How do I convince my husband's doctor to use Ativan instead of anti psychotics?

Valium is a disassociative and Lorazepam is not. Lorazepam is simply anxiolytic, fast acting and short acting. Seroquel and Risperidone are very powerful anti-psychotics. The answer may lay somewhere in between, such as SSRI's or SNRI's. I would suggest any prescribing be done by a neurologist with experience in treating Alzheimer's. Guesswork by a general practitioner or a well-meaning family member will be a long trial and error process. Been there. Done that.

Dear Buzzsmom,
Please do not use Risparadol! It is not advised for seniors. It was given to my 86 year old mother, during a short hospital visit, to calm her. She remained on it for several months, which left her with some serious side effects, which included shuffling her feet, and a 'zombie-like' existence. We just couldn't accept the results of what was happening to her. Do your homework! I did, and found out that Risparadol can create nightmarish symptoms for your loved one. Physicians are often too busy to really know the affect that drugs cause. This is an anti-psychotic drug. Once I researched and figured out the picture more clearly with my mother, I pushed to have her taken off Risparadol. Instead of weening her off the drug, which is recommended (and I asked for a slow withdrawal), they cut her off cold turkey! Her symptoms became worse because of the immediate withdrawal! I was outraged!
Finally, after a full week, her symptoms disappeared, and the drug was out of her system. I felt this was truly abusive.
She is now on Zoloft, twice a day, which has worked well, with minimal side effects. Her mood is mild.
Before you have to ride a roller coaster with your loved one, please do your research. Your loved one can't, the medical personnel don't know your family member like you do, and often don't have time to sort through for you, especially these days... We all want our family members experiencing this difficult journey, to be as comfortable as possible, and keep as much of their dignity intact as can be achieved.
Because my mother needed and continues to need a mood stabilizer, we monitor carefully. She may require a change eventually, but we at least feel better prepared and know we're truly doing the best we can on my mother's behalf when we meet with doctors, as we're armed with information. Good luck!

Since you are not a medical doctor and cannot write prescriptions, why do you think Quetiapine (Seroquel) would be bad for your husband? Sounds to me like your husband has been misdiagnosed for 75 yrs. with a mood disorder and was not adequately nor correctly prescribed an anti-psychotic. Lorazepam just sedates and does not correct or rebalance the brain's chemistry. Seroquel does that without having the dependent characteristics. The dose has to be low at first to see if he can tolerate it. The others who have written about their own personal stories of psychiatrists trying one med after another and then "cocktails" is EXACTLY how one finds the "key" to unlocking the brain's mystery BASED ON THE INDIVIDUAL. The brain is very complicated, and we still know very little of how it works, and it takes time to get the right formula and combination for your loved one. Ativan is NOT recommended for patients with mood disorders and what you are describing with hallucinations, etc. is a mood disorder. Coupled with the vascular dementia makes his brain have a really hard time communicating by neurotransmitters. Having had a mood disorder for almost 65 yrs., I can tell you as a nurse, let the doctor earn his degree. Try the Seroquel and if hubby doesn't tolerate it, then try another. You have to be patient when dealing with an unknown set of variables. Just so you know, the Gold Standard for mood disorders is still Lithium Carbonate, used in Europe long before it was approved in the U.S. in 1970. Suggest that. It is a natural substance and it is not known how it works, but there is a natural spring coming up from the ocean in Bimini (around Nassau, Bahamas), and people who swim in that cove experience a very calming effect. I have been there too. Good luck!

Appy has given this problem its correct name: Musical Medications.

When it comes to neuropsychiatric diseases or conditions in non-dementia patients, even the most experienced doctors are reduced to trial and error.

In many dementia patients, symptoms and behaviors that exist today, this week, or this month, may very well be totally different tomorrow, next week, or next month.

Patients, family members, caregivers, nurses, doctors and even medications are at the mercy of the ongoing and constantly changing disease of dementia.

What works for one doesn't work for all and what may work for the one right now may not work for the same one in the near future.

All doctors take an oath to "First, do no harm". Try to become a sympathetic partner with your husband's doctor and let her/him understand that that is also what you wish. On your husband's behalf, everyone should be considering the "risk/benefit ratio" which I say in layman's terms means "make sure there is more to gain than there is to lose".

Vascular dementia, I'm so sorry to say, is often a more swiftly progressing dementia than some of the other forms, although it certainly isn't always that. If your husband's symptoms are progressing quickly and changing rapidly, he may be in a period of decline because more is changing in his brain. In and of itself however, that doesn't indicate immediate further decline. Depending on what is happening to him physiologically and whether or not it continues, he could stabilize. If so, that could be either short or long term.

Consult with the doctor and say you want your husband to be able to try the most effective medications for his situation with the least possible side effects.

You say he is never left alone, so I believe I can surely presume that he cannot get to his medication on his own. That means he cannot overdose on any of the benzodiazapines he may be prescribed, so that should not be a worry.

As for addiction, if he has been taking valium since he was 5, and for 75 years as I believe you state, he would be 80. Isn't that correct? If it were my parent, spouse or child, I would be more concerned about the other side effects, even of the benzodiazepines, than I would about the addiction.

Your husband may have progressed too far for this to work, but because it worked for both my aunt and my mom with different types of dementia, I am a big fan of Buspar. It is an anxiolytic (anti-anxiety) medication. With dementia, some aggressiveness and combativeness comes from frustration and anxiety. It may not hurt to try it and it could help in that case. It probably wouldn't help if he has become psychotic/paranoid. I'm not sure if it can be given concurrently with valium but I think so. Ask the doctor if it's a possibility.

Many hugs and lots of luck...please keep posting...carol

I would try and find a doctor that actually listens to the family member. This can be difficult in a managed care situation but can still be done. A geriatric neurologist would be the best way but if there are no benefits it is costly. I think I would start by looking at what my medical insurance covers and does not cover and become proactive and go from there. Good Luck .

Oh my God, what the hell is that doctor thinking? Forgive me, but I feel a rant coming on.....

It has always irked me that some (not all) physicians turn a deaf ear to close family members who know better then anyone else what works and what does not, You have experience with what your husband has been able to tolerate and did well on in the past, and this should be given a lot of consideration. I would insist on knowing WHY the doctor is looking at drugs such a Risperadal, which has VERY bad side effects: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS. What the hell? If it were me, I would point this out to the doctor and ask again why your husband should be prescribed that med. Then watch him avoid you as much as possible.
No, I don't blame you one iota for wanting to avoid those drugs. Good for you for being informed. I thank God that there are carers like you in the world who will go to bat for those who cannot protect themselves.

Big (((HUGS))) to you.

PLEASE BE VERY, VERY CAREFUL WITH ATIVAN! Giving Ativan to an elderly dementia patient can be deadly...I know this first hand, as it happened to my own Mother...per the ER doctor, she suffered a TIA, was recovered, and would be going home from the hospital the next day. Unfortunately, the ER nurse also told us they gave her a lot of Ativan to calm her...she never recovered from it, was basically comatose, and died one week later. Google 'Ativan and the elderly' and you will see many horror stories there. Yes, Ativan does help some people, but you have to be extremely, extremely careful. Best of luck to you...

I agree that you probably need a neuropsychiatrist to help fund the right drugs.

After my husband had his stroke, he went thru a period similar to your husband's current behavior. The psychiatrist started a long period of musical medications. They would try one for a while and when it didn't work, or it made him too foggy to be functional, they tried another. They tried cocktails of multiple drugs. It's kind of a crap shoot finding the meds that works for each person.

When my husband got Ativan, he was too groggy to function. I've seen snails with more motivation and speed. Just because it works fast, doesn't make it necessarily better. If you're against the antipsychotics, you might ask if you can try a smaller dose of the Valium more frequently. That way, you might have less trouble with the speed that it takes to take effect. At least you know that drug worked in the past.

You may already know that Risperdal and other antipsychotics can have long term, bad side effects. Our experience: My husband got the one of "involuntary muscle movements that may become permanent" (per their commercials) after being on risperdal and Ativan for several months. He was unable to sit still and had to go for a walk every hour he was awake and it make his leg all twitchy. He couldn't even sit down for the length of a short meal withoutwithout having to get up and fidget. It took more than a year after he stopped and a period of antiparkisons's drugs for the symptoms to go away. It did help control the aggression, but didn't do much for the hallucinations. But they eventually went away on their own as his brain healed. Your husband seems to be in a different situation with dementia, because his brain isn't healing now.

Good luck. Here's a (hug) for you.

I take care of an elderly couple. The elderly woman is 87 years old. She told me she had been taking valium for 20+ years. Her doctor switched her to Lorazepam about 2 years ago. She is overly nervous and has many anxiety issues. Like valium, it is a highly addicted medication. The drug is reacting opposite of what it claims to do. She hallucinates, she has insomnia, she is wobbly and off balance when she walks. She can no longer walk without a walker. Please read the side affects of this drug (Lorazepam/Ativan) before you find a doctor to switch medication for your husband. My personal opinion and experience with this elderly woman is that Lorazepam/Ativan is a horrible drug. I blame a lot of her medical issues on this medication. Withdrawal symptoms of both these medications can be fatal. If the elderly take more than they are prescribed, it could be fatal. It's almost like a no win situation, but when it affects the person in ways that no longer contribute to their well being I feel it should be discontinued with the help of their doctor. They should never discontinue on their own because of the withdrawal symptoms. Just thought I'd throw in my two cents...

Would you feel more comfortable getting a second opinion from a behavioral neurologist or a geriatric psychiatrist? If the new doctor also doesn't think Lorazepam is a good choice, ask for an explanation you can understand.