Parkinson’s disease is a progressive movement disorder that damages nerve cells in the brain. This damage causes motor symptoms like tremor, stiffness, and problems with movement, and it can also cause nonmotor symptoms, such as memory problems, trouble sleeping, depression, and anxiety.
Between 43 and 53 percent of people with Parkinson’s disease also have an anxiety disorder. Untreated anxiety can significantly worsen your quality of life with Parkinson’s by worsening motor symptoms like tremor or freezing, and make it hard to get enough sleep, says Mill Etienne, MD, MPH, an associate professor of neurology and medicine at New York Medical College. “Anxiety in Parkinson’s disease is common, under-recognized, and very treatable,” says Dr. Etienne.
Signs and Symptoms of Anxiety
Anxiety feels like dread, fear, or uneasiness, and can be caused by a temporary stressful situation. But when anxiety continues and gets worse over time, it’s called an anxiety disorder.
Symptoms of anxiety in Parkinson’s include:
Continuous worry
Trouble concentrating
Fast or pounding heartbeat
Pain with no other explanation
A feeling of shaking or buzzing inside your body
Muscle tension and headaches
Irritability and restlessness
Excessive sweating
Shortness of breath
Insomnia
Dizziness
Fatigue
Nausea
When you live with anxiety, you may avoid activities and people you love. “Anxiety in Parkinson's disease includes several disease-specific manifestations that differ from typical generalized anxiety disorder, most notably fluctuating anxiety tied to motor states, anxiety related to motor symptoms and medication complications, and fear of falling,” says Diego Torres-Russotto, MD, the chair of neurology and the Distinguished Endowed Chair in Neurology at Baptist Health Miami Neuroscience Institute, part of Baptist Health South Florida.
Anxiety can also worsen Parkinson’s symptoms, such as tremor, dyskinesia, and freezing of gait, says Sarah E. Buckingham, MD, a neurologist with Stamford Health Medical Group Neurology in Connecticut. And as Parkinson’s disease progresses, the risk of anxiety increases.
Understanding Anxiety in Parkinson’s Disease
Parkinson’s disease can cause anxiety for several reasons, including its symptoms and treatment. “Anxiety in Parkinson’s disease is caused by a combination of brain changes, medication effects, and psychological stressors related to living with a chronic neurologic illness,” says Etienne.
The Biology of Parkinson’s Anxiety
From a biological standpoint, Parkinson’s affects the production of dopamine and other brain chemicals involved in mood and anxiety, [as well as causing] damage to brain messaging pathways that regulate emotion, says Etienne. “Anxiety in Parkinson’s also tends to fluctuate with the course of the disease and medication adjustments, and it often occurs alongside depression or other nonmotor symptoms.”
Besides a response to general symptoms, anxiety can fluctuate during “off” periods, says Dr. Torres-Russotto. Off times describe a worsening of symptoms between doses, when dopamine levels are at their lowest. In one study of 200 people with Parkinson’s, up to one third experienced higher levels of anxiety in their off times compared with “on” times (when their medication was working well).
Other Causes of Anxiety in Parkinson’s
Beyond the effects of Parkinson’s disease in your body, anxiety can grow alongside the difficulties of living with this condition. “Psychologically, anxiety may stem from fear of motor symptoms (freezing, falls, tremor), loss of independence, unpredictability of symptoms, and concern about disease progression,” says Etienne.
Parkinson’s can trigger anxiety related to these disease factors:
Parkinson’s symptoms: Symptoms like palpitations, shortness of breath, and sweating can trigger anxiety or make it worse, says Etienne.
Poor sleep: A common symptom of Parkinson’s, sleep disruption can cause a range of mental health issues, including anxiety.
Isolation and loneliness: Parkinson’s symptoms may prompt you to avoid social settings, which may increase feelings of seclusion and anxiety.
Uncertainty: You may feel anxious not knowing how this progressive disease will affect your independence or future quality of life.
Psychotic symptoms: Some Parkinson’s medications can also worsen psychotic symptoms like hallucinations, which can feel frightening and trigger anxiety symptoms, says Etienne.
But you can minimize these symptoms with treatment. Most people who have anxiety in Parkinson’s disease find relief with the right treatment plan, says Buckingham.
How to Reduce 'Off' Times in Advanced Parkinson's
Discover lifestyle tips that can help reduce Parkinson’s off times.
Next up video playing in 10 seconds
How to Manage Anxiety in Parkinson’s
If you notice increased anxiety with Parkinson’s disease, you can try several lifestyle changes and treatment options, including psychotherapy, group support, and medical treatments. The first step: Talk to your provider.
“We know patients experience better outcomes when they are open with their doctor about all their symptoms, including those which may be uncomfortable to discuss or may feel taboo,” says Dr. Buckingham, who stresses the importance of working with one’s provider to establish an individualized treatment plan.
Anxiety treatment recommendations should address all contributors to symptoms, including disease process, medication management, and day-to-day triggers, says Etienne.
Ask About Treatment Adjustment
If you experience heightened anxiety symptoms with Parkinson’s, you can ask your provider about adjusting your treatment. This is especially true if you have off times, and Buckingham recommends asking about adjusting Parkinson’s medications to relieve anxiety symptoms in the off state.
Sometimes, providers may recommend other changes, like giving medication more often, adding additional options, or switching treatments if they cause side effects like hallucinations, poor impulse control, and agitation, says Etienne.
In advanced Parkinson’s, anxiety associated with severe motor fluctuations or unpredictable off time may prompt consideration of more continuous medication strategies, says Etienne. This could include carbidopa-levodopa infusion (Duopa) directly into the small intestine or apomorphine infusion (Onapgo) given under the skin.
Consider Anti-Anxiety Medication or Antidepressants
When anxiety gets more intense, intrudes into your life, or begins to worsen Parkinson’s symptoms, your provider may recommend treatment with medication, says Buckingham.
“When medication is needed, SSRIs or SNRIs are often preferred and are generally safe in Parkinson’s, while benzodiazepines should be used cautiously due to risks of falls, sedation, and cognitive impairment,” says Etienne.
SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective noradrenaline reuptake inhibitors) are antidepressants that also treat anxiety. Your provider will assess your symptoms, history, and needs to help you decide on the best anxiety treatment for you.
Try Talk Therapy
When anxiety happens consistently and doesn’t change with your motor symptoms, targeted psychiatric treatments like cognitive behavioral therapy (CBT) can help, says Etienne. CBT, a type of talk therapy performed by a licensed mental health provider, can retrain how you think about your illness and anxiety to improve symptoms in everyday life.
Seek Out Group Support
Knowing others share your experience can better help you manage powerful emotions that may come with your diagnosis. “Strong social support, caregiver education, and participation in Parkinson’s support groups can reduce isolation and anxiety,” says Etienne. Seeking support from peers can help you stay connected and learn new coping techniques.
Minimize Triggers
Once you learn your anxiety triggers, you can avoid them. Treating depression; managing pain, constipation, or urinary symptoms; and minimizing caffeine or other stimulants can significantly reduce anxiety,” says Etienne. Some symptoms, like dizziness from sudden blood pressure changes or heart palpitations, can make anxiety worse, so treating those symptoms can prevent triggering it, Etienne adds.
Seek Help for Sleep Problems
Sleep problems can also spark anxiety, so it’s important to get enough high-quality rest each night. Over half of people with Parkinson’s report difficulty sleeping, which gets worse with anxiety and as the disease progresses.
You can optimize your sleep by following sleep habits like these:
Keep a regular sleep schedule, even on weekends.
Get out of bed as soon as you wake.
Eat three to four healthy meals at the same time every day.
Avoid napping, especially for too long or too late in the day.
Cut off caffeine after lunch.
Don’t drink alcohol after dinner, which can affect your deep sleep.
Limit smoking cigarettes, which contain nicotine (a stimulant).
Exercise regularly, but avoid vigorous activity in the two hours before bed.
If good sleep still eludes you, let your provider know. They can check for other conditions that may disrupt your sleep and help you develop a treatment plan.
Prioritize Healthy Lifestyle Habits
Exercise not only helps reduce anxiety symptoms, but it also improves sleep quality, says Buckingham. Aerobic exercise has been proven to slow Parkinson’s disease progression, Buckingham adds.
Aerobic exercise makes you breathe harder and increases your heart rate. Examples include:
Dancing
Boxing
Brisk walking
Running
Water aerobics
Cycling
Playing tennis
Before you start a new type of exercise, check in with your provider. They may want you to see a physical therapist to make sure you can stay safe doing your chosen activity. Also, make sure you enjoy it — that will boost your chances of sticking with it long-term.
“Regular aerobic exercise is an essential tool to help manage anxiety in the short term and curb disease progression in the long term,” says Buckingham.
Try a Mind-Body Activity Such as Yoga or Tai Chi
When the unpredictable nature of Parkinson’s symptoms and progression causes anxiety, mindfulness, relaxation techniques, breathing exercises, and structured routines can help you cope, says Etienne.
Torres-Russotto recommends yoga and tai chi to lessen anxiety. Research suggests yoga decreases anxiety by calming your nervous system. And meditation rewires your brain so you can more easily avoid an anxiety spiral.
The Takeaway
Parkinson’s disease frequently induces anxiety symptoms like constant worry, muscle tension, insomnia, dizziness, and irritability.
Nerve cell damage, off times, uncertainty about the future, poor sleep, isolation, and changes in movement and independence can all contribute to anxiety in Parkinson’s disease.
To manage Parkinson’s anxiety, your provider may recommend treatment adjustments, talk therapy, peer support, trigger avoidance, mind-body practices, medications, and lifestyle changes that support overall health.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Pontone GM et al. Anxious Fluctuators’ a Subgroup of Parkinson’s Disease With High Anxiety and Problematic On-off Fluctuations. Parkinsonism and Related Disorders. December 2023.
Antonini A et al. Current and Novel Infusion Therapies for Patients With Parkinson’s Disease. Journal of Neural Transmission. September 2023.
Bounds CG et al. Benzodiazepines. StatPearls. January 30, 2024.
Sheffler ZM et al. Antidepressants. StatPearls. May 26, 2023.
Gerritzen EV et al. Online Peer Support for People With Parkinson Disease: Narrative Synthesis Systematic Review. JMIR Aging. July 2022.
Scott AJ et al. Improving Sleep Quality Leads to Better Mental Health: A Meta-Analysis of Randomised Controlled Trials. Sleep Medicine Reviews. December 2021.
As the Parkinson’s Foundation first-ever chief medical officer, Sneha Mantri, MD, MS, leads medical and clinical care efforts, guiding the Foundation’s care portfolio and strategy to ensure impactful, sustainable initiatives.
Dr. Mantri is a practicing movement disorders specialist with extensive training and experience. She completed her medical education at Columbia University, residency at the University of Virginia, and a movement disorders fellowship at the University of Pennsylvania and Philadelphia VA Medical Center.
She brings her patient-centered philosophy to the Parkinson's Foundation, emphasizing that people come before their diagnosis and that Parkinson’s care must be personalized.
Throughout her career, Mantri has focused on building collaborations and expanding outreach to rural communities while raising Parkinson’s awareness in the medical field.
She developed collaboration with the Margolis Institute for Health Policy through the Duke Clinical Leadership Program in 2024 and participates in a PBS-NC panel discussion for her integrated, interprofessional care model.
She serves as a Macy Faculty Scholar, currently working to expand humanistic and community-engaged practice nursing, and physical and occupational therapy. She has also been leading THRIVE-PD since 2019, an early-intervention team-based care model for people with Parkinson's across the Carolinas.
Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.
McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.
