Seroquel for non violent delusions

Even if the delusions are not causing her to be agitated and visibly upset they may still be causing her problems. She may not be expressing (or even hiding) -her grief, that she is feeling overwhelmed, or that she is worried in some way about these delusions. Is she one to keep her worries and emotions private? If sundowning is involved it’s possible things hit her harder in the evenings when family is no there to see her. I think it might not hurt to see how she does on the seroquel. Keep in mind it can take a week or more to take full effect.

Seroquel seems to be commonly prescribed for people with dementia—at least I have seen a lot about it on this site.

My dad in MC has been taking it for several months to manage agitation, and it does seem to have helped without noticeable side effects—although he is anxious on the best days, so the meds have not fundamentally altered anything, just taken the edge off. I was worried about his taking it at first but have become less worried over time.

You could try starting with just 25 mg/day and see how it goes. If she seems woozy or sedated, she can always stop taking it. We had the same concerns when we started my mom on it but she’s been fine.

25 mg once daily is a low dose. I would try it to see how she does. You can search this forum for Seroquel. And read all the old posts if you want. The search thingy is at the top of the page.

@Merla

A couple of thoughts.

Seroquel, along with the other atypical antipsychotic medications, does carry a Black Box Warning for increased risk (I've seen 1.7 times vs placebo) of death. The increase seems to be around cardiovascular events or infection.

That said, Rexulti does have FDA approval for use in dementia and carries the same Black Box Warning. The difference is that Rexulti did the required trials to get the dementia indication and the makers of Seroquel did not as it is already available as a generic so the investment in getting the FDA approval would be pointless.

Any medication decision needs to be made in the context of a PWD having a terminal illness. If she has delusions, she's likely mid to late stage with a life expectancy that reflects that.

Do the delusions distress her? I can appreciate that it is hard to have the same loop of nonsense conversation with your LO, but if she's looking forward to her wedding or dreaming of what she'll do with her money maybe it's best to join her there. Of course, if she's fretting that she was jilted or thinks someone is trying to take her inheritance that's different. Who brought up the delusions? Is it something you brought up with her team, or did they bring it up? Once a PWD moves into care, sometimes they will showtime for their close family.

Has the NP offered or trialed any other medications? If this is an anxiety driven behavior for her, an SSRI might help. The downside here is that this class of medication can take about 6 weeks you know what sort of benefit it offers her. It has to be increased slowly and weaned slowly if discontinued. The atypical antipsychotics do start to work faster with full therapeutic effect in a month and can be discontinued without weaning down.

Dad's delusions were mostly benign or even pleasant but earlier they were awful for him and, by extension, my mom. He did fixate at times about who was alive vs dead. His reactions seemed very different than the PWD who broke down upon hearing of death of a parent decades ago as if it was the first time. He seemed kind of flat emotionally about the deaths of even people close to him; it was like he was taking attendance. When he could recall that my younger sister (his favorite human ever after himself) had, in fact, died he was oddly blase about it. IRL, her death broke him and caused the spiral that led to his ARD diagnosis.

We did opt to give dad Seroquel for his agitation. He started with 25 mg in the evening which reduced his sundowning and led to less fractured sleep. After 6 months, he started to take a second 25mg with breakfast to tamp down the sundowning which was starting earlier in the day. We did notice that it made him sleepy the first 5 or so days until he was used to it. It does seem to increase fall risk for some people.

Good luck.
HB

Hey Merla, my wife started at 50mg a day several months ago and we are now up to 150mg a day for her severe agitation which I’m not sure is doing anything at this point. I’ll just toss a couple things out. Yes, it can make them drowsy at first. But I think it’s less as time goes on. Everyone is different. It is considered the least harsh of all the antipsychotic drugs. That’s why it’s always the first choice. 25mg is the lowest dose. And anything up to about I think 150 mg is considered in the low dose category. I dunno. I would weigh how much these delusions really bother her before doing it. The road to hell is paved with good intentions. I think a lot of us who’ve had experience with several drugs have high frustration when it comes to meds. There’s no denying there will come a time. Just make sure you’re getting the straight story.

My mom started 25mg of the generic Serequel a few months ago. Then she went to 50, then 100mg. She was in the hospital a month ago & they bumped it to 200mg. It does make her drowsy but it's given at night & she's not drowsy during the day at all. Otherwise there are no side effects so far.