Remeron (mirtrazapine) vs Trazodone

Quilting brings calm

Anyone here have experience with Remeron?  I called the family doctor this afternoon  because we couldn’t wait for the first neurologist visit next week. Mom cries all day, every day, complains incessantly about burning in her feet and fingertips, still complaining  about the irritation in her private area( that has been biopsied and is nothing but irritated skin). So the doctor said to stop the Trazodone and go on Remeron. It will probably be the generic equivalent of it. 

I took Dad to the cardiologist today and visited with Mom when we got back to the ASL. 

 Today was worse than even the last couple weeks. She told me she ‘just wants to go home’( that’s new) and that she just wants to die( she’s said before she doesn’t want to live this way). It’s the first time she said it as ‘I want to die’ though. 

We are up to 5 calls between noon and 5pm ( I saw her between 1-2).  That’s not counting the last two that were calls after  I put her on hold and took the call from the nurse returning my call.  The noon  call was while Dad and I were still in the doctors office. That happens every time I am at the doctor with Dad. 

So does Remeron work better than Trazodone for anxiety and depression in people with dementia?  I believe it’s going to be the pills rather than the dissolvable Remeron sol tab. Not sure since my phone kept beeping with the calls and the voice mails while I was talking with the nurse. 

Also- what do you tell your LO with dementia when they obsess about whether or not they will run out of money?  She will eventually, but she won’t be in our reality by then. 

MN Chickadee

My mother takes Remeron for sleep. I suppose it may help with anxiety, though I wouldn't know because she's asleep! It works well for her at night. 

Given your LO appears to have hallucinations of pain and itching (I know you have posted before of looking for for physical causes and come up empty with the doctors) I would find a geriatric psychiatrist or a regular psychiatrist who has experience with dementia. This is way beyond a primary doctor's wheelhouse. 

Quilting brings calm

MN - it’s supposedly an antidepressant, just a different class  than Sertaline or Trazodone. Also supposed to treat anxiety.  Just wondered how well it worked on people with cognitive issues. 

She has a consultation  scheduled with a neurologist at a memory clinic next week, referred by the PCP. Just couldn’t wait until then as she was so miserable.  Will ask the neurologist about a psychiatrist. She had one visit with at a geriatric psychiatrists office  early 2020 ( prior to Covid restrictions) and refused to go back, so it will have  to be a different one. 

I don’t know that the feet and fingertips are imaginary- no tests  have been run to see if she has neuropathy. Neurologist should be able to do those tests.  I just know that a GYN determined  there was no issues with that area. 

I agree her family doctor has reached the end of his expertise in certain areas. 

Quilting brings calm

So, the medication was delivered to the assisted living center yesterday. The LPN went into  my parents apartment, and retrieved my moms blister packs of medication from the locked cabinet  so she could swap  medications.  mom saw her.  

Since then I have had 4 phone calls from mom about the medication switch. Two last night. Two today.  Ever tried convincing a dementia patient that it’s ok to stop taking  a medication that doesn’t work and start taking one that might?  Ever tried convincing a dementia patient that one dose of the new medication does not a cure make?   I think these conversations total an hour on this one topic and I got nowhere. Redirecting didn’t work either. Mom also would not  admit that she has been crying for weeks…as she was crying. 

This afternoons phone call was so bad that the director called me afterwards and advised me to quit answering mom’s calls for a while. 

Rescue mom

It’s so hard to realize that we cannot “explain” to them or “reason with” them anymore. That part of their brain is broken. They cannot be reasoned with. It upsets and frustrates them, and exhausts you, when you undoubtedly need your energy for other things. 

You just do it. Don’t tell her, just include the new med with others. Or if she notices,  tell her it’s better,  or digests easier—whatever simple reason, maybe a fib, works best for her. But no need to belabor it, or explain in detail. She can’t comprehend that anymore.

My mother also worried constantly about money, and during lucid moments in the last few years, also regularly said “I want to die.”  She needed soothing and reassurances she’d be cared for, then a distraction. Anti-depressants/anxiety meds helped a lot. About money, everyone told her everything was fine  and we’d take care of her no matter what. Then a distraction. Kept it very short and sweet, then distract her.

The constant phone calls can be managed or limited with controls on the phones. As you said, they go nowhere—you can no longer explain, nor “convince” —and prolong her upset. The staff director gave good advice. If there is a serious problem, the staff will call you.

This all sounds very typical of disease progression, and as someone else said, way beyond a family doctor or PCP. She will undoubtedly benefit from a geriatric psychiatrist, or a psychiatrist with experience in dementia. It’s good you’re seeing a neurologist next week, they may also be able to offer more help.

As for the Remeron, some people here have talked about using in the past. Like most such drugs, it helped some, and didn’t help others. Sometimes it can be hard and time-consuming to find what works best for each individual. Different people need suffer drugs.

Battlebuddy

I agree with above poster that the right drug cocktail needs to be fitted to each person. Remeron was the first drug my husband was put on . He wasn’t sleeping well at time of diagnosis and would wake up with anxiety. Probably also depressed. It has served us well for 5 years. He sleeps very well. The neurologist recently upped it and I felt like it took 4 weeks to kick in . Like many antidepressants so give it time

Quilting brings calm

Rescue and Battle, you sound like you’ve both been in my head! Thank you for validating me. I appreciate the support as I am definitely not a natural caregiver. I worked hard at it for my children (and I think I did well with them), but it’s so much harder to attempt it with my parents.   

I need to get much better at the deflecting and redirecting techniques.  It’s just so engrained in me to answer questions when I’m asked them. But answering the same question countless times in the same phone call isn’t working LO,  obviously. 

It would have been nice if the LPN had tried to make the switch an hour later when my parents  would have been at dinner.  But she probably was due to leave work before that. 

Mom is not the first member of the family to be on antidepressants, and she was on Prozac before this all started a  couple  years ago.  She asked to be taken off them spring 2020. That was, of course,  not a good  solution.  Later PCP put her on Xanax and then Trazodone.  Now we are making this switch.  I agree it will take a few weeks. 

Despondent

https://alzconnected.org/discussion/comment/104283#Comment_104283

It amazes me how somethings are remembered like seeing nurse switching drug packs but then forget something you told them and want them to remember!