Dear Dr. Roach: My friend is 63 years old. She was diagnosed with Parkinson’s disease two years ago. She started having tremors probably two years before her diagnosis, but they were being attributed to longtime use of a psychiatric medication that was prescribed for her bipolar disorder. She is opting not to take any medications for Parkinson’s and has been trying to treat it holistically through diet, spirituality, Reiki and positive thoughts. She is on quite a few medications for her bipolar disorder and high blood pressure.
I think she is anxious to add any more medications to the mix. She gets painful cramps in her feet if she walks too much, and her hand tremors are quite noticeable and seem so debilitating. The specialist she sees wants her to take the medications, but my friend is determined to do it her way.
I worry that by not taking the medication, she might be speeding up the damage that Parkinson’s can cause. I also think she would feel better on the medications. I was wondering about your thoughts on this situation.
R.D.
It can be extremely difficult to determine whether a person’s symptoms, like tremors, are due to Parkinson’s disease or medications (called drug-induced parkinsonism), since the tremors can look exactly the same. The only way to be 100% sure is to see whether the symptoms go away when stopping the other medications, and it can take up to six months for the symptoms of drug-induced parkinsonism to go away. However, movement-disorder experts can get some clues through a careful exam; for example, a loss of smell is associated with Parkinson’s disease, not drug-induced parkinsonism.
If a drug suspected of causing drug-induced parkinsonism cannot be safely discontinued, then the symptoms can be treated the same way as Parkinson’s disease, with both non-pharmacologic therapies and the same medicines that are used to treat Parkinson’s. Non-pharmacologic treatments that are effective for Parkinson’s include diet treatment. (Both Mediterranean-style and DASH diets were shown to delay the onset of Parkinson’s and delay its progression when present.)
Spirituality and positive thoughts might be helping your friend deal with her symptoms, and Reiki is reported by practitioners to reduce stress and improve well-being. Although there is no clear benefit from Reiki in clinical trials, there is no harm apart from financial, as long as your friend still uses medication if necessary. The fact that you see your friend’s symptoms as debilitating argues that her current regimen is not effective.
As far as your concern that not taking medication will speed up the course of Parkinson’s, this isn’t likely. The medications we have do not prevent Parkinson’s from progressing; instead, they improve a person’s quality of life. I’ve had many patients who are very anti-drug, and they will often delay taking medications until they are quite impaired. However, I feel strongly that it isn’t my place to try to convince them; it is their body and their choice. Still, many will later say that they wish they had started treatment earlier.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu
