Anxiety and depression are prevalent nonmotor psychiatric features in patients with PD and should be considered as areas for therapeutic intervention. These affective disorders contribute to the accelerated disability and functional morbidity in patients with PD, and are correlated with poor quality of life and increased caregiver distress. Despite the high prevalence of anxiety and depression in PD, these conditions are often unrecognized and untreated in a large portion of PD patients. Various instruments may be utilized to diagnose and assess anxiety and depression. However, despite attempts to improve the sensitivity and specificity of these instruments for use in the PD population, uncertainties remain. The best approach may be to remain vigilant for the presence of anxiety or depression, to have a low threshold for intervention, and to utilize an individualized approach. The scientific data on the efficacy of nonpharmacologic and pharmacologic treatments for the treatment of anxiety and depression in the PD population are relatively sparse, and derived from studies enrolling small numbers of patients. However, the data suggest that available interventions may be efficacious for the PD population. Nevertheless, clinicians should rely on empiric assessments of known risks and putative benefits to guide treatment decisions. Additionally, a targeted and individualized multimodal approach utilizing education, social support, and psychotherapeutic interventions along with pharmacologic therapies should be considered.
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