Need fast acting relief for agitation.

Arrowhead

My wife, stage 6, has occasional bouts of agitation. Some are severe, some are not; some last long, some are short. I believe it’s not often enough to keep her on full-time medication. I’m hoping for something I can give her near the beginning of an episode that will calm her down. Any ideas? I thank you in advance.

Marta

She is ready for full-time medication. So much better to be proactive. The soonest any oral medication given when she starts to be agitated is 20-30 minutes. She may resist taking medication when an episode has already started.

if you haven’t done so already, read about triggers for agitation (often caregivers are the trigger, me included), and how to de-escalate once an episode has started. Teepa Snow has videos about most caregiver issues on YouTube.

btw:I am a provider who cares for dementia patients. Give her neurologist a call. You can do this.

jfkoc

I agree....look for the triggers and talk with her Dr. Sometimes the best treatment is just listening.

M1

Arrowhead, I'm with Marta on this---ironically, many of the medicines that are given daily--such as the SSRI's like Celexa, Lexapro, Zoloft--and the atypical antispychotics--Seroquel, Risperdal--are safer than the medicines for anxiety that are given on an as needed basis. The short-acting medications tend to be benzodiazepines (Ativan, lorazepam, Klonopin, even Xanax/alprazolam) that are not safe, can cause falls, and are addictive. It's kind of counterintuitive. but I agree, give her doc a call.

GothicGremlin

Hi Arrowhead --

I think my sister is just a bit ahead of your wife, and so I've been dealing with this too. She's just started having hallucinations too, on almost a daily basis - but that's another topic for a different thread.

I agree with the others about medications. Peggy saw a neurologist last month, and I had her assessed by a visiting nurse (Peggy's in memory care), and an occupational therapist (Peggy keeps tipping over and falling). We've ended up changing some of her medications. Jury is still out on a couple of other things.

Triggers are definitely a thing now. One way I've been able to overcome it is to play Peggy's favorite music for her, and then sing along to the songs with her. Is there some activity like singing that your wife particularly likes that you can do along with her? In my sister's case, sometimes it's enough to make her forget about the anxiety - at least until the meds kick in.

tigersmom

Arrowhead, I agree with the consensus here. After resisting anything but donepezil for my DH, we started him on a very small dose of generic Celexa a month ago. He had extreme separation anxiety and he was starting to pace a lot in the afternoon. Since the SSRIs, as M1 mentioned, can take up to eight weeks to fully take effect, it is a little early to tell, but I think it's helping and it is certainly not harming. His dose was slightly increased this week. The problem with the short-acting meds, as M1 said, is that they aren't great for people with dementia. In fact, they can cause paradoxical reactions -- they worsen, rather than improve, the agitation and anxiety you're trying to relieve. I am lucky to have a very smart psychiatrist for a niece, and before I started him on this I talked it over with her. She said if it were he husband, she would have started him on these meds sooner. And they're cheap. With my DH's Part D plan, generic Celexa costs $1.36 a month for a 30-day supply. I would definitely speak to your wife's doctor and tell him or her what you're seeing. It's bad for you as her caregiver, but it cannot be comfortable for her to live with the agitation. Good luck to you both.

harshedbuzz

Arrowhead-

We chose to use medication proactively. IMO, it is better to relieve the distress the PWD feels, which may be considerable before you see the behavior, rather than attempt to play wack-a-mole with the kind of medications indicated for acute onset agitation.

Medicating for mood with meds like SSRIs and/or low dose Seroquel (etc) is going to be less sedating in terms of falls and other risks than a Benzo at a high enough dose to restore calm. A low dose cocktail can allow you to use non-medication approaches like validation to calm her. There are the logistics of dosing to consider as well-- if you have a daily routine she's more likely to accept a new pill than if you try to get her to take something in the midst of an episode when she might be paranoid.

HB