The Hidden Risk: How Antidepressants May Worsen Parkinson’s Symptoms—and What Patients Need to Know
Some antidepressants can worsen motor symptoms in Parkinson’s disease, leaving patients trapped between depression and movement disorders. Here’s what you need to know.

When 65-year-old Meera Joshi from Pune began her battle with Parkinson’s disease, she was already juggling tremors, stiffness, and fatigue. But it wasn’t until she was prescribed antidepressants for her growing anxiety and depression that her world truly shifted. “Within weeks, I couldn’t even hold a spoon,” she recalls. “It was like my Parkinson’s had taken a sharp turn for the worse.” What Meera didn’t know—and what many patients are never told—is that certain antidepressants may worsen Parkinson’s symptoms.

This heartbreaking and increasingly common scenario highlights a critical but often overlooked issue in neurological care: the complex relationship between antidepressants and Parkinson’s disease.

Parkinson’s and Depression: A Dual Battle

Parkinson’s disease (PD) affects nearly 10 million people worldwide. In India alone, cases are rising steadily with aging populations. Besides hallmark motor symptoms like tremors, rigidity, and slowness, nearly 40%–50% of Parkinson’s patients suffer from depression or anxiety. It's not just emotional—it’s chemical. The same dopamine deficiency that causes physical symptoms also affects mood regulation.

“Depression is not just common in Parkinson’s—it’s often an early symptom, even before tremors begin,” says Dr. Akash Mehra, a neurologist at NIMHANS, Bengaluru.

Treating this depression is essential. Left unaddressed, it worsens quality of life and accelerates disability. But ironically, the very medications used to treat depression can sometimes worsen Parkinson’s.

The Antidepressant-Parkinson’s Puzzle

Not all antidepressants are created equal. Drugs like Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are commonly prescribed. However, these medications can interfere with dopamine pathways in the brain—exactly what Parkinson’s patients can’t afford.

SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft), for instance, may diminish the effect of dopamine replacement therapies like levodopa, leading to increased rigidity or tremors. Additionally, they may affect balance and coordination, exacerbating fall risks in older adults.

A 2021 study published in Movement Disorders revealed that patients using SSRIs reported worsened motor symptoms and increased "off" periods, where medication loses effectiveness. Although the mechanism isn't fully understood, experts believe serotonin-dopamine interactions in the brain are to blame.

Real People, Real Struggles

Ramesh Varma, a retired professor in Delhi, noticed something strange a month after being prescribed escitalopram. “My hands were shaking more. I had trouble walking. I thought my Parkinson’s was getting worse,” he says. His neurologist later confirmed the culprit—his antidepressant.

“It’s scary because you're already dealing with a tough illness, and then the treatment for one part of it makes the other part worse,” says his daughter, Ananya.

This emotional turmoil—caught between needing mental health support and fearing side effects—is a reality for thousands.

What Should Patients and Caregivers Do?

If you or a loved one with Parkinson’s is experiencing worsening motor symptoms after starting antidepressants, here’s what you should know:

1. Don’t Stop Medication Suddenly

Quitting antidepressants abruptly can cause severe withdrawal symptoms and worsen depression. Always consult your doctor first.

2. Request a Medication Review

Ask your neurologist and psychiatrist to coordinate your treatment. Not all antidepressants worsen symptoms—tricyclic antidepressants like nortriptyline or bupropion are sometimes better tolerated in PD patients.

3. Look into Non-Pharmacological Alternatives

Cognitive Behavioral Therapy (CBT), mindfulness, regular exercise, and even group therapy can significantly reduce depression symptoms without interfering with PD medications.

4. Track and Report Symptoms

Keep a daily log of both mood and motor symptoms. This helps doctors identify patterns and tailor treatment better.

Hope on the Horizon

There’s growing awareness of the antidepressant-Parkinson’s interaction. The Michael J. Fox Foundation and the Parkinson’s Foundation have begun funding research into safer psychiatric treatments for PD. Indian institutions like AIIMS and NIMHANS are also looking into integrative care models that bridge neurology and psychiatry.

Moreover, emerging therapies like dopamine agonists with mood-enhancing effects, as well as newer drugs like safinamide, are showing promise in managing both depression and motor symptoms without the same risks.

Parkinson’s disease already challenges every movement, every emotion. Patients shouldn’t have to choose between mental peace and physical control. Awareness is the first step toward safer, smarter treatment.

Meera, who switched her medication under her doctor’s guidance, now feels more stable—both in mood and motion. “I still have bad days,” she says, “but at least I can smile without worrying that I’ll fall.”

Let’s ensure that every Parkinson’s patient in India and beyond gets that chance.

Sources & References:

• Parkinson’s Foundation (parkinson.org)
• Movement Disorders Journal, 2021
• Michael J. Fox Foundation
• National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru
• Indian Journal of Psychiatry