Medications for mood swings

Sophie Girl

My DH was diagnosed with  mild to moderate dementia about eight months ago.He was put on Rivastigmine.  Which the doctor is increasing slowly.  The last increase in this coming September.   

Other than the forgetfulness the mood swings are bad.  Very volatile.  I asked the doctor if there was something that could help with this.  His reply that the meds for mood swings are very hard on the heart.  He only prescribes them as a last resort.

I was wondering if anyone else have had this kind of problem. And if they have found something that would help.

DW

TheMonck

TThank you for your post.I just agreed to a mood med for my DW and nothing was said about it being hard on the heart.

abc123

Hi Sophie! I’m no doctor BUT I’ve never heard of a doctor saying that. Plenty of conversations here about meds but never heard that. Hopefully the right folks will read this thread because we do have some doctors AND nurses here!

live in daughter

Hi Sophie, what worked best for my Mom was Risperidone. She was on Seroquel but her mood swings were not being subdued. There are side effects for each medication but it was our thought that the mood swings my Mom was going thru were also very stressful on her heart.

She had heart problems but we never had any heart related side effects from her Risperidone. Our goal was for her comfort and we were able to achieve relief for her with Risperidone and for break through anxiety Xanax.

Hope this helps.

​fesk

Did the mood swings start before or after the Rivastigmine was started or after an increase?

Are the mood swings recent? Was bloodwork done or a test done to rule out a urinary tract infection? They can cause mood swings. 

As for medicine being hard on the heart, it would depend on the type of medicine the doctor was speaking about. All medications have different side effects. Antipsychotics are often used for mood swings. They increase the risk for stroke. I have also seen some side effects regarding the heart for these meds or in combination with other meds. That may be what the doctor was referring to. The doctor should be able to explain this better to you. If the doctor is not a specialist, I recommend you consult with one.

Jo C.

Dear SophieGirl, was the physician who told you that a dementia specialist?   Having a specialist as part of the healthcare team is the best practice and really necessary as our Loved Ones (LOs) become highly compromised by their dementia. 

It is true that the antipsychotics can cause an increase in stroke or heart attack, but it is not a given and not always.  There are risks with many meds and our physicians are the experts on what is a risk versus benefit for our Loved Ones with all meds.

NOTE:  I would consult a good dementia specialist such as a Neurologist who sees dementia patients as a routine part of his/her practice or a GeroPsychiatrist.   Personally, I would not leave this solely with a primary care MD nor even with a Geriatrician; but that is just me.  A specialist can also give you an accurate diagnosis for type of dementia present; there are multiple types of which Alz's is only one.  This is important as meds for one type of dementia can be contraindicated in another.  My own LO was incorrectly diagnosed for type of dementia by her Board Certified Geriatrician and it really complicated matters until we got to a dementia specialist and received an accurate diagnosis.

Every person with dementia is different from another; please do consult your specialist regarding the different helpful meds.  My LOs behaviors were over the moon and nothing seemed to help.  My LO also had a history of heart disease, so when the specialist suggested using a low dose of Risperdal, I was uncertain.  I did consult my LOs cardiologist and he saw only very low risk.  Since my LO was living in absolute misery, we decided quality of life was the most important priority.  We moved forward with the Risperdal.

To my utter astonishment, the dreadful behaviors and mood swings with agitation and aggression were vanquished.  At first, I thought it was an artifact, but no; it was truely a change.  NOTE:  Remember, this is only the story of one person's experience, yours may be different.  My LO was on this med for several years until death in her 90's from a different cause altogether.  When we tried to taper the med off, the behaviors began to resurface in short order.

 I can only relate our experience which may not at all reflect anyone else's; again depend upon your physician's/specialists assessments of risks and benefits and rely upon that. 

One thing I learned after much time was that if my LOs dread behaviors were driving me to distraction, imagine how those feelings make our LOs feel - it is a hellish existence for them to feel all that fury and agitation and upset.  If there is a reasonably safe way to alleviate that for them, that is something to look into. Again; do use your physician's assessment including your dementia specialist.

 Best of thoughts being sent your way; do let us know how it is going and what you decide; you can only do what is right and best for your LO in concert with your physicians assessments and judgments.

J.

 J.

  

Jo C.

Rivastigmine side effects information from Mayo Clinic:

https://www.mayoclinic.org/drugs-supplements/rivastigmine-oral-route/side-effects/drg-20065860

If any of these have become an issue including the aggression, this may possibly be something to discuss with the doctor as well as any dementia specialist you may decide to see.

J.

harshedbuzz

DW-

I am so sorry you and your LO are living with this.

It sounds like maybe you talked to your PCP about meds. Ideally, a PWD who is having issues with anxiety, agitation or aggression should be in the care of a geriatric psychiatrist. That is the subspecialty with the most experience in prescribing psychoactive medications for a person whose brain is compromised by disease. Some neurologists can and will prescribe this class of medications. IME geripsychs are more inclined to tweak meds to get the best fit for each patient with minimal side effects whereas both neurologist dad saw took a OSFA approach of 25mg Seroquel at bedtime and "Please don't call me in the morning". YMMV. 

Jo C is spot on (no surprise there) in what she shared about the risks, but you do have to weight quality of life for your LO. Behavior is communication; a person with mood swing is suffering. Extreme mood swings can interfere with providing good care and maintaining safety which can lead to placement at a time when neither person is ready for that.

My dad was a difficult person before dementia-- with it unpleasant was his baseline with swings into rage. But in the office he would showtime like nobody's business which confused the geripsych who couldn't be sure we weren't looking to just drug dad into oblivion. So I purposely riled dad up one afternoon when he was accusing me yet again of selling his house for less than the princely sum he believed it to be worth which was a total delusion. I recorded him threatening me and sent a video clip to his geri psych. 

That said, if your DH is threatening to harm you or himself, he might need to be transported to the hospital in your region with a geripsych unit for a short stay and medication management. It's best to know which hospital that is ahead of time and to keep a charged cell on your person at all times.

HB