Can someone who has experience with the elderly and antidepressants share insight?

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glazgogirl Asked August 2013

Can someone who has experience with the elderly and antidepressants share insight?

My father has vascular dementia, which has mostly affected his short-term memory. He has had 3 stents put in over the last 5 years, one of these was in June. He is on Crestor, Namenda, Atenolol, Clopidergrel, Low Dose Aspirin, & Donezapil and he has a pacemaker. He has been depressed for many years. Long before his heart problems occurred--I am inclined to believe the depression contributed to his heart problems. My mother has had two major surgeries on her spine in the last 6 months and they have been living with me while she recovers. At first he was determined to get home, but he has accepted that its not going to happen for awhile yet. All he does is sleep anymore. Sometimes he reads. He barely eats. I am sure some of his lethargy is a side effect of his medications, but not all of it surely? He has almost no initiative. What I am wondering is given all his medications, would an antidepressant be of any help to him? He will be 80 in a few months. He has been an active man all of his life, with many passions like gardening and cooking and friends and he's just kind of . . . stopped. He is not hard to care for. I just know he would feel so much better if he took a walk now and then and moved his body, but I also know I can't make him do anything. Am I just trying to find a way to change something that cannot be changed?

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score 0 · Answer 1

I most definately agree with the majority of the commentors. Your father is on WAY TOO MANY DRUGS. His cardiologist should be the one that controls what he needs for his heart. Other than that...my mother has been on Paxil for almost 15 yrs. She recently was prescribed Namenda to slow down her Dementia and her Primary is taking her off the Paxil. Your father would benefit by seeing a Geriatric Pscy...(a young one) and let them determine whether your Father would benefit from an anti-depressant. Yikes when I read those meds. Keep us informed on how your plan works out...

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score 0 · Answer 2

ferris1 - Donepezil is generic for Aricept.

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score 1 · Answer 3

Thank you. We've got him down to 3 meds.

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score 2 · Answer 4

Your father's medications send up a big red flag. Namenda, Aricept, and a cocktail of 15 other medications caused my mother to go into renal failure which then caused a debilitating stroke. If your father's current physician and psychiatrist do not thoroughly review and reduce your father's meds, then you (if you're DPOA) or your father have the right to request a new physician and psychiatrist. A reduction in meds brought my mother out of Hospice. Good luck to you and your dad.

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score 0 · Answer 5

pstiegman , Thank you for that information. I have and continue to research this and antidepressants trying to find an answer. Before all of these drugs it seems as though senility was rare. My own grandmother was sharp as a tack at age 91 and never took a pill . They didnt even do cholesterol testing back then. What do you do, do you believe in not taking them, just curious. I saw on Dr Oz that people have heart attacks on or off it and didnt seem to help being on them. I also wonder about pravastatin. Look on amazon and write in "lipitor" under books, you'll be shocked. Thanks again, all info taken into consideration.

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score 1 · Answer 6

Ferris, check it out on Medscape and the FDA website ! :-)

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score 2 · Answer 7

Perhaps pstiegman is confused about myelin sheaths forming over nerve cells. A destruction of them usually causes MS and cannot be restored and mental status declines. Be very careful in offering advice which you cannot back up with a medical degree and license.

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score 1 · Answer 8

That's very interesting. I have been coming to the conclusion, for a while now, that the FDA is not our friend. I will take all of your input into consideration. Thank you.

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score 1 · Answer 9

A widely accepted theory involves myelin. Cholesterol is essential in the formation of myelin. The more lipophilic statins are able to cross the blood-brain barrier and decrease the amount of CNS cholesterol below the critical value necessary for the formation of myelin. Inadequate myelin production results in demyelination of nerve fibers in the CNS, resulting in memory loss. Once the offending statin is removed from the patient's system, myelin stores are replenished and mental status returns to normal. In our two patients, as well as another patient who received simvastatin,[1] mental status returned to normal within 1 month of discontinuing the statin. (source: medscape)

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score 0 · Answer 10

reverseroles: follow link, look at brain images. http://www.sciencedaily.com/releases/2013/05/130510150143.htm
The FDA issued warnings early in 2012 and then, after pressure from the drug manufacturers, issued another statement saying the benefits out weigh the risks.

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score 1 · Answer 11

Tapering off is better, and reduce only one medication at a time. Start with the aspirin, because aspirin and plavix should NOT be combined. Wait a few days, then taper another and be alert for changes in his mood. If you can get the Crestor down to 20 he might perk up. This is not a permanent repair, because vascular dementia continues to progress.

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score 0 · Answer 12

pstiegman, where did you hear that over the long term statins cause dementia to worsen? My doctor and my sons doctor both told me that was untrue. I believe it IS true and I wonder if lipitor is what caused Moms dementia to begin with. Our Dr said it helps dementia by clearing out arteries. Funny thing, every old person I know that has their mind never took statins. If you look on amazon a Dr wrote a book on it saying it steals your mind. Interesting, please let me know your thoughts. I am supposed to take lipitor myself daily, I take it 2 times a week and my cholesterol is usually the same as always. I researched and read that Pravastatin doesnt pass the brain barrier and is the best statin out there. My Mom was switched to it, now I wonder why.

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score 0 · Answer 13

Both the primary and cardiologist need to be advised of what each is prescribing. That's how over-prescribing occurs when the patient (loved one) doesn't tell one doctor which drugs are being prescribed.

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score 0 · Answer 14

I think she means Clopidogrel (Plavix) and Donepezil (Aricept). I don't think I would add any, but I would consider cutting back on the aspirin, which can block the other medications, and minimize any statin drugs, like crestor, because over the long term they increase dementia. Consider spacing medications out an hour apart if possible, and always start with the dementia drugs first, then give the cardiac meds. I have a sister who is epileptic, we always give the seizure meds an hour ahead of the behavior meds, and the cardiac meds after that and we never never give her aspirin or calcium first, or else seizures increase. Timing is very important.

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score 1 · Answer 15

Thank you so very much! Mom is going to call his doctor tomorrow. His primary only prescribes the dementia meds. He has a separate doctor for his heart. THANK YOU!!!

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score 2 · Answer 16

Now that I have the correct spelling of those other two drugs - Donepezil which is Aricept another dementia drug like Namenda and also sedating, and Clopidoqrel - which is an anit-platelet drug used in heart patients, I can now answer. Both Aricept and Namenda will do nothing to reduce dementia and they are both sedating. The other drug is for his heart condition. Both heart medications should not be causing the sedation, and should not be stopped. Both Aricept and Namenda can be stopped because they are just bandaids for dementia. My suggestion is to ask his doctor to take your father off all drugs that are unnecessary for his heart condition. You can reduce the cholesterol through diet and again, dementia is a terminal condition. Best wishes...

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score 0 · Answer 17

Wow. I spoke to Dad's doctor a few months back and asked about getting him off the Namenda and the Donezapil (Generic for Aricept, I believe--Clopidegril is generic for Plavix). He said we could if we wanted to. He said it doesn't prevent dementia, it just slows it down. So he pretty much left it up to us. I haven't done my research, though, so I was hesitant to take him off them. Your words and suggestions are very comforting and encouraging. Are there any problems with discontinuation syndrome with these drugs? Should they be tapered? I will, of course, talk to his doctor. Your thoughts are useful to me. Thank you again!

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score 1 · Answer 18

My 83 yr old MIL has vascular dementia. Nemenda doesn't do anything for vascular dementia. My MIL would get really angry and be yelling all day long. We had her doctor prescribe some trazadone and that has helped. But she also, like your dad, mostly lays in bed all day. She does eat, and forgets she ate 2 hours later. lol. But that's common with dementia patients. I would discontinue the Nemenda. Also, it is very helpful is his primary care doctor is a geriatrician. They have training specific to the elderly and have a better understanding of their needs.

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score 0 · Answer 19

I could not find drugs Donezapil or Clopidergrel, so cannot comment. I am familiar with Crestor (hypercholesterolemia) which caused my husband's legs to cramp so badly - took him off; atenolol (hypertension) needed; Namenda is not going to slow the progression of dementia and does cause sleepiness, constipation, etc.; and a 81 mg. Aspirin at night cannot hurt unless he has bleeding problems. A person with a pacemaker needs exercise not only because the heart is a muscle, but the rest of his body will atrophy unless he gets exercise. It is very common for those patients with heart trauma events to experience depression. Most of the drugs (I know) can cause depression because that is the nature of the interaction with doing good, but also can cause bad side effects. However, address all of your concerns with your father's doctor who knows his history better than I, and although I am a nurse I do not want to be accused of practicing medicine without a license. All in all, he needs a exercise program, encourage fluids (mostly water), and eating fruits and veggies to help with the constipating effect of those drugs. My husband is almost 87 yrs., and I took him off everything except a thyroid med. He's in pretty great shape too!

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score 1 · Answer 20

My dad has been on 25 mg of Zoloft since July 2012, and just recently had the dosage "bumped up" to 50 mg. It has worked wonders. He has suffered from depression and PTSD from WWII and neither problem was ever addressed. Once my mom went into a nursing home, my husband, daughter & I have moved into my parents' house as he cannot take care of himself alone any longer. He was extremely combative, had tons of sleeping disorders (still does) and would lock us out of the house. It was horrible, scary and heartbreaking. His doctor thought Zoloft might help and she was soooooo right.

Obviously they aren't a magic bullet and for some people they might have adverse effects, or not work at all. But they have changed the quality of his life, and ours and without them he would have to be placed in a nursing home.

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score 3 · Answer 21

Find a better doctor to step in and spring clean the meds list:
My mom, 90, was on WAY too many meds, as each time there was an incident the old doc would just layer on another one. This year she almost died in the hospital. She wouldn't eat. She was withering away.
The best thing I did: I found her a better doctor and we cleaned up all her meds and took away most of them, some were redundant or interacting badly with others. After a month she was better but still agitated so then we added back Seroquel (mood stabilizer) and Cipralex (anti depressant) in very low dose.

I also investigated natural remedies :
When she was in the hospital I sat with her for a couple hours 2x day and made her slowly sip my special drink: gave her a lot of digestive enzymes (health food store, just open the capsules pour in the powder) in a tasty protein smoothie everyday and it brought her appetite back.
I also insist on plenty of B vitamins, minerals, live culture yoghurt, and all tasty foods.
And playing her favorite music. Fresh flowers. Cheerful stuff.
Now she is much better and walking again with a physio who comes to the house.

PHEW
It has been an exhausting battle, making demands to the medical system, but it's one worth fighting. Don't give up, you can make a big difference.

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score 2 · Answer 22

This sounds good. This is why WE are called caregivers. Because WE CARE. Not to sound angry, but the medical profession is a day to day money making machine. Be proactive, take charge, ask questions.

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score 1 · Answer 23

Thank you all so much for your input, answers, and kind thoughts. Mom and I coming up with a plan.

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score 0 · Answer 24

Not helpful for vascular dementia -- that is.

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score 1 · Answer 25

I would SERIOUSLY question why he is on Namenda, Atenolol, and Donezapil. It is highly unusual, IMHO, to be on more than one of these -- and from what I read, none are very helpful! Maybe take the list to a pharmacist to see what they say. Sometimes the dr. that prescribes meds is hesitant to take a patient off. Or maybe, after hearing from the pharmacist (different ones at different drug stores wouldn't be a bad idea unless you have one you can really trust!), you could ask the dr. if maybe your father was supposed to have stopped the other drugs when he started the most current one?

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score 2 · Answer 26

The traditional medical doctors almost always over medicate, because they do not see what is happening day to day. You need to call the dr. Most likely they can lower or take him off or try something else without SIDE EFFECTS. I took my best friend off all his hand full of meds and got him on all natural cures for pain, bp, kidney health. He got so much better.

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score 4 · Answer 27

My mom has the same thing but is awake in her 90's.I took her off anything that made her sleep and it was great. I would call his dr or get him there, any drug that makes him tired should be changed or taken off of. Are these new meds to him or was he on them and awake before? my Mom takes an antidepressant and its was a miracle for her when she started many years ago, she will always be on it. Try Music and old TV shows and get him off whatever meds the dr says he can get off of. Namenda? Does that work, is that really necessary? My mom cant walk, talk or barely see and I puree her foods and feed her with music on, she is all smiles.Loves to hear me sing and sometimes makes her body wiggle to it. I think there is hope you can liven him up, dont ever give up ok and best of luck to you.

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score 4 · Answer 28

Your excellent question was in today's (Aug. 20) email from AgingCare and thanks for asking it because I think many of us share the same concerns. How much intervention is appropriate to the conditions and how much is us wanting the conditions to be different?

That list of meds is intimidating in terms of adding another one. Something you might change right away is the amount of full spectrum light your father gets. Would he go outside with you for a bit of sun every day. Here in Florida, 10 minutes probably would do the job, and then more depending on how far north. Early morning is best. If he won't go out, there are special light fixtures available. Possibly he has something like SAD -- Seasonal Affective Disorder -- which causes depression because of lack of light.

Blessings to you to overcome your own sadness and to your parents in their suffering.

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Can someone who has experience with the elderly and antidepressants share insight?

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