Depression and Alzheimer’s

@cbender40

Your mom is fortunate to have you looking out for her.

You say your mom was on a "mood stabilizer"; was that an SSRI (Lexapro, Prozac, Zoloft) or something more often used in bipolar disorder like an atypical antipsychotic (like Seroquel) or anticonvulsant (like Depakote or Lacitmal) or old school Lithium? Did it otherwise work well beyond the feeling tired?

Google tells me that the medication prescribed is very expensive; there's a patient savings program but not for those on government insurance. This a compound of older medications with expired patents making them available inexpensively as generics. The first component is the active ingredient in Wellbutrin which is similar to an SSRI but without the common side effect of tiredness. I take this medication myself and have no side effects from it although some people claim it makes them jittery.

The second ingredient is a cough suppressant, if she's ever taken Robitussin she's used this part of the medication before.

I can understand your concerns about the risks of polypharmacy. I have the same with my medically complex mother. One thing I do to lessen the risks is to have her meds filled at the same small independent pharmacy. The other thing I do is prioritize mom's breathing, heart and mood. Given that dementia is a progressive and terminal condition, there might come a time when medications prescribed for prevention (like a statin for most) aren't as critical to someone with a life limiting illness.

When dad needed psychoactive meds, we took him to see a geriatric psychiatrist. They're the experts on this kind of medication for PWD and are often more creative in their approach sometimes creating a cocktail of meds to boost the benefit to the PWD while minimizing side effects. If you can get in to see a geri psych I highly recommend it.

HB

My mom has struggled with depression for a long time. With the dementia diagnosis things got worse. The doctor decided to switch antidepressants from Wellbutrin to Amitriptyline. The process was a nightmare. She had to be weened off the old one and the dose of the new medication was increased very slowly. She was a mess, crying for no reason. After many months she was finally settled into a dose that worked for her. The depression was better, but she was very tired(she had always complained of being tired). We recently had to move her to a different facility. The new place is a bit more experienced with medication and said that she should never have been given her antidepressant in the morning, since it can cause tiredness. Now that she is taking it in the evening she is much more alert during the day and doing well. I think there for a while mom was so depressed she did not want to be alive. In my opinion being tired is better than that. It’s so hard to know what to do. Keep in mind your mom may not be the best judge of whether the medication is worth the tiredness. We did try a mood stabilizer with mom for a short time. She was furious and said she didn’t need medication for her so called bleep bleep mood problem (She has never been one to swear in the past). It did no good, so we stopped it. This is so tough to figure out. I hope you find a solution.

Your decision seems wise. After checking on counter indications with other meds she’s on, I feel like anything that might lighten her mood is better. I was very concerned when they wanted to give my mom trazedone for her anxiety (she wanders/paces all the time and is a high fall risk), and decided tired is better than that anxious. It is helping.

What sucks with this disease is that we can’t make someone better. So it really isn’t about comfort. As long as it doesn’t put her at risk for other medical issues I would say no harm in trying.

My mom takes 10mg daily of Lexapro, and that has helped her a lot with both anxiety and depression. She was on Zoloft for a while, but that just caused her nonstop diarrhea. Lexapro seems more gentle—at least for her.