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 Trazadone/Mirtazapine/Depakote 
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Joined: Sun Aug 29, 2010 5:46 pm
Posts: 610
Post Trazadone/Mirtazapine/Depakote
A "consulting pharmacist" has reviewed my mother's records at the SNF at the request of the director of nursing due to issues with pain, anxiety, weeping and insomnia. Among the suggestions of possible meds are trazadone for insomnia and pain; mirtazapine for sleep and appetite (with a reduction in the Effexor that she is now taking); and depakote as an alternative for pain and anxiety.

I searched the forum but didn't find anything on these meds. Does anyone have any comments about them?

At least the pharmacist said that only one thing at a time should be changed, but holy cow, my mother is already on so many meds. I asked if the pharmacist was aware of the LBD diagnosis and was told that she is. But still, I don't know if I am comfortable with a pharmacist making these recommendations. Shouldn't the neurologist weigh in on this?

The director of nursing, who called me about this, also mentioned that my mother told her, "My mom is really mad at me." She was referring to me! The DON said that she is regressing and confusing me with her mother. (Her perception that I am mad stems from the fact that I tried to clarify with her that she was mixing up her toothpaste and denture adhesive, and she gets very upset if anyone tells her that she made a mistake or was wrong, so she thought I was mad.) This feels like a whole new phase.

Thanks,

Julianne


Fri Jan 14, 2011 3:35 pm
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: Trazadone/Mirtazapine/Depakote
Julianne, I'm going to just share how I think I would approach this. Note that Coy is in early stages yet so this is pretty hypothetical for me.
1) I would not let the fact that the suggestion came from the pharmacist deter me, but I would run each suggestion by the neurologist before starting it.
2) I would not let the fact that she is already taking a lot of drugs deter me. There are a lot of different attitude toward drugs. Mine is, if it has a chance of improving quality of life, bring it on! If it doesn't work or makes things worse, oh well, try something else.
3) I would very definitely go slowly, one change at a time, titrating it carefully. (It took about a year for us to establish the drug mix that Coy uses.) It is hard to be patient when so many symptoms need addressing, but one at a time is the only practical way to know what works and what doesn't.

I often think that my role with Coy is more like his mother than his wife. You have reversed roles with your mother. You are now behaving like her mother-- nurturing her, instructing her, making decisions for her. It doesn't surprise me that that is the direction her confusion takes her -- seeing you as her mother. I just hope she had a good relationship with her mother! :lol:

You're doing great. Hang in there!

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Fri Jan 14, 2011 4:16 pm
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Joined: Sun Aug 29, 2010 5:46 pm
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Post Re: Trazadone/Mirtazapine/Depakote
Jeanne, you are right, and I won't reject an idea just because it came from the pharmacist. Maybe I am uncomfortable because the DON is driving this, and I wonder if it is because my mother's behavior is starting to be disruptive and time consuming. And while this is a good facility, I don't think they are very well versed in LBD, which also concerns me.

Yes, my mother and I have been in the process of a role reversal for the past several years and now it has gone full circle. It was just so strange to hear that she referred to me as her mom. (And no, unfortunately she and her mother did not have a good relationship. :o( Long story there.)

I am doing what I can but it is so sad that things have come to this. Wish I could do more to help her.

Thanks for your encouragement!

Julianne


Fri Jan 14, 2011 4:29 pm
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: Trazadone/Mirtazapine/Depakote
Julianne, I don't remember if this has come up in earlier conversations, but if you haven't seen it you might find an article by Dr. Boeve interesting. It includes a table with suggested medications. (It is from 2004, though, so it may not be the same list he would compile today.)

I've seen Robin mention it and had a devil of a time tracking it down. If you go here, there is a link to the full article: http://www.lbda.org/feature/1347/diagnostic-review-and-medicine-management-of-dementia-with-lewy-bodies.htm

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Fri Jan 14, 2011 4:38 pm
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: Trazadone/Mirtazapine/Depakote
It is very possible that the DON is suggesting this because it would make their lives easier. But might it also improve your mother's quality of life? Sleep deprivation, after all, is sometimes used as a torture device. If your mom's behavior improved because she got the sleep her system needs, would that be a bad thing?

None of us want to see our LOs kept in a drugged state for someone else's convenience. With your vigilance, I can't see that that has much chance of happening here, can you?

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Fri Jan 14, 2011 4:43 pm
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Joined: Wed Dec 30, 2009 1:46 pm
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Location: WA
Post Re: Trazadone/Mirtazapine/Depakote
Julianne, you might try searching 'trazodone' instead of 'trazadone'. I'm pretty sure I posted about it a few months ago. Derek's doctor tried him on it for insomnia. I don't offhand remember the dosage but the lower dose didn't help him sleep and the higher dose didn't help him, either, and sharply increased his aggression & anger so it was discontinued. It's very individual--it just didn't work for him.

_________________
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.


Fri Jan 14, 2011 4:44 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: Trazadone/Mirtazapine/Depakote
Yes, Boeve's "Continuum" paper is a must-read and must-frequently-consult resource!

You might search the Forum again. I found 62 posts containing the word "trazodone." (There are also lots of posts with the spelling trazadone.) it's on Boeve's list so it frequently comes up. I've seen posts about the others as well, though mirtazapine is likely referred to by the brand name of Remeron.

Many in our local support group take trazodone (Desyrel) as a sleep aide. (I think the dosing is different as a sleep aide than as an anti-depressant.) A smaller number take Remeron (mirtazapine). I would question why two anti-depressants -- trazodone and Remeron -- are needed. Why not just take trazodone as both a sleep aide and anti-depressant?

Several in our local support group are given Depakote for anxiety (or for seizures) as an alternative to Ativan or Seroquel.

Certainly a neurologist or psychiatrist should do the prescribing for these medications but many dealing with LBD have found that a PharmD can be worth his/her weight in gold.


Fri Jan 14, 2011 4:55 pm
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Location: Minnesota
Post Re: Trazadone/Mirtazapine/Depakote
Quote:
Why not just take trazodone as both a sleep aide and anti-depressant?
Robin, according to my psychiatrist, at the dosage for an anti-depressant many people experience unacceptable side effects. She says she does not prescribe it at those doses, but instead uses a better-tolerated antidepressant in addition to a low-dose of trazodone for sleep, if both are needed. I don't know, of course, if that is the answer this pharmacist would give, but it was an answer that made sense to me when she explained it.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Fri Jan 14, 2011 5:07 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: Trazadone/Mirtazapine/Depakote
And did you ask why Remeron rather than Effexor?

And I would check to see if Remeron and Effexor are sedating. If so, then why trazodone?


Sat Jan 15, 2011 12:36 am
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Joined: Wed Sep 30, 2009 8:25 am
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Post Re: Trazadone/Mirtazapine/Depakote
My MIL is on remeron/mirtazapine. She only takes it at night immediately prior to laying her head on the pillow. It has helped her sleep and keeps her appetite up. Before she started taking this med she would be up every hour on the hour and mix up days and nights. Now she only gets up two or three times between midnight and 9 am. Nothing is perfect but this has helped. Of course, what works for one person may not work for another. We got lucky.

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Donna (age 56) caregiver for mother-in-law Margaret (age 88).


Sat Jan 15, 2011 10:07 am
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Joined: Fri Nov 05, 2010 11:30 pm
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Location: southern cali
Post Re: Trazadone/Mirtazapine/Depakote
im not going to be too much help here but hubby has been on both the trazodone and the marazapine

the trazadone was for sleep.. and it worked well and he tolerated it fine..

when the hallucinations began again and the depression was starting to show more.. they switched him to the marazapine... he has been on a low dose ,15mlg.. for 8 weeks and i think its causing more anziety and not helping with the depression... we talked to the doc last week on the phone and when we see her in 2 weeks, if its till the same, she will increase the dose to 30ml.. at 30 the anziousness should lessen and the depression should be helped more.. but the sleep will be helped less and at that point she may add back in the trazadone... she said its a funny pill and the actions are more pill for less and less pill for more, when it comes to different symptoms..

good luck and yes the role reversal is odd.. i definatly feel like the mom to my hubby...
cindi

_________________
sole CG for hubby.1st symptoms, 2000, at 55. Diag with AD at 62, LB at 64.. vietnam vet..100% ptsd disability,sprayed with agent orange, which doubled chances for dementia. ER visit 11-13,released to memory care..


Sat Jan 15, 2011 10:18 am
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Joined: Fri Jan 15, 2010 9:33 pm
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Location: Vermont
Post Re: Trazadone/Mirtazapine/Depakote
The role reversal with parent/child is a tough transition, at least it was for me. When I got over the initial shock that I had to be the parent to my dad for his safety and health, I got used to it and it became routine that I would have to make all decisions for him. But, I tried to include him in decision-making as much as possible, or at least I'd tell him what was going to happen and why I'd made the decisions that I did. There were times when I didn't tell him everything because I didn't want him to be hurt or angry, so I just did what had to be done without his input.
I'm sure it's tough for all of you spouse CGs out there too. Lynn

_________________
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.


Sat Jan 15, 2011 11:55 am
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Joined: Sun Aug 29, 2010 5:46 pm
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Post Re: Trazadone/Mirtazapine/Depakote
Today, my mother told my sister about a strange episode this week . She couldn't stop shaking and crying for about two hours, and she felt very cold. A couple of the nurses were in her room with her. I heard nothing about this from the facility. But I wonder if this is part of the reason why the director of nursing is exploring meds for her for anxiety and so forth. My mother cries a lot--every morning she cries when she wakes up and often she cries during the night. She also cries easily any other time that she gets upset or is very confused.

My mother referred to me as her mom when talking to my sister today, and when I went to see her, she couldn't recall the name of her second son. She struggles for words all the time but this is the first time I have seen her fail to recall the name of a child. These changes seem startling to me but I suppose they are just part of the process.

Julianne


Sat Jan 15, 2011 9:25 pm
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Joined: Fri Dec 31, 2010 3:07 pm
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Location: Minnesota
Post Re: Trazadone/Mirtazapine/Depakote
Julianne, this may be a new baseline. Or it may be quite transitory. It may improve dramatically if you can get the right combination of drugs, or on its own, or it may indicate a progression of the disease. Time will tell. (Isn't that hard to live with? :shock: )

Coy had a few days very early in the disease when he was confused about family members. He didn't recognize his daughter when she visited. He didn't know if he had kids, let alone their names. Once he asked me (with great embarrassment) whether I was his first wife or his second. (At least he had the count right.) I thought that this was the way it was going to be, but that confusion cleared up in less than a week, and has not returned since.

I think that you need to brace yourself for the worst -- maybe this is the new normal for your mother. But until you know for sure, I'd continue to hope for improvement.

_________________
Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Sat Jan 15, 2011 9:44 pm
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Joined: Sun Aug 29, 2010 5:46 pm
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Post Re: Trazadone/Mirtazapine/Depakote
Thanks, Jeanne, I will certainly continue to hope, though there have been a lot of significant changes for the worse over the past month or two. It is starting to feel like the new normal.

Yes, time will tell, but it is so hard not knowing what Lewy will do next!

Julianne


Sat Jan 15, 2011 9:56 pm
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