Antidepressants... Are we beginning to see negative results in our elderly from taking brain altering drugs?

Thank you SueC1957, for sharing all of this information with me. I agree, a year has been way too long. I will make an appointment with a geriatric neurologist asap. Hopefully we can get some answers soon. Again, thank you.

Karen,
She lived by herself and was mentally normal a year ago. Then she fell and was taken to AL after rehab. She was taken off all 3 meds at the same time? Since then she's suffered from delirium? She's been prescribed new drugs and continues delirious? Sounds like it has a lot to do with the meds, doesn't it? I'm assuming she's had an MRI and brain scans?

Who is prescribing the new drugs? It should be a geriatric neurologist.

From the Mayo Clinic website;
Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of your environment. The start of delirium is usually rapid — within hours or a few days.

Delirium can often be traced to one or more contributing factors, such as a severe or chronic medical illness, changes in your metabolic balance (such as low sodium), "MEDICATION", infection, surgery, or alcohol or "DRUG WITHDRAWAL". (my capitalization and quotation marks)

Signs and symptoms of delirium usually begin over a few hours or a few days. They often fluctuate throughout the day, and there may be periods of no symptoms. Symptoms tend to be worse during the night when it's dark and things look less familiar.

Experts have identified three types of delirium:
Hyperactive delirium- Probably the most easily recognized type, this may include restlessness (for example, pacing), agitation, rapid mood changes or hallucinations.
Hypoactive delirium- This may include inactivity or reduced motor activity, sluggishness, abnormal drowsiness or seeming to be in a daze.
Mixed delirium- This includes both hyperactive and hypoactive symptoms. The person may quickly switch back and forth from hyperactive to hypoactive states.

Behavior changes may include:
Seeing things that don't exist (hallucinations), restlessness, agitation or combative behavior, calling out, moaning or making other sounds, being quiet and withdrawn — especially in older adults, slowed movement or lethargy, disturbed sleep habits, reversal of night-day sleep-wake cycle.

"SEVERAL DRUGS OR COMBINATIONS OF DRUGS CAN TRIGGER DELIRIUM", including some types of pain drugs, sleep medications, medications for "MOOD DISORDERS", such as "ANXIETY" and depression, allergy medications (antihistamines), Parkinson's disease drugs, drugs for treating spasms or convulsions, asthma medications. (my capitalization and quotation marks).

Any condition that results in a hospital stay, especially in intensive care or after surgery, increases the risk of delirium, as does "BEING A RESIDENT IN A NURSING HOME". (my caps and quotation marks)

Delirium may last only a few hours or as long as several weeks or months. If issues contributing to delirium are addressed, the recovery time is often shorter.
The most successful approach to preventing delirium is to target risk factors that might trigger an episode. Hospital environments present a special challenge — frequent room changes, invasive procedures, loud noises, poor lighting and lack of natural light can worsen confusion.
Evidence indicates that these strategies — promoting good sleep habits, helping the person remain calm and well-oriented, and helping prevent medical problems or other complications — can help prevent or reduce the severity of delirium.
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I hope this information can help you. You need to have a sit down discussion with her doctor about this and bring in a specialist (geriatric neurologist). A year is way too long for her to suffer from this. Obviously this approach isn't working.

Good luck and God Bless.

I don't know how to help her. 

Thanks to all of you. I appreciate all the great input. Mom was taking nortriptyline and sertraline along with the ativan. All three of those drugs have been changed now.  Could this be what is causing her to have delirium? 

Karen,
Whomever 'didn't' detox your mom off of benzos (Ativan) was not following protocol.

From AddictionCenter.com;
"Generally, doctors recommend tapering off of Ativan rather than quitting “cold turkey,” as this can be dangerous. Those who stop taking Ativan without weaning themselves off the drug first may experience severe withdrawal symptoms, including seizures, hallucinations and psychotic reactions."
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Ativan has been known to cause instability, especially in the elderly. They probably feel that her fall was caused by Ativan.
I can personally attest to instability, as my balance has been affected since I started taking Ativan 1 mg. on the nights before I go to work. For me, it's a small price to pay for a good night's sleep. I can not fall asleep easily and I can't stay asleep for more than 3-4 hours. It's hell to lay there and look at the clock every hour and worry that you won't be rested enough to function at work. It works very well and I wake up feeling rested. But I have done a "2 step" on occasion. Thank God I'm young enough to correct it before I'd fall. I'll probably stop it when I retire, as I won't have to get up to go to work.

I come from a long line of anxious people, (as pointed out by the psychiatrist that I saw once!) My mother benefited greatly from Ativan, like your mom, for near 20 years. They have since taken her off of it and put her on an antidepressant called Remeron. My son suffers severe anxiety, takes Klonopin and is helped by it. Unfortunately, he took comfort in heroin also to control his symptoms. (Another story)

Antidepressants are all the rage right now!
Have anxiety... take an antidepressant, have depression... take an antidepressant, have bladder trouble (yeah, bladder problems)... take an antidepressant. I think the medical community (of which I am one--a nurse) have had SO many problems with SO many drugs (look at the opioid (narcotic) crisis, the benzodiazepine problem, etc.) that they think they have finally found a classification of drug that hasn't made us junkies or addicts yet.

HOWEVER, THAT'S WRONG. Look up the side effects of Cymbalta, a popular SSNRI, (a Selective Serotonin and Norepinephrine Reuptake Inhibitor antidepressant.) There is nothing attesting to its addictiveness BUT the one-time psychiatrist said he wanted to put me on it for a year then WEAN me off over 6 months! Heck, you can wean a heroin addict off quicker than that. If that's not addiction, I don't know what is.

There are whole websites devoted to the addictiveness of this drug. The poor users of this drug have to open capsules and take out the tiny pills inside because they can't function if they taper off any other way. There are horrible "brain zaps" (electrical brain pain) if tapering too quickly.

So what are the doctor's doing? Substituting one addictive drug for another! It's all B.S. Let's call a spade, a spade.

I'm off my soap box now. Sorry, I needed that.

Medications help a lot of people. It's good that the patient or caregiver has good communication with the doctor and the doctor is well informed. To me, the patient's wellbeing and comfort is the top priority and I'm not picky about how that is accomplished. Everyone is different, so, sometimes it take some time and trial to get the right medication.

And then, the patient's needs may change over time too. My LO used to require Cymbalta or she would cry, panic and just worry herself sick, but, she's not on it, Ativan, nor Seraquel any longer, and doing just fine. Of course, her dementia has progressed now, but, she does fine with just one med for agitation. She is on palliative care and only takes a few meds to control diabetes and blood pressure.

If the patient does not have cognitive decline, then, I'd still be eager to make them as comfortable as possible each day. To me, why suffer with anxiety or depression, when you don't have to?

I stand corrected Midkid, I concede sometimes benzos are useful long term, but only if there is thought behind it and not some doc writing a script for a dozen repeats at a time. I know from my parents how quickly you can become addicted and how difficult it can be to wean off of them, making the OP's mother go cold turkey is criminal, or it should be.

Cwillie--
I agree with you, even as a long term benzo patient. I have to see my psych dr twice a year, I cannot ever go over my allotted dose and I can't ever have more. That is pretty limiting. He has told me that by age 75 I have to be off them.

However, without them and the antidepressants, I would have exited this world long ago. It's a tricky line to walk--and doesn't help that people (I don't mean you) are pretty judgy about taking them. Walk a mile in my shoes and feel gut wrenching anxiety for 24-48 hrs and you'd be begging for something. Many folks turn to alcohol--probably if I had a couple stiff drinks a day nobody would bat an eye. But DRUGS! OMG!!

I think we all do what we have to, to get by in life. I'm not proud of my mental instability, but I don't run away from it.

I agree that "It seemed heartless and cruel to stop prescribing it cold turkey." Surely they could have setup a monitored withdrawal program. Are they thinking that her current symptoms are still withdrawal and she will eventually get through them?

As to not discussing this with you, are you officially your mother's medical POA (healthcare proxy)? Have you placed that document on file at the facility?

"It seems to me, antidepressants are not safe for anyone to take, long- term or short-term." Certainly they are not ideal. Certainly we would all wish for less risky solutions. But untreated depression/anxiety  is not safe, either. We can only utilize what is available until better methods are available.

All drugs have long lists of side effects. Drugs may still be the best option available at the present time.

We are seeing so many elderly people with dementia now because there are so many elderly people now. When very few people lived past 65 there were very few people who developed dementia.

Ativan is NOT an antidepressant. It is a benzodiazepine, used for anxiety, sleep disorders, epilepsy--it is NOT something you should go off of, cold turkey. I take Clonazepam (Klonipin) for GAD. I have taken it for 20 years and it works well for me, every time. Same dosage for 20 years. Without it--well, I wouldn't be here, that's for sure.

Along with benzos most psych docs prescribe an antidepressant (Prozac, Zoloft, Cymbalta, too many to name here)....taking someone off benzos with no help is beyond cruel.

I'd be kicking up such a stink if this happened to my mother. If her antidepressants are not helping her--then SAY SOMETHING! You can be mom's advocate. Don't accept a drs quick dx, ask more questions and stick up for mom.


Yes, she's probably "addicted" to the Ativan. Ok, let's all get over that horrible word. QOL is worth some judicious use of proper pain meds and/or anti anxiety meds.

You need to find a new dr and get yourself educated about these meds she's on and what can be done to help her. Delirium can definitely be a part of withdrawal.

Ask someone how fun detoxing from benzos is. It's hell and should not be done without some very close monitoring. I had a friend who committed suicide b/c her dr suddenly took her off some psych meds she really needed---and the physical and mental pain she suffered before she ended it all was horrible to see.

No, nobody really knows HOW antidepressants work. They just do, or don't. The older tri-cyclics were discovered in the quest for antihistamines. The newer SSNRI's target the brain better, but for me, are worthless.

Your mom needs a complete psych workup now and something to ease her suffering. I am so sick of people's horrible fear of the possibility of addiction to a drug overwhelming their NEED to be able to function and feel well.

There are MANY benzodiazepenes. Maybe a different one for mom. One fall shouldn't make her high risk.

Ativan isn't an antidepressant, it is used to treat anxiety. IMO none of the benzodiazepines are intended for long term use, although in years past doctors often handed them out like candy ( aka mother's little helper).