugh Factory and a long-time friend of Williams, works with many legendary comedians and knows firsthand the troubles some face off-stage. “He’s genuinely, genuinely one of those guys, such a high energy, we would never figure out anything. He would never let anybody get inside to know what was going on,” says Masada. “They don’t want to talk about their problems. They always want to make people laugh.” In 2011, Masada, with the help of psychologist Ildiko Tabori, started providing onsite therapy for performers at the Laugh Factory to help them cope with the highs and lows that often come with being an entertainer. 

Mental health expert Dr. Jeff Gardere explains that depression and substance abuse among performers is more common than one may think, and Williams was no exception. “He was a lifelong addict. It’s a lifelong illness that you take a day at a time … this is a medical problem, and we have stop seeing people who have drug addiction as evil, bad, weak people,” says Gardere.

Yahoo News and Finance anchor Bianna Golodryga spoke with Masada, Tabori and Gardere shortly after Robin William’s passing: 

Did Childhood Emotional Neglect Play A Part In Robin William’s Struggle With Depression?

 

By Jonice Webb, Ph.D

Since Robin Williams’ sad and shocking suicide on August 11, friends, family, fellow stars, and even reporters have offered multiple explanations for the virtually inexplicable:

Why did he do it?

Some of the many possible factors which have been proposed are depression, alcohol, drugs, and Parkinson’s Disease. But I see another potential factor which is never mentioned by anyone. A factor which falls between the cracks just as its sufferers do: Childhood Emotional Neglect (CEN).

CEN causes untold numbers of people to question the point of being alive. People with CEN feel empty and alone. But they were trained in childhood to keep their problems and needs out of view. Because they believe that their emotions and needs are a burden, they not only hide them from others; they even hide them from themselves.

CEN folks live in a prison of self-blame, self-doubt and emptiness. Yet they are unable to ask for help. Some can have secret suicidal thoughts throughout their lifetimes. Some act upon those thoughts, leaving family and friends forever baffled and pained.

Unlike medical disease, depression and substance abuse, CEN is not noticeable or diagnosable. It hides from everyone, even from the sufferer himself. People with CEN do not know the source of their pain. They only know their most deeply-held truth: they cannot let it be seen.

Since CEN is so invisible, how can anyone say that it was a factor in Robin’s suicide? The truth is, I can only surmise. But I can say that several facts about Robin’s childhood, combined with his behaviors as an adult, point to CEN. Here is a list of them:

 

1. Robin’s father was a high-level GM executive and his mother a fashion model. He grew up surrounded by wealth and privilege, but not by attention. His parents were seldom home, and he was raised mostly by the maid, who was also his primary companion.

 

2. Robin’s description of himself as a child: “short, shy, chubby and lonely.” He described spending much of his childhood in the family’s huge house, playing with toy soldiers, alone. In 2009, Robin told People Magazine that in his childhood home, “the ideal child was seen, not heard.” This mantra is a hallmark of the CEN family.

 

3. During a 2001 episode of Inside the Actor’s Studio, Robin gave credit to his mother for helping to develop his humor because, as a child, he worked to be funny as a way to get her attention.

 

4. All who knew Robin agreed that he kept his pain hidden, deep underground. Only those who spent considerable time with him or knew him well got glimpses of his true sadness and hurt. Carefully guarded pain: it’s the stamp of CEN.

 

Read the rest of the article at PsychCentral

Jonice Webb has a PhD in clinical psychology, and is author of the book Running on Empty: Overcome Your Childhood Emotional Neglect. Webb has been licensed to practice since 1991. She has been interviewed on NPR and over thirty radio shows across the United States and Canada about the topic of her book, and has been quoted as a psychologist expert in the Chicago Tribune. Prior to joining PsychCentral, she was the Mental Health Editor for BellaOnline, the second largest women’s website in the world. She currently has a private psychotherapy practice in Lexington, MA, where she specializes in the treatment of couples and families. Webb currently resides in the Boston area with her husband and two children. To read more about Dr. Webb, her book and Childhood Emotional Neglect, you can visit her website, Emotionalneglect.com; or view her short videos on YouTube.

In Memoriam: Robin Williams 1951-2014

Transcript:

“Please don’t worry so much, because in the end, none of us have very long on this Earth. Life is fleeting, and if you’re ever distressed, cast your eyes to the summer sky, and the stars that strung across the velvety night. And when a shooting star streaks through the blackness turning night . . . into day . . . make a wish. Think of me. Make your life spectacular. I know I did.”

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Photo from wn.com shows a photo of Robin WIilliams with the words Killed By Drugs superimposed on it along with a copy of a tweet by actor-comedian Rob Schneider which reads:'Now that we can talk about it, Robin Williams was on a drug treating the symptoms of Parkinson's. One of the SIDE-EFFECTS IS SUICIDE!

Health Experts Blast Rob Schneider’s Parkinson’s Drug Twitter Rant

 

The above screenshot from wn.com shows one of a series of tweets by Rob Schneider, a longtime friend of Robin Williams, who blasted what he called ‘the evil pharmaceutical industry’ for admitting that 100,000 people in the USA die a year from prescription drugs’, some of which list suicide as a side-effect.

It didn’t take long for doctors and other health experts to blast back. James Beck, Vice-President of Scientific Affairs for the Parkinson’s Disease Foundation, says, “suicide shouldn’t be a primary worry for the majority of Parkinson’s patients”, and that if Schneider didn’t know the specifics of William’s treatment, then his tweets were ill-informed and irresponsible.

Dr. Irene Richard, Professor of Neurology and Psychiatry at the University of Rochester Medical Center, and a Science Advisor to the Michael J. Fox Foundation for Parkinson’s research says, ‘Suicide is of no more concern in patients with Parkinson’s versus those who don’t have Parkinson’s.

More than 50% of people who are diagnosed with Parkinson’s develop clinical depression, and the Parkinson’s Disease Foundation says that about 30% of patients reported being depressed even before their diagnosis and that antidepressants are often an effective treatment.

But as ABCNews reports, some Parkinson’s drugs do list an increased risk of suicide as a possible side-effect. In fact, the U.S. Food and Drug Administration (FDA) warns that patients taking either levodopa or SINEMET, two drugs commonmly used to treat Parkinson’s, ‘should be observed carefully for the development of depression with concomitant suicidal tendencies.”

Dr. Irene Richard says that the only Parkinson’s treatment acknowledged to have a possible association with an increased risk of suicide is Deep Brain Stimulation, a surgery in which electrodes are implanted in the brain to control its electrical activity, and any candidate for this type of operation would be carefully screened for history of depression and other mood disorders.

So, at best, fans of Robin Williams are left to speculate about whether his self-admitted depression was worsened by any medication he was prescribed following his Parkinson’s diagnosis.

(Sources: wn.com | ABCNews.com)

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