depakote as a mood stabilizer instead of atypicals?

jen ht

Dad's NP at MC calls me to check in from time to time. She has mentioned depakote as a mood stabilizer instead of atypicals due to the black box warnings on atypicals. Dad has been here for almost 4 months. Her concerns for him are related to agitation and irritation - sometimes with another resident and sometimes in general about his home care/hurricanes/not wanting to be there (in MC). Redirection is sometimes helpful. He also stays in his room a lot more now. Celexa is on board as an addition when he arrived at this MC. He came here from his previous MC in another state (2 months there) with lorazepam. She would like to eventually lower that one, but doesn't want to lessen it while still seeing agitation and irritation.

I am watching for other frustrations (pain or irritants that might be improved) in the meantime. We have a dental appt for a broken tooth tomorrow. His hearing aids gave out (they are very old - surprised they lasted as long as they did) and we have an appt for new hearing aids in a few weeks. His rhythm monitor that sends message to communicate with his EP in his previous state has started beeping more than it should and turns out he is due for a power source replacement. We have an appt with an EP in late November. The director of nursing at the MC is concerned that not replacing the power source could lead to a host of other problems for Dad.

So far I have only taken him to 1 other Dr. appt. We don't go out of MC for other reasons.

Thoughts or input on depakote and/or other things? I know the biggest victory is that he is closer to me and in MC - which means that he is safe.

Thanks in advance,

jen

M1

I absolutely think the depakote is worth a try. There are issues with it that in my mind are equivalent to the black box issues with the atypicals ( levels and liver function need to be monitored), but there are plenty of folks here who've had success with it.

The other issues are more complicated. Will he be able to use hearing aids reliably in MC? There are plenty of stories of them getting lost, thrown away, or staff just too busy to bother with someone who can't monitor them independently.

The pacemaker (or defibrillator?) issue is even more difficult. I would ask the EP doctor for an opinion on what might happen if you don't replace it, but this may be somewhat akin to asking a barber if you need a haircut. I'd think hard about it though. A lot depends on why it was put in in the first place. If it was a defibrillator to prevent sudden cardiac death in the setting of heart failure, i personally wouldn't replace the power source in someone with advanced dementia.

jen ht

Thank you @M1 ♡

Truly appreciate your input.

gracias,

Jen HT