My 89 yo Mom recently had her lexipro dose increased from 5 to 10 to combat some paranoia and other behavioral symptoms, due to some cognitive decline. and those have mostly disappeared, but 4 weeks since change and she’s experiencing waves of sadness/crying. Random times of a day. Once or twice daily. Tough to watch as a son/caregiver. Any experience w this ? Thx for your feedback.
A UTI often presents as a behavioral problem in the elderly.
Is there any frequency or urgency needing to go to the bathroom?
At 89, your mom's brain is significantly more sensitive to neurotransmitter changes than a younger adult's, making the 10mg dose of Lexapro potentially too stimulating or causing "emotional blunting". Crying spells and waves of sadness can be common side effects of an altered SSRI dose.
Why This Is Happening
Several factors could explain why she is experiencing these waves of sadness:
Delayed Side Effects: While 4 weeks is enough time for her body to adjust physically, the brain's complex response to a higher serotonin level can result in delayed emotional or tearful outbursts.
Dose is Too High: Sometimes, a dose increase can lead to "emotional blunting" (feeling flat) or a worsening of depressive symptoms.
Hidden Underlying Symptoms: Often, when major symptoms like paranoia disappear, underlying or masked feelings of depression or sadness become more apparent.
Age Sensitivity: Older adults process medications much slower, which can make them more prone to emotional volatility when their medication is adjusted.
Action Steps to Take
Because she is experiencing these symptoms frequently, you should take the following actions:
Call Her Doctor Immediately: Report these random crying spells and waves of sadness to her prescribing doctor or geriatric psychiatrist.
They may need to decrease the dose back to 5mg, try a different dose, or recommend a different medication.
Keep a Symptom Log: Note the exact time, duration, and any triggers for the crying spells to help the doctor evaluate if this is an environmental reaction, an adjustment period, or a true adverse side effect.
Monitor for Severe Side Effects: Older adults are more susceptible to low sodium levels (hyponatremia) caused by SSRIs. Watch for acute confusion, severe weakness, or unsteadiness.
*Do not adjust her medication without speaking to her doctor first, as sudden shifts in SSRIs can cause withdrawal-like reactions.
If you want to research geriatric depression treatment or resources, consult the National Institute on Aging for more information.
Do not wait to call. Because it has already been 4 weeks since her dose change and these crying spells are happening daily, you have enough information to contact her doctor or geriatric psychiatrist today.
You only need to track the symptoms for 1 to 2 days to get a baseline pattern before making the call. In geriatric care, the rule of thumb is to monitor new emotional volatility for a few days to ensure it isn’t a fleeting issue, but since she is already a month into the change, a prolonged logging period is unnecessary.
What to Track Over the Next 24–48 Hours
When you call the clinic, having a concise 1-to-2-day log will make your conversation highly actionable for the provider:
Timing: What exact time do the waves of sadness occur? (e.g., 2 hours after taking the medication, or late afternoon during "sundowning" hours?).
Duration: How long does each crying spell last? (e.g., a quick 5-minute burst or an hour of unyielding sadness?).
Triggers: Is it completely random, or does it happen during transitions like waking up, changing rooms, or when the environment gets noisy?
Physical Red Flags: Is she experiencing increased dizziness, unsteadiness, or a sudden change in sleep?
What to Say When You Call
You can call the triage nurse or doctor right away and say:
"My 89-year-old mother had her Lexapro increased from 5mg to 10mg four weeks ago. While her paranoia has improved, she is now experiencing daily, unprovoked crying spells and waves of sadness once or twice a day. I have tracked this for the last 48 hours and would like to speak with the doctor about whether 10mg is too high or if we need to adjust her treatment plan."
A month is the typical clinical window where doctors evaluate dose adjustments in older adults. They will appreciate that you have a brief log ready, and they can safely advise you on the next steps without risking SSRI withdrawal.
To help me give you more relevant information, what time of day does she take the Lexapro, and have you noticed any changes in her walking, balance, or sleep since the dose went up?