The Connection Between Parkinson’s Disease and Depression

Parkinson’s disease (PD) is not just a movement disorder; it also affects mental health, which can create a complex interplay between physical and emotional symptoms. Neurological changes that affect the limbic circuits, dopamine cells, and serotonergic levels in the brain are disrupted and can influence symptoms of depression and anxiety. These neurological changes not only affect movement but also mood regulation, motivation, and reward processing. Additionally, cognitive changes including dementia associated with PD can lead to higher rates of depression and decreased motivation to engage in meaningful activities, which can impact social interactions, communication, and overall quality of life. Research indicates that approximately 38% of those living with PD contend with symptoms of depression. While this rate is significantly greater than that of the general population, certain clinical characteristics increase incidence of depression associated with PD including but not limited to severity of motor symptoms and cognitive changes.  

People living with PD may experience both motor and non-motor symptoms that affect communication. Research has often identified depression as the leading non-motor symptom in PD. Those grappling with depression reportedly experience poorer cognitive performance, lower quality of life, and worse overall functional status. These difficulties can impact therapeutic interventions and further limit a person’s motivation to engage in conversations or group activities, ultimately leading to social isolation. 

PD associated communication challenges may include difficulties with thinking, such as trouble focusing, recalling details and words, and processing information as quickly as one used to, as well as difficulties with speaking, such as reduced vocal volume and difficulty producing crisp, clear sounds. Depression and anxiety can heighten these speech issues by creating additional mental blocks or increasing self-consciousness, making it harder for individuals to find the words they need or stay focused during conversations. These compounded communication difficulties may create misunderstandings or discourage people from participating in social settings altogether, exacerbating feelings of isolation and frustration.

While less common, swallowing issues, known as dysphagia, can also negatively impact quality of life by interrupting the ease and comfort of eating for individuals with PD. PD can affect the muscles responsible for coordinating the swallow and maximizing airway safety, making eating and drinking longer and more effortful, leading to fatigue, prolonged mealtimes, and a potential decline in hydration and nutritional intake, which can further affect mood and energy levels. These challenges and fears cause some people with PD to avoid eating in social situations because of a fear of choking or drooling. Avoidance of eating and social meals is a particular concern for people with PD and depression, because the sharing meals with others creates a vital social framework, establishing meaningful interpersonal connections through the universal language of food while simultaneously providing structured opportunities for conversation, emotional expression, and cultural exchange. Research consistently demonstrates that communal eating practices significantly enhance psychological wellbeing by reducing feelings of isolation, stimulating the release of mood-regulating neurotransmitters, and creating neurological associations between nourishment, social engagement, and positive emotional states that together form protective factors against depression and anxiety. 

How Speech and Language Therapy Can Help

At its very heart, speech and language therapy is about building confidence and maintaining meaningful connections. Speech therapy addresses cognitive and communication related changes associated with PD, trains safe and effective swallowing techniques so individuals with PD can continue enjoying meals with loved ones, and also strengthens motor-speech skills to enhance clarity and confidence in communication. In many ways speech therapy interventions aim to alleviate the impact of depression and anxiety by enhancing opportunities to meaningfully connect to oneself and those people and activities that matter most in life.

When building a speech therapy treatment plan, it’s important to consider that PD presents uniquely in each individual, affecting cognitive communication skills and the strength and coordination of voice, speech, and swallowing muscle groups to varying extents. Research indicates that up to 90% of individuals with PD will experience speech and voice changes over time, while a smaller percentage may face swallowing difficulties.

Although these changes can be concerning, evidence-based intensive speech therapy interventions have been proven to enhance cognitive, communication, and swallowing function for individuals with PD. Early recognition and intervention are key to ensuring the most successful outcomes. Speech therapy helps maintain the strength and coordination of various muscle systems, optimizing communication and swallowing abilities while slowing the progression of symptoms. A comprehensive treatment plan should additionally consider the relationship between stress, emotion, psychosocial wellbeing, motivation, cognition, and socioemotional elements on swallow function and communication behavior. Incorporating personalized mindfulness strategies to heighten awareness of both physical and emotional states throughout the day and how they influence mood and speech and swallow function is an important component of a successful treatment plan.

Voice and Speech Therapy

When it comes to voice and speech therapy for PD, LSVT LOUD® is internationally recognized as the gold standard treatment. This evidence-based 4 week intensive program utilizes structured, high-effort, and repetitive exercises designed to drive neuroplastic changes that help individuals with PD recalibrate their perception of vocal loudness for clear speech and effective communication. By focusing on producing speech at a typical, healthy volume, participants improve their ability to communicate effectively. Research has shown that emphasizing increased amplitude of movement through the single cue “loud” creates a positive ripple effect across the entire motor-speech system, leading to enhancements in articulation, expressiveness, facial movement, and even swallowing function. While LSVT LOUD® is primarily a motor-based intervention, it has been found to enhance cognitive-communication skills and overall communicative confidence. Research has demonstrated that the intensive, high-effort nature of LSVT LOUD positively influences broader communication functions, including attention, processing speed, working memory, and executive function—all of which are critical for effective communication and may be more acutely impacted in those experiencing depression.

Candidates who complete the 4-week intensive treatment can expect:

• Improved vocal loudness and voice quality to be heard and understood without the need for repetitions
• Improved breath support and control
• Improved intonation and expressivity in speech
• Improved speech clarity and intelligibility
• Greater ease and success communicating in real-world settings
• Improved attention and focus
• Improvements initiating, maintaining, and responding in conversations
• Greater social connection and participation
• Improved communicative confidence and quality of life
• Less drooling 
• Easier and safer swallowing

All Open Lines® speech-language pathologists are specially trained and certified in this treatment method including in-house supervision from LSVT Global faculty and clinical expert, Dr. Jessica Galgano.

Group Therapy for Parkinson’s

Group speech therapy provides a specialized therapeutic environment where individuals can practice evidence-based techniques such as the Lee Silverman Voice Treatment (LSVT LOUD®) protocol in a collaborative setting. These structured sessions enable participants to receive professional guidance while simultaneously benefiting from expert coaching, peer modeling, and reinforcement. Research indicates that the consistent practice facilitated by group dynamics may help maintain neural pathways critical for speech production, potentially delaying speech deterioration through principles of neuroplasticity and motor learning.

The psychological dimensions of group speech therapy extend far beyond the mechanical aspects of voice production. Participants frequently report decreased feelings of isolation as they connect with others experiencing similar challenges, creating a supportive community that understands the unique frustrations associated with Parkinson’s-related communication difficulties. This shared experience fosters emotional resilience, with group members often developing camaraderie through mutual encouragement during vocal exercises. Clinical observations suggest this psychosocial support component significantly enhances therapy adherence and motivation, with many participants reporting improved confidence in social communication contexts following group intervention. The combination of specialized speech techniques with emotional support creates a comprehensive therapeutic approach addressing both the neurological and psychological aspects of Parkinson’s-related communication changes.

Swallowing Therapy for Parkinson’s

Working with a licensed speech and language pathologist who specializes in swallowing treatment can help individuals with PD find effective strategies for safe and enjoyable eating. Therapists often utilize a combination of exercises to strengthen the coordination, force of movement, and amplitude of movement of the muscles involved in swallowing while also introducing aspiration precautions and compensatory techniques to maximize airway safety, such as managing bite size and tucking the chin when swallowing to protect the airway and prevent aspiration (food or liquid entering the airway) and to reduce coughing during meals. The exact exercises and treatment interventions will vary from person to person, taking into consideration the presenting neurophysiological issues.

A licensed speech-language pathologist can conduct a comprehensive evaluation to accurately assess the nature of your swallowing difficulties. Based on the findings, they will develop a personalized and holistic treatment plan tailored to your specific needs. This plan will incorporate targeted, evidence-based exercises, techniques, and strategies designed to enhance swallowing function and support overall quality of life.

For additional information on swallowing treatment options for individuals with PD see our blog Addressing Speech and Swallowing Challenges in PD 

How to Get Help

Caregivers and family members additionally play a crucial role in supporting people with PD, especially when it comes to communication and mealtime enjoyment. Patience, empathy, and an understanding of the condition’s multifaceted impacts can make it easier for individuals with PD to stay engaged in meaningful interactions. The support of loved ones and the expertise of speech and language professionals can create a comprehensive care approach, helping individuals with PD continue to communicate, connect, and enjoy their daily lives despite challenges.

By addressing both physical and emotional needs, we can improve quality of life for people with PD, helping them to navigate both communication and swallowing issues with greater confidence and ease. Engaging in consistent, compassionate interventions has been shown to make a substantial positive impact, fostering connection and promoting a sense of well-being.

If you or a loved one is struggling with Parkinson’s disease, Open Lines® can help. Our practice is uniquely focused on treating both the pathology of neurological speech disorders and the emotional fallout that can result. Contact us via phone (212-430-6800), email [email protected], or by filling out our convenient contact form. Improve your communication skills and unlock your potential with Open Lines® Speech and Communication in New York today!