Non-Motor Symptoms Associated with Focal Dystonia

Other symptoms might exist with your focal dystonia.

There is evidence that patients with cervical dystonia (and probably other types of focal dystonia) have an increased frequency of anxiety and depression compared to the general population. This is not due to the fact that you have cervical dystonia or blepharospasm; it is not a secondary mood disorder.

There is evidence that the mood disorder precedes the onset of the dystonia, sometimes by many years. It seems that the disturbance in the balance of neurotransmitters (see the section on neurotransmitters) in the brain, which leads to the development of dystonia may also cause an increased risk of a mild mood disorder such as anxiety or depression.

This can be treated very well, once recognised, by the use of a small dose of a modern antidepressant medication such as citalopram, sertraline or paroxetine. When you are being treated for cervical dystonia, please mention to the neurologist or your general practitioner if you have any feelings of anxiety or depression. Many patients do not talk about these symptoms to the doctor because they feel that it is quite normal to have anxiety and depression with their dystonia. Many patients think that to discuss these symptoms indicates some form of psychological weakness. Many patients can worry that they will become “hooked” on the drug and will have difficulty stopping the antidepressant therapy. This is certainly not the case.

Our experience with patients with anxiety and depression is that they respond very well to a relatively small dose of a mild antidepressant and do not require increasing doses or become addicted to them. It can be difficult to convince the patient that they will be very much better on antidepressant therapy. Most of our discussions about therapy focus around the fact that this disorder (cervical dystonia) is caused by an imbalance of certain neurotransmitters in the brain, which causes both the depression/anxiety and the movement disorder (cervical dystonia). In other words in order to correct the disturbance in brain function, which causes both the cervical dystonia and the mood disorder it is often necessary to treat with both botulinum toxin AND an antidepressant.