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Sabs13 Asked January 5, 2024

My 75 year old mother has mdd, ocd and crippling anxiety it’s coming up to 1 year of this extreme episode. Need help!

Anybody had a similar experience? What was the outcome? We’ve changed meds and gone for second opinions. She’s not improving to the point now where she was getting psyychotic so they put her on olanzepine. Now she is cycling between a good day and a bad day. On a good day she is depressed and hardly getting out of bed. Bad days, she is anxious, asking reassurances and feels she has been pulled back in time. She is refusing therapy and our family is really exhausted trying to take care of her. She had 2 hospital stays which made her worse.

Sabs13 Jan 7, 2024
She says often her head feels blocked which none of the drs seem to explain or understand!
AlvaDeer Jan 8, 2024
There just IS no explaining these "feelings", Sab. Sadly enough. And even when they can be explained, it doesn't stop the anxiety of the "feelings". I think that Moondancer is making a good point about some sort examination of the number of drugs being taken.
To let you know how very POTENT any psychotropics are, I recently was prescribed a drug called cymbalta. I was having some increased BP, some nerve pain in my neck, and some anxiety and my doc said "maybe these issues are playing with one another; let's get you on low dose of cymbalta which is a mild anti depressant and often helps with nerve pain.
Well, I took one and the result was a day spent in the bathroom with non stop liquid yellow stool, explosive and impossible to hold onto (sorry for the graphics). Later that night I couldn 't sleep. Unusual for me. Then I got something I have never had (tho my Mom did and was good at describing, which is restless leg syndrome. Where you just keep moving your legs. I was quite beside myself and started looking up the drug online. Turns out my experience not all that unusual. I just stopped the med after one pill. Told my doc "Hey, I will keep the pain and anxiety, thanks. I am a PRO at them. But THIS is a nightmare".
We are all different in our responses to meds, and medications all play with one another, and our reaction to them can be fine one day and bad the next.
So sorry your Mom's going through this.
Moondancer Jan 6, 2024
It appears to me that she is receiving a very dangerous drug cocktail with these many meds. Ambien alone could cause half her symptoms without adding an anti-psychotic, benzos, and two antidepressants. Escitalopram can be an effective SSRI (I see she is no longer on it) but you cannot pile these many meds on top of each other.
I have a LO with similar conditions and it has taken a very long time with a psychiatrist who is a psychopharmacologist to find the right combo of meds.
Until she --her mood--is stabilized I can't imagine she would benefit from or be able to participate in talk therapy.

Of course you cannot do this all yourself but I urge you to take a look at the website below to see the effects of combining some of the meds she is on. Easier said than done but you need to find a psychiatrist who will go slowly enough to find the right meds:

https://www.drugs.com/drug-interactions/klonopin-with-mirtazapine-703-357-1640-0.html

Applies to: Klonopin (clonazepam), olanzapine MAJOR problem

"Ask your doctor before using clonazePAM together with OLANZapine. This can cause low blood pressure, shallow breathing, weak pulse, muscle weakness, drowsiness, dizziness and slurred speech. This may be more likely to occur in older adults or those with a debilitating condition. You should be counseled to avoid activities requiring mental alertness until you know how these medications will affect you. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safely use these medications together. "


Moderate Problem clonazepam and mirtazapine--
"Using clonazepam together with mirtazapine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. "
Sabs13 Jan 8, 2024
After reading this I think we need to look for a pychopharmacologist to re assess her meds! She has a lot of dizziness sadly.

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Midkid58 Jan 6, 2024
This sounds eerily like my MIL. She obsesses over one thing to the point her kids just want to give up.

She's only on benzos, refuses AD's and any other medication because that just isn't 'her'. Some days are much worse than others.

Since she is in Hospice Care she doesn't see any drs. All I can say is, I wish they hadn't moved her back home to 'die'. She is in a bad way and not safe, but the kids think if they place her in a NH, she will die in a week.

(It's weird, b/c on her bad days, she insists that the kids HAVE got her in a NH.)

For your mom--there well may be absolutely nothing you can do to calm these cycles, but I wouldn't quit trying to figure it out.

Neuropsych evals are comprised of verbal testing, (memory, ability to read and make sense of what's read) physical strength, possible scans of the brain to see if there is any evidence of silent strokes. If she is not cooperative, it won't help.

So--the medications are taken regualrly or just when she's having a 'day'. You may want to medicate her 24/7 and see if that helps. Anxiety gets it's own energy when it's going. I have it, somedays it's awful, but I try to stay one step ahead by being aware of my abilities and inabilities and triggers.

But, then, I am not impaired. I can always talk my way 'down'--sounds like your mom can't do that.

IN the end, if she can't cooperate and it gets worse, you may have to move her to somewhere she can get the 24/7 care she needs. I imagine you are all exhausted by this.
NeedHelpWithMom Jan 6, 2024
Your husband and his siblings are only prolonging her agony by keeping her home.

You MIL’s quality of life is completely gone. If she would die in a week, it would be a blessing for her.

This has to be so hard for you to watch, Mid.

I know that it’s your husband and in law’s decision to make and that they don’t care about your opinion on the matter. It’s such a sad situation.

Truly hoping that this won’t last much longer for everyone’s sake.
Beatty Jan 5, 2024
Does refusing therapy mean refusing 'talk' therapy or refusing more? Eg refusing further medical appointments or investigations?

Does your Mother live alone? With a spouse, yourself or others?

I am thinking her level of symtoms must be debilitating for her. Can she look after herself on a day to day basis?
Sabs13 Jan 6, 2024
This episode began in March 23 with severe ocd with words, she spent hours on a word spelling it and saying it. She has suffered with ocd and a few bouts of depression over the last 30 years. She refuses talk therapy (in hospital they did exposure therapy for 2 months that didn’t work at all) she’s had all the medical examinations and everything is fine. She lives with my dad who is 80 and is basically doing everything for her!they moved in with me as he couldn’t manage on his own and we do her care between us. She went from independent and relatively normal to almost a scared child like state refusing meds water food at times. She can’t take care of herself at all and spends most of the time in bed. She has a good day with low anxiety but depressed and a bad day with high anxiety and constant reassurances. She was on escitalopram and mirtazepine before this episode then dr added zolpidem and benzos. In hospital they swapped to sertraline which didn’t suit her at all, now she is now on duloxetine mirtazepine zolpidem clonazepan and olanzepine. But it’s not helped at all apart from olanzepine which helped with the psychosis.
Geaton777 Jan 5, 2024
Have all other possible medical and health problems been discounted? Stroke? Tumor? Does your Mom have a history of mental health issues?

She's sort of young to have something like ALZ (which strikes earlier than other dementias) and those don't sound like symptoms for that, but everyone is unique.

I agree with Alva that a thorough neuro/psych exam should be done if it hasn't already.
Sabs13 Jan 6, 2024
Yes she has a history of ocd and depression. She had a traumatic childhood and witnessed domestic violence. They did mri of brain twice both times unremarkable.
AlvaDeer Jan 5, 2024
I am wondering if she has a thorough neuro-psyc workup, and wondering if you approved of the doc and the testing, because to me this sounds like more than only anxiety and depression. I might get a second consult.

I am an ex RN. I also suffer from anxiety and have long had a whole lot of experience with both anxiety and depression when I was working. Interestingly enough, recent research (AARP has stuff on this) showed that MDs are now encouraged to examine patients for anxiety, especially our elders, at each exam. They say it is getting "missed".

I can tell you right now that there is nothing like getting old for increasing anxiety. I am 81. I am WELL AWARE of the losses I am experiencing in memory, in balance, and I am well aware of how much more is coming. It is VERY anxiety provoking, and the MORE SO if you cannot talk about it.

Brings me to the next thing. DO YOU discuss this with your mother. If not, why not? Will she talk about it. Can she express to you why things are worse and what she fears? Because if she can then we aren't looking at dementia, but if she can't at all, we may be looking at something more than just anxiety.

I can't tell you much more. I can ask you to continue to observe. To try to talk with your Mom about this. My daughter, 61, and I discuss this a whole LOT.

I wish you both the very best.
Sabs13 Jan 6, 2024
what Is involved in a neuro psych evaluation. We have been to 4 different psychiatrists and they all seem baffled with her condition. Each one has a different approach but none can definitively tell us why she is cycling. They don’t think she has Alzheimer’s or dementia. The dr said pseudo dementia as she kept saying her memory is gone. It’s not she remembers most things long and short term. She says she feels sick in her head and that her head feels blocked. On a bad day she is like a different person impossible to reason with talking fast and anxious and paranoid. On a good day she understands and talks nirmally abs isn’t anxious. She can communicate what she feels and thinks bit refuses any talk therapy. E try and talk to her but often get I don’t know as an answer.

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