Parkinson’s: What can I do about tiredness and dizziness?

How long have you been diagnosed with Parkinson’s?

fern123, you might talk to your doctor. You've been on a low dose of Escitalopram for 40 years. It might help to raise the dosage or to switch to another SSRI. Sometimes this type of medication becomes less effective or ineffective over time.
Fatigue may be a part of Parkinson's worsening with akinesia. Which excuses a slight shift away from your question,
The research regarding Parkinson' s is getting interesting. https://www.parkinson.org/blog/science-news/2024-top-science-news#:~:text=A%20study%20found%20that%20the,too%20much%20or%20too%20little.
I'd be looking at focused ultrasound. https://www.fusfoundation.org/the-technology/treatment-sites/?country=United%20States&indication=Parkinson%27s%20Disease

Welcome, @fern123. I moved your question to the Parkinson's Disease support group here:
https://connect.mayoclinic.org/group/parkinsons-disease/
I see that you having also been taking escitalopram, an SSRI antidepressant, for 40 years. Do you take any medication for Parkinson's? Have you asked your doctor to do a medication review?

A medication review is always a good idea, especially if you're taking lots of meds. For examplle, som edrugs for ostopoenia should only be taken for 5 years because they can make your bones brittle. But if that's just a recent discovery, your doctor may not have known it when he first prescribed it. and I would doubt that they have the time/staff to proactively look at every person's medications and find out things that might affect them on a regular basis. It's easy enough to put an annual review on my calendar and do it once a year.With the shortage of doctors, we need to find ways we can help them help us.