If YOU had to pick a med for your loved one...

As an internist i am shocked that the provider did not give you more guidance and that he turfed that important discussion to the pharmacist- both are completely inappropriate and i would be looking for a new doctor right away. Complete BS in my opinion- making that decision is his/her job, not yours!!!! That said, from what you're describing she probably needs an atypical antipsychotic like Seroquel or Risperdal to have any effect on the delusions, Zoloft and gabapentin aren't likely to improve those. Assuming no contraindications I would have started Seroquel first. I'd forget about the gabapentin, relative and Lamictal are the anticonvulsants that are useful in some cases but usually reserved as second line drugs for difficult cases.

you always have the option of taking her to the emergency room and asking for psychiatric evaluation and admission. Hospitalization is not easy but she may get stabilized faster in an inpatient setting. I suspect that's your best bet given that this doc is not giving you appropriate help.

Caregiver here— I agree with the others. Pharmacists are great around knowing side effects, interactions and ways in which a medication can be given, but drug options should be in the hands of a specialist physician— ideally a geriatric psychiatrist if you can access one.

Hallucinations call for an atypical antipsychotic. We were Team Seroquel for dad. These do have the scary Black Box Warning but given at the lower doses used in dementia are very effective for improving quality of life for the PWD and those who care about them.

Dad was already on an SSRI (Prozac) when diagnosed and we did increase that initially, but it wasn't enough for the anxiety and agitation. Seroquel was what did tamp down dad's delusions and his hallucinations (auditory and visual); the former were upsetting for him, but he never seemed troubled by his hallucinations (often friends or relatives). Zoloft might bring some improvement, but it could take a month or more to get a sense of what you can expect from it.

Gabapentin seems like a Hail Mary in this situation. It can impair cognition further and cause dizziness which increases fall risk. I wouldn't bother with this one.

HB

Gabapentin is for nerve pain- such as neuropathy. I was told it does have ‘some’ antidepressant value. I doubt it does anything for delusions, hallucinations etc as it doesn’t alter brain chemistry. It can make people drowsy and unstable on their feet. I wouldn’t use it unless she had nerve pain.

You need a different doctor. His office should have called you and discussed these medications directly with you. Choosing across categories of medications is a medical decision- not one the pharmacist can make or advise about.

The usual reason for hospitalization is inability to care for her at home under the current circumstances, that she is combative and/or a danger to herself or others. I hope you hold power of attorney for her, it's going to be much easier if you do (if not, you need to get on this asap with a certified elder law attorney, or you may have to file for guardianship, which is a harder process).

I agree with you on inappropriateness of doc. Outrageous! If the doc wanted to include family input, that should have happened in a discussion with doc so that an informed decision could be made, questions asked. Find a new doc, asap!