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 Need Help. Latest info on best Anti-Depression medication 
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Joined: Sat Mar 27, 2010 6:15 am
Posts: 44
Location: USA
Post Need Help. Latest info on best Anti-Depression medication
What is the Anti-depression medicine that is most likely to work on the Elderly with lewy dementia without side-effects?

I just recently got my dad off all the extra crud they had him on.

He is now bedridden because of foot sores and is on a strong IV anti-biotic regimin for an infection that has gotten into the bone of his foot. He just had a stay in the hospital where I was successful in keeping them from putting him on all kinds of meds that would make dad nuts. And I got them to do an MRI and to remove all the new medications that have sedated him over the past year.

Now the Social Worker at the VA Home gave him a depression test and duh he is depressed. Well he is practical. he is not stupid he knows what they did to him (put his shoes on wrong) and why he may lose his foot.

ANYWAY, they want to get him back on more drugs to "prevent suicide".

What anti-depressant can I recommend be tried 1st if they insist on this?

My dad has severe sensitivity to all cold, allergy, and even vicodin and tylenol PM. Severe confusion, fever, erratic heartbeat. So I hate that they want to drug him everytime he blinks wrong or when he states the OBVIOUS!.
He knows not to tell the truth on those test but he was so mad at them this time that he told them like it is.

He was just on an anti-depressant and it made absolutely no difference. He still was not stupid and HAPPY. He is never going to be happy..... He was the same as he is now off the anti-biotic as he was when he was taking it. venlafaxine every morning 75 mg. Same as now. He may even be more clear headed now but how can a person tell when the doctor prescibes and changes dosages of multiple drugs all on the same day?

The social worker was not happy that I got him off all the new drugs when my dad had the MRI and neurology appt so this is her way of getting back at me.

Testing dad for depression while he has been off his feet, threatening to move him to the alzheimers hallway. He has been off his feet since February (because of the very VA Home that is testing him). While he has a severe infection, while he is on massive anti-biotics and he also just this past few weeks had an anti-parkinson medication added.

Oh well, I could go on forever. If they gave me the depression test right now I would do worse than my dad.

help. What anti-depressant works without fogging the mind in the elderly?


Wed May 26, 2010 9:30 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
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Unfortunately one medication doesn't have the same positive benefits and no side effects in all people.

Boeve, writing in 2004, likes the SSRIs, as I recall. (Have you checked out his recommendations?)

A recent study of antidepressants in PD showed that a tricyclic (nortriptyline) performed better than the SSRI. I probably posted about the study here. You can do a search of "nortriptyline."

Also, many anecdotal stories of antidepressants that people like or don't like are posted here. You can do a search on the term "depressant."


Thu May 27, 2010 12:32 am
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3316
Location: Vermont
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My dad is on Sertraline. He is still very depressed, and he has so many other symptoms and is on so many meds now it is really hard to tell if he'd be worse without it or not.
It probably hasn't done any harm, but how would we know when they put him in so many different drugs in a couple of months' time, and he has declined so much mentally and physically? It is really hard to know, as Robin says, what is going to work and what isn't. It varies so much person to person that I guess you give one thing a try at a low dose, see if it helps, and go from there.


Thu May 27, 2010 10:47 am
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Joined: Sun Oct 04, 2009 10:18 am
Posts: 276
Location: Washington State
Post Antidepressant
Everyone is different in how they react to meds, but here is our story.

My Mom is on a low dose of sertraline and I really think it has helped her. We started with four weeks of 25 mg in the morning and saw some improvement with no lasting side effects (well, some weight gain but that was good for her) then went to 25 mg in the am and 25 mg in the pm. Doubling the dose by adding the 25 mg in the evening was too much, too fast. She described feeling dizzy, "feeling strange", loss of cognition, some GI problems. Took her off the 25 mg in the evening. After waiting for a few weeks we added 12.5 mg in the evening to her 25 mg in the morning. This seems to be the right amount. No noticeable side effects.

The result is that most of the time she is more accepting of people and activities around her. She is trying harder to improve her quality of life. The periods of despair are less frequent. Although she still wants to die (she doesn't want to face the end stages of the disease) now she will mention seeing the trees change in the fall and going out in the snow this winter.

Good luck.


Thu May 27, 2010 12:49 pm
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
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That's great news Annie. That must be a big load off you and your husband, knowing she's happier and getting more acclimated. I so wish my dad would get involved in activities. It's so sad to see all that's available and know he refuses to go out of his room except for meals. Even now when I try to take him around the building for a ride in his wheelchair he either refuses to go, or after a min. or two asks to be taken back and put in bed.


Thu May 27, 2010 2:49 pm
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Joined: Sat Mar 27, 2010 6:15 am
Posts: 44
Location: USA
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AnnieN & LCTVT
Thank you for your comments and stories they are really helpful.
I have talked them out of doing anything for right now since they still
have him on strong anti-biotics and he still has the infection.
He also recently started on levetiracetam within past 2 weeks.

I did try a search on this sight for antidepressant but I think we've used the term so much I could not weed out the info I needed.

I spent 6 hours with my dad today and he seemed fine to me.
He was much better than I expected and his mind was clear although he seemed exhausted. Being off the medications seems to have returned his personality somewhat already as he is cussing and has a little fight back in him again. I can't stand his cussing but he used to not be able to say a sentence without 2 cuss words in it. I never thought I'd be glad to hear him talking that way.

If it does come down to a new anti-depressant I may suggest the sertraline after I do some research on it. I told the doctor today that I wanted to wait until these other issues are cleared so we can add ONE thing at a time and monitor dad and not get him back into the fog he was in.

Plus I don't want them adding any new medication until dad's follow-up neuro appt in June.

I appreciate you guys so much. It makes me feel like I am not nuts when I try to "manage" what they are doing to my dad. The healthcare people have such a hard time believing THE DRUGS can have more adverse effects because of Lewy Bodies.


Thu May 27, 2010 9:46 pm
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
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Grace - I think you are doing the right thing by researching, talking with others. and managing your dad's healthcare. Some drs. are still very defensive with family members trying to make informed decisions, asking questions, suggesting that they go slowly with the meds, whatever. In some areas the culture is different. Where my dad is, many people in the medical profession act like it's the old days where drs. are gods and the rest of us are either stupid or shouldn't dare ask, suggest, do our own research, etc. I think every patient needs an informed advocate and you are doing a great job by gathering as much info. as you can and doing what you think is right for your LO. Stay strong. Lynn


Thu May 27, 2010 10:14 pm
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Joined: Tue Aug 03, 2010 9:13 am
Posts: 8
Post Re: Need Help. Latest info on best Anti-Depression medicat
Quote:
What anti-depressant works without fogging the mind in the elderly


Lots....

The problem is:
1) it is not a one size fits all problem. An anti-depressant that works on one person may do nothing good for another person.
2) Anti-depressants work real good for "depression". They tend to not work as well on other conditions. Is the "depression" in LBD classic depression? My feeling is no.

Antidepressants that really "fog the mind", largely that's what the early ones developed did. Elavil is a good example.

If you get an anti-depressant that helps the depression in someone with LBD, that could alieviate a lot of suffering. That being said LBD people seem to have more adverse reactions to meds than ordinary people, and I don't think anti-depressants built for normal depression work terribly well on them.

-just my opinions-


Thu Aug 05, 2010 8:04 am
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Joined: Tue Aug 03, 2010 9:13 am
Posts: 8
Post Re: Need Help. Latest info on best Anti-Depression medicat
I guess I should have said (explicitly)....

-If you decide you want your loved one on as few meds as possible then this is the right decision.
-If you decide you want to try various things (know that they might not work or possibly even have really bad side effects) then this is the right decision.

Only the family member (or the person with LBD, if they are still competent) should be making these decisions. The doctors have no right or moral authority to badger you one way or another. There is no clearly "intellectually right" choice, so it should be up to the patient or the loved one caring for them (if they aren't competent).


Thu Aug 05, 2010 8:17 am
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Need Help. Latest info on best Anti-Depression medicat
My husband has been taking trazodone at bedtime, not for depression but for sleep enhancement. It is a SARI rather than a SSRI antidepressant. I cannot vouch for its effectiveness but I can say that he has experienced no noticeable side effects in the month he has been taking it. It is my understanding that SARIs are better than SSRIs for geriatric depression.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Thu Aug 05, 2010 9:56 am
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3316
Location: Vermont
Post Re: Need Help. Latest info on best Anti-Depression medicat
"Only the family member (or the person with LBD, if they are still competent) should be making these decisions. The doctors have no right or moral authority to badger you one way or another."

- Good luck with that, everyone! I only wish that were true everywhere and with all drs. and nurses. We have been told it is unethical to take an end-of-life patient off life-prolonging drugs, our requests have been ignored by several drs. and CNPs, and a friend was told that if he didn't agree to put a battery in his parent's pacemaker (93 yr. old, immobile, blind, Alz. patient who had already lived for 10 yr. in an ALF) he'd be charged with elderly abuse.

If you live in a community where the culture is different, where the medical folks either support the ideas of "death with dignity" and "slow medicine" for end of life patients or they will honor the patients' and the family members' philosophy, you are lucky!

_________________
Lynn, daughter of 89 year old dad dx with possiblity of LBD, CBD, PSP, FTD, ALS, Vascular Dementia, AD, etc., died Nov. 30, 2010 after living in ALF for 18 months.


Thu Aug 05, 2010 11:04 pm
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Joined: Thu Aug 26, 2010 7:11 pm
Posts: 31
Post Re: Need Help. Latest info on best Anti-Depression medicat
mockturtle wrote:
My husband has been taking trazodone at bedtime, not for depression but for sleep enhancement. It is a SARI rather than a SSRI antidepressant. I cannot vouch for its effectiveness but I can say that he has experienced no noticeable side effects in the month he has been taking it. It is my understanding that SARIs are better than SSRIs for geriatric depression.



My mom has been on Celexa since last Sept. We had our conference at UCI today and they indicated that depression had been a problem for my mom, but didn't see strong evidence of it today. They seemed fine to keep her on it. I believe it has helped, but now I'm wondering if it's the best option for her?


Mon Aug 30, 2010 8:10 pm
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