Psychiatric Drugs for Alzheimer's patients

@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