Agitation and anger and a couple of questions

Anna2022

My DH is starting to have angry outbursts when things don't go his way. It's intermittent but noticeable.

For example, he gets easily frustrated around tasks that used to be easy for him - the TV remote is the most recent source of frustration- he has replaced the batteries several times in the last few weeks, blaming faulty batteries rather than "operator error." If I offer to help, he gets angry at me and refuses any assistance (I have learned to wait until he asks for help, all the while keeping an eye out for escalation)…What can I do to help him manage his anxiety/agitation/frustration around this?

His agitation and anger is short-lived but lately getting more frequent and is produced by more and different events.

He usually has no insight into his issues but last night he had a moment of clarity and said, "I used to be on top of all things, now I can't even use the TV remote."

Is it time for medication help? He currently takes Sertraline but is there something to use as needed if the anger and agitation becomes even more pronounced and longer-lasting? Maybe ask to increase the SSRI dosage now? What meds are indicated for agitation and anxiety? I read here that Seroquel might be an option…Is it too early to have Seroquel at the ready? Is it available in liquid form that I can add to a glass of water? And can it be used intermittently or is it another daily med?

I will contact his doc on Monday but I thought I would ask here for input as well. I manage his medications but we still participate in the fiction that he is in charge … and I know he will resist at needing an additional medication or changing dosages but I'll cross that bridge when I come to it.

Jeanne C.

Definitely discuss with his provider. Seroquel and Risperdal are both atypical antipsychotics. They help with aggression, agitation, obsession, delusions, and hallucinations. If appropriate, the doc should start him on a low dose and gradually increase as needed to be effective. I don't think either can be given as needed, because they need time to build up to efficacy and both require that the patient be weened off rather than suddenly stopping. I believe both come in liquid form.

We've had some success with the combination of Lexapro and Risperdal for my husband with FTDbv. Dosage adjustments have been needed as he has progressed, but we're infinitely better off than before the meds.

I'm hoping one of the medical professionals in the group will chime in.

M1

definitely not too soon to try low dose Seroquel, it would probably help him sleep through the night too. It should be given daily though and not “as needed.”

tigersmom

@Anna2022 , I would definitely ask his doc about the antipsychotics. We are in week 3 of low-dose seroquel, and while it doesn’t seem to be working wonders for DH’s cognition, it has helped with the angry outbursts. Starting dose was 25 mg twice a day, raised to 50 mg twice a day after 4 days. Most of the SSRIs have dosage limits in older people, and DH was already at the max (20 mg) for citalopram (generic Celexa). Many PCPs and neurologists do not want to prescribe the antipsychotics, including DH’s neurologist. I had to find a geriatric psychiatrist who would. So if you get pushback, do as @M1 advised me, and push right back. Good luck to you.

Anna2022

Thank you @Jeanne C. , @M1 and @tigersmom . Your help is invaluable!

SDianeL

My husband started with agitation and anger with the TV and remote also. He had already lost the ability to use a cell phone. About that same time he was having trouble getting his medicines ready in the morning and would get really angry. I told him after the 3rd anger episode that if he did that again I was going to do it. A few days later he brought them to me to do. His Geriatric Psychiatrist prescribed Risperidone at first at bedtime for hallucinations. Once he started the agitation & anger outbursts she increased it to one am/pm. As they escalated, she told me to give him an additional 1/2 tab as needed. It helped. Shortly thereafter I had to place him in memory care due to my cancer diagnosis. The last 2 months his anger & agitation have greatly increased as he entered into incontinence. He curses & physically attacks the caregivers. They increased his medications to the point that he sleeps most of the time and is not communicating when I visit. The doctor is trying to find the right dose where he's compliant but not agitated. Easier said than done. Today we went around lunchtime and he woke up to eat but didn't communicate except I did get an "I Love You" from him and a smile. I'll take it. It's so stinking sad.

Anna2022

https://alzconnected.org/discussion/comment/212245#Comment_212245

@SDianeL So very sorry to hear about your DH issues with anger. I do hope the docs find the right dosage, he must be miserable. And you must be under a lot of stress! Thank you for sharing your insights!

ImMaggieMae

@Anna2022 I would definitely plush for Seroquel or Risperidone. My DH took very low dose Seroquel that was raised a couple times over a months time and didn’t help for extreme agitation. He was put on Risperidone, which is like a wonder drug for him. The one he takes is liquid, measured with a syringe and squirt in his mouth. You could probably mix it with pudding or something but it’s such a tiny amount that I wouldn’t add it to a glass of water. My DH has never resisted taking it. He knows it makes him feel calmer. It’s something that has to be taken daily, usually in two doses. It doesn’t generally make him drowsy.

Anna2022

@ImMaggieMae Thank you for the insight!

harshedbuzz

Seroquel allowed mom to have dad home safely until about 7 weeks before he passed. His geripsych was the most valuable person on his team aside from mom.
HB

H1235

I agree that medicine might be the best route. As far as the tv remote and other things that anger him, what if you found a way to do it for him and allow him to not feel like helpless. For example “Is the tv remote acting up again I had trouble with that the other day. I’m not sure if I can remember how I fixed it but maybe I can give it a try”. If he is struggling to cut up his chicken, cut up both yours and his and claim you’re trying a new recipe. I know it hard to come up with something creative like that at the moment. Easier said than done. Good luck.

Anna2022

https://alzconnected.org/discussion/comment/212299#Comment_212299

@harshedbuzz Your input has been fantastic whenever I see your responses. Thank you so much for sharing your experience, strength and hope.

Anna2022

Good ideas! Thank you!