“People say that the first five years are a ‘honeymoon period’,” reads one of the questions below. The only person I’ve heard refer to Parkinson’s as a ‘honeymoon period’ is Anders Stålhammar on the podcast, and given the podcast’s reach, I believe it is currently the most influential voice spreading this analogy. The website is now another major channel. I find comparing life with PS to a honeymoon slightly offensive and belittling, regardless of whether it’s in an early phase or not. And secondly, it’s rarely (though sometimes!) just a matter of a few months. Wouldn’t it be better to phrase the question without this rather dull analogy? Perhaps it’s just me who’s getting hung up on this. I really appreciate everything you do with the podcast and the website, but even good things can be improved. Thank you for your commitment!

The description of the period following a diagnosis of Parkinson’s disease arose when L-dopa was first introduced in the late 1960s and early 1970s. It was the therapeutic effect of L-dopa that was experienced as a relief from many symptoms, but many people developed a range of complications shortly after starting L-dopa, hallucinations, violent involuntary movements, rapid, sudden dose-related fluctuations with freezing episodes, etc., which we no longer see to anywhere near the same extent today. The period before these complications arose was described by doctors as a ‘honeymoon’ phase, which quickly gave way to more severe conditions.

Great progress has been made in modifying the effects of L-dopa using various combinations of medicines, and we no longer see these conditions; although fluctuations involving dose gaps and hyperkinetic episodes do develop over time, the aim is that, for the majority of patients, these should not occur within 5, or rather 7–10, years, by which time a stable, non-fluctuating therapeutic effect is intended.

The ‘honeymoon period’ thus referred to a period during which the therapeutic effect of (a type of) medication was effective and free from complications. Unfortunately, this persists in the seriously mistaken belief that L-dopa only works for a limited period (5 years!) and that one should not start treatment with L-dopa too early, as it only lasts for a short time. This is incorrect, and the professional recommendation is to start treatment upon diagnosis, as the disease has already been present for several years. However, it is necessary to combine different types of medication to avoid dose gaps and other complications, and the doses should be ‘optimal’ and ‘individualised’, i.e. tailored to symptoms and effects.

A very readable medical article in English has recently been published on the concept of the ‘honeymoon’ (honeymoon phase), which also quotes patients who, like the enquirer, find no connection whatsoever between a ‘honeymoon’ phase and being diagnosed with Parkinson’s disease.

It is therefore an outdated concept that now only leads to misunderstandings and paints a picture of drug treatment that is no longer accurate, but was very much the case around 50 years ago.

Håkan Widner