Antidepressant usage

JJinVA · January 19

I was wondering about other’s thoughts/experiences with anti-depressant usage in Alzheimer’s patients. For context, my mother is late stage 5. She previously was on an antidepressant though apparently not taking it when she was still living at home. I moved her into assisted living (not memory care yet) a little over a year ago and she was restarted on Effexor then. Sleep and misunderstanding of time has been a huge issue with her to the point that she previously was staying up all night and sleeping all day. While being in assisted living was helping somewhat with a schedule, she was still frequently up in the middle of the night and up early in the morning. In doing some research I discovered that Effexor is known to contribute to insomnia in dementia patients so I consulted with the psych nurse practitioner to adjust medication. She’s been tapering off for the past month and will be done in a week or two. She was also started on Seroquel to help with the sleep. From what I can tell the sleep is mostly better except for a couple days here and there. She seems less agitated unless something out of the norm is coming up like a doctor appointment she has to go out for or a friend wants to have lunch with her.

The NP approached me the other day to confirm that the Effexor would be done soon. But then she started talking about putting her on another antidepressant right away. It got my back up a little because I hesitate doing too many changes at once in case there are any changes physically, cognitively, or emotionally as it hinders the ability to isolate the potential cause…meds vs. Alzheimer’s kind of a thing. I also wonder how much antidepressants actually work in dementia patients while the brain is actively deteriorating. I certainly want to make her life as comfortable as possible but I don’t want to overmedicate her to the point that she’s a lump in a chair.

I would appreciate any thoughts/insights/experiences that can help me figure out the best path forward.

pamu · January 19

My mom (87) has been in MC since Sept 2025. When she was admitted she was on a low dose of Velafexine for mood/anxiety prescribed by her PCP. She refused to go back to her geri-psych doctor (she doesn't believe she has dementia) but after a hospitalization then placement in MC they've increased her dosage of Velanfexine and added Remeron in October when her anxiety and negative behaviors ramped up from agitation, depression. The geri-psych at the facility said she does not think mom needs Seroquel or another type of anti-psychotic right now (cautious due to fall risk) but they are keeping a close eye and make increases to Remeron if/when needed. The addition of Remeron has definitely made an improvement to mom's mood and well being. She still has ups and downs but they're not as drastic. It has not made her groggy or sleepy during the day. If she has a difficult day and is especially agitated, they will give her Ativan (which she still occasionally has even on the other meds). Do you think your mother needs to be on an antidepressant? There must be a reason the NP wants to continue with a different medication and not just stop. I'm thinking her NP will use caution and add medications slowly and a low dose to start. If you are against it, I would communicate your hesitation to find out what the benefit would be.

H1235 · January 19

In my experience an antidepressant can definitely work for a person with dementia. My mom switched antidepressants and it was awful. The tapper off one and slow increase of the other had her an emotional wreck. Now that she is up to a good dose on the new medication she is much better. Her doctor spent months on this. She increased the dose of the new medication excruciatingly slow. I would look into it a bit, but it’s my understanding that seroquel is more of an antipsychotic vs antidepressant. I do know it can also help with sleep. I was told seroquel can take weeks to take full effect. I agree with you that starting another medication so soon might make it difficult to tell which one is giving her relief or causing her problems. If she is still having some anxiety I think I would definitely consider an antidepressant. Maybe talk with her doctor about possibly holding off for a bit longer so she can adjust to the seroquel. Remember antidepressants are usually started at a very low dose and increased slowly. It will be a gradual process. You should be consulted with each increase dose. When you feel she is in a good place tell the doctor you don’t want any more increases. If she becomes too sedated ask to have the dose cut back a bit. It can be tricky to get things just right. I hope you can find something that works.

JJinVA · January 20

https://alzconnected.org/discussion/comment/263895#Comment_263895

I’m just not sure if she needs to be on an antidepressant for mood but maybe anxiety. I think I just automatically questioned it because I was curious if the NP was saying it as a default because she was on something before. Also when she saw her my mom was still in bed even though it was late morning but my mother has never been a very active person.

harshedbuzz · January 20

@JJinVA

Regarding an anti-anxiety/anti-depression medication:

It's not uncommon for geri psychs to prescribe an SSRI or an SNRI for anxiety along with an atypical antipsychotic like Seroquel. A "cocktail" can allow the anti-psychotic to be effective at lower doses avoiding or minimizing side effects.

HB

Jessilynn40 · February 1

I need some help if at all possible.. my step father who is only 61 years old with alcohol induced dementia ( frontal lobe dementia) was just admitted into a hospital in massachusetts because he was talking about taking his own life and having mild sun downing episodes and it was very hard for my mother being 2 hours away from all support and family to handle his issues all alone and at this point he was not on ANY type of sedating meds and ect expect memory medication.. until he was places in the hospital now he is on trazdone 50mgs 3 tabs at bedtime and in the morning, seroquel 25mg 2 in the morning and 3 at bedtime and Divalproex 250mg 1 tab 3xs aday along with other added meds when they cant control his behaviors .. he now cant form words , slurring his words , hallucinating , very unsteady on his feet , now they have to straight cath him cause he cant pee along with days without a bowel movement , he sleeps all day and is up with horrible behaviors at night so they give him more sedating meds for there safety and the other patients but my thing is there is always a reason for people acting out and could be as simple as having to go to the bathroom or hungry/needing a drink , also new place and people .. i feel all the meds are making him worse instead of better and its a chemical restraint.. i stated that they should have slowly introduced one med at a low dose at a time not all 3 at strong doses all at once .. anyone else have this happen and have any help suggestions or resources to help .. scared for his safety

Antidepressant usage

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