Psychiatric Drugs for Alzheimer's patients

Merla

My parent has stage 4 Alzheimer's.

My parent is in her mid 70s and is not happy with being at memory care which she arrived at 6 months ago. She just isn't adjusting well, won't engage in activities, stays in her room a lot, talks about leaving all the time, is depressed to be at memory care and is anxious. In the past few weeks her emotional state has declined and nothing pulls her out of it, sounds on the brink, talks about how she wishes she were dead and goes through phases of hating everyone and everything. One time when I spoke with her on the phone she sounded like in an altered state like a weird angry voice as if she were some crazy person. She also had one bad morning where she was defiant to staff, highly agitated, mean to another resident.

In any case, she isn't currently isn't taking any mood stabilizers though she has an upcoming appointment with a psychiatrist nurse practitioner. I spoke with her nurse and I was surprised to learn that they often prescribe antipsychotics to people with dementia as a mood stabilizer or anti anxiety remedy even if the person isn't experiencing significant delusions.

In any case I want you one to be prepared for this appointment.

What is best practices for mood stabilizing medication for people with dementia?

I had assumed she would get an ssri of some sort and some type of medication related to anxiety like Xanax if she is in a state of panic.

should I advocate her staying away from anti psychotics? I really think most of her depression and anxiety stem from her being stuck in memory care. Her mood was ok prior one year ago before her whole life was upheavaled. I've heard mixed reviews on antipsychotics but have also heard people with dementia are more likely to have adverse reactions to more traditional anti anxiety medications. She went to the ER because she was uncharacteristically agitated so much they wanted to rule out an UTI and the drs there gave her Olanzapine (Zyprexa) to take as needed until she has her psychiatrist nurse practitioner appointment.

Also my parent is fat phobic to an extreme so I really don't want her on a medication that will cause significant weight gain unless absolutely necessary. I would be highly disturbed if the medication made her not care she was gaining weight to be honest.

I would like to take a conservative approach to medication because it's not an emergency. I'm hoping medication will open her up to engaging more in the community.

amynolla

My mom was put on Serequel and it has made a big difference in her agitation and anger. She takes it in the morning and evening. Her neurologist tried to wean her off the morning dose but I noticed a big negative difference right away so she’s back to the two doses a day.
My whole goal everyday now is to keep her calm and as happy as can be and the medication seems to help.
As far as weight gain, if she gained a little weight and didn’t care about it then why worry about it. If she’s more comfortable emotionally, then a little weight gain is a worthy trade off in my opinion.

harshedbuzz

@Merla said:

My parent is in her mid 70s and is not happy with being at memory care which she arrived at 6 months ago. She just isn't adjusting well, won't engage in activities, stays in her room a lot, talks about leaving all the time, is depressed to be at memory care and is anxious. In the past few weeks her emotional state has declined and nothing pulls her out of it, sounds on the brink, talks about how she wishes she were dead and goes through phases of hating everyone and everything. One time when I spoke with her on the phone she sounded like in an altered state like a weird angry voice as if she were some crazy person. She also had one bad morning where she was defiant to staff, highly agitated, mean to another resident.

Behavior is communication. It sounds as though she needs help with her mood because she no longer has the cognition to make use of the kind of non-pharmacological strategies she would have had prior ro dementia.

In any case, she isn't currently isn't taking any mood stabilizers though she has an upcoming appointment with a psychiatrist nurse practitioner. I spoke with her nurse and I was surprised to learn that they often prescribe antipsychotics to people with dementia as a mood stabilizer or anti anxiety remedy even if the person isn't experiencing significant delusions.

This is true.

In any case I want you one to be prepared for this appointment.

What is best practices for mood stabilizing medication for people with dementia?

I had assumed she would get an ssri of some sort and some type of medication related to anxiety like Xanax if she is in a state of panic.

My dad was on a cocktail of medications prescribed by a geriatric psychiatrist. He was already on a SSRI, but it wasn't cutting it. Dad was still anxious, angry and nasty. The geri psych added a low-dose antipsychotic which dialed these feelings back enough that we were able to mostly redirect and validate when behaviors popped up.

should I advocate her staying away from anti psychotics?

IMO, no. Antipsychotics work well at very low doses, and they work much more quickly than an SSRI would. It can take a month or more to know what sort of benefit an SSRI might have. If the med isn't working well, than you have a period of weaning off the medication before trial another SSRI. There's also some thought that the disease process in the brain impacts how meds work. With dad, it got to a point where the SSRI alone wasn't cutting it.

I really think most of her depression and anxiety stem from her being stuck in memory care. Her mood was ok prior one year ago before her whole life was upheavaled. I've heard mixed reviews on antipsychotics but have also heard people with dementia are more likely to have adverse reactions to more traditional anti anxiety medications.

It's hard to say. IME, some PWD lose the capacity to be happy or even content regardless of where they are— the dementia causes this, not necessarily a MCF. My dad was agitated and aggressive even before his late diagnosis while living in his own home with mom catering to his every mood. My aunt got upheavaled (love that term) out of her ocean front cottage into a suburban MCF and positively thrived. A dear friend put aside her own life to be mom's 24/7 caregiver and her mom was non-stop cranky.


She went to the ER because she was uncharacteristically agitated so much they wanted to rule out an UTI and the drs there gave her Olanzapine (Zyprexa) to take as needed until she has her psychiatrist nurse practitioner appointment.

I really don't like the "as needed" approach to medication in dementia. I prefer proactive, rather than reactive care. Caregivers end up playing wack-a-mole with mood waiting until a PWD is so agitated the dose being given is generally insufficient for the level of dysregulation. And it's worse in a facility where different shifts may have different ideas about when the med is needed.

Also my parent is fat phobic to an extreme so I really don't want her on a medication that will cause significant weight gain unless absolutely necessary. I would be highly disturbed if the medication made her not care she was gaining weight to be honest.

Weight gain is generally dosage dependent. The doses used for those with schizophrenia and even bi-polar disorder are much higher than those given to most PWD. For Seroquel, the medication dad took, the dose range for schizophrenia is 400-800mg; dad took 25 mg twice a day.

TBH, in late-stage dementia, weight loss is the enemy. My aunt went from 150 on admission to MC to under 80lb when she died. Dad lost so much weight in the final weeks of his life that his gender wasn't apparent.

I would like to take a conservative approach to medication because it's not an emergency. I'm hoping medication will open her up to engaging more in the community.

An ER trip for agitation seems emergent to me. I would keep an open mind during the appointment and discuss the pros and cons of the different options including how long before your mom has some relief from the feelings she can't regulate.

The other piece is that even if mom lands in the lap of a terrific prescriber and you're able to extinguish her anxiety and agitation, you may not overcome the apathy that is part of dementia. Dad's doctors were talented and creative but neither found a medication or behavioral approach to get him to engage when he was at home or in the MCF.

HB

H1235

Moms anger issues started when she was diagnosed and she was told she couldn’t drive or Live alone. We tried increasing the antidepressant she had been on for years, but that didn’t work. For a short time we added an anti seizure medication off label to stabilize her mood, but it did nothing. She also heard the doctor prescribed it and was not happy. She she she doesn’t have a #*$& problem with her mood. Then we took her off the antidepressant she had been on for years and tried a different one (Amitriptyline). This was a very ugly process. She had to be weened off the old and the the dose on the new was increased very very slowly. Mom was an emotional mess through this process. After several months she was finally feeling better. She was still not happy(at least with me), but she wasn’t crying and she would actually talk to me. I’m really not sure it was worth changing antidepressants. Now she is in a snf and is depressed and mad again. No one has suggested antipsychotics yet, but she is depressed and mad. She is not screaming and physically combative. Although she has thrown out the f bomb, but only at me. It is so hard to know what to do.

SDianeL

Ditto what HB said. Dementia causes depression and anxiety. She would probably be that way anywhere. Many people with dementia who live at home say they want to go home. To them home is a feeling not a place. Soon your mom won’t remember where she used to live if she hasn’t already forgotten. Also many PWDs don’t socialize or interact with others for many reasons. The facility may be encouraging her but it may not work. I would speak to the nurse there. She definitely needs medication in my opinion.

Merla

Thanks for your thoughts.

My parent is usually kind and sweet and polite to staff so her being defiant and agitated was a dramatic change but I don't think it was severe agitation by any means. However consented to the ER trip because her behavior was escalating in the past couple of weeks.

Im hoping medication can help her adapt to memory care better. She is so dead set against it so engaging her in activities is near impossible. I do think dementia has decreased her ability to be happy but this acute depression and anxiety is related to being in memory care. Her memory care has a lot to offer so I'm hoping some type of medication helps.

Chashmad

My mom was similar. Serequel has helped her significantly. She takes it twice a day.