What is a good anti-depressant for someone with dementia?
My 86 year old Mom and I have just gone through a very sad experience together. Mom's beloved sister, the sweetest thing in the world who we visited every day at her apt where she lived independently, fell about a month ago. She was alone in her apt. and she broke her hip. During the hip surgery the following day, she apparently had a small stroke. They discharged her from the hospital three days later to rehab. Long story short, a week later she was back in the hospital with pneumonia and CT scans revealed she'd had two more strokes. The Dr. said no hope. Feeding tube was discontinued, and my Mom and I spent everyday at the hosp. w/ her. Stroking her head, talking to her, standing by her as she died. That process took five days. The entire journey has been extremely sad and exhausting. This lady was spunky and fit! We're all just stunned, but the worst is my Mom. She cannot get her head around the reality that her sis is gone. She just can't grasp it. This happened on Fri. night, and I told Mom Sat. morning. Ever since then it's been questions, over and over, the same things, and she desparately wants to see her sister. Mom and I were with her every day, but her son took over in the evenings. That is when she died. He made the decision to have her cremated. She is gone. I keep telling Mom she's in Heaven w/ all of her loved ones. Mom is so down, and sad, and frankly....so am I. Do you think I should call her Dr. tomorrow about an anti depressant, and if so, would you have any suggestions? I know the elderly are sensitive to many meds. Any help would be so appreciated. We're SAD!! And Mom is confused!!
7 Answers
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One thing to consider is that the antidepressant meds take about 4 - 8 full weeks to reach the desired level in your body and you have to be pretty religious in taking them and at the same time otherwise the meds can be either useless or make them more anxious or worse. You have to think about if your mom can do this or if you or someone else needs to be counted on to do this and will. Personally I'd wait a couple more weeks to see how she is balancing out her emotions. Good luck.
In addition, it often results in decline in cognitive and functional capacity over and above the decline that results from dementia alone. Depression appears to have a particularly negative impact on "instrumental activities of daily living," including preparing meals, housework, managing finances, shopping, caring for others, etc.
Clearly, overcoming depression is important for people with dementia. But, recent studies have failed to demonstrate that antidepressants improve depression more than the attention received by participating in a research study.
But grieving is not the same as depression. If Mom did not show signs of depression before her sister's death I think I would wait a while and see if this diminishes. No harm in talking to her doctor about it now, but I think I'd wait before starting a drug.
Is there no memorial service planned? My husband's body was cremated, as was my father's, and in both cases the service was comforting and gave a sense of closure. I don't know if that would have helped your mother to accept the finality of her sister's passing, but it probably would have helped you.
But when a study seems to contradict observed experience, I wonder why. In this case I think that in real life when a good doctor prescribes antidepressants for someone with dementia (or anyone else) he or she watches the results carefully, adjusts dosage and/or changes to a different drug based on the observations. The doctor is aiming for the optimum drug treatment. I suspect in the study one drug was used and probably at the same dose for everyone. But we already know that one size does not fit all. It would certainly not be a surprise to me that the wrong drug at the wrong dose isn't effective.
I have read about studies (one in England, I think) that show Aricept is only effective in about 3% of all cases. By "effective" they meant it delayed entry into a nursing home. But for the caregiver and the patient "effective" is more likely to be about quality of life up to the point of needing skilled nursing care. Also many other studies have shown that while Aricept may have minor impact in Alzheimer's (for which it was developed) it has a much bigger impact in Lewy Body Dementia. If your loved one was among the 3% of AD patients it really helped by the study standards, or if it helped your loved one have a higher quality of life even if it didn't slow down the progress, or your loved one had LBD, you'd not want insurance companies to base their decision about covering Aricept on that study in England.
Studies are awesome and necessary. They don't always prove what they seem to prove and a few studies may not be conclusive and may only indicate the value of more studies.
To answer your question, when my grandma was first diagnosed with dementia the Dr. gave her Zoloft.. at the time he said a lot of elderly patients show signs of depression with the onset of dementia but I know in your moms case, this has been intensified by the sudden loss of her sister. We did notice a small change in my grandma after she had been taking the Zoloft for a few weeks though. Obviously, because of dementia, she was still forgetful and had a hard time wrapping her mind around things, but she did regain some of the interest in her tv shows/crafts/word puzzles after the medication and didn't just sit and zone out all day like she did before the meds.