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Mother's Little Helper
August 4, 2014 11:15 AM   Subscribe

YANMMD -- you are not my mother's doctor. But you probably can do a better job than her current one. Please help.

My 87-year-old mother recently moved back to her hometown, a place we'll refer to as Hellhole, Arkansas. She is in excellent physical health (cholesterol a tiny bit high, but ratios good, not overweight, no smoking or drinking). Mentally she has always been a miserable person, and this has worsened (along with serious short-term memory loss) in the past few years. She is 13 of 15 on the Geriatric Depression Scale. She lacks appetite and can't focus.

The doctor she is seeing, one of the few in Hellhole, is at least 70. He made inappropriate comments while "examining" my tits when I was a teenager and is IMO one of those last-in-his-class-at-a-third-rate-med-school physicians who survived because he serves a mostly ignorant population. The nearest gerontologist is 2+ hours away from Hellhole, and I can't get her in until December.

I believe that it's worth trying her on dementia or anti-depression meds, and my sister conveyed this to Dr. Hellhole. He put her on Zoloft (I don't know the dose yet) and said he'd check her "in a month."

Everything I have read suggests that a: Zoloft may not be the best drug for seniors, b: it sometimes takes 12 weeks for results in elderly patients c: she should be very closely monitored and d: he probably prescribes it because he plays golf with the rep.

I'm calling him this afternoon. (I'm on her HIPAA paperwork). I KNOW I'M NOT A DOCTOR. But I've probably done more reading about geriatric depression than her doctor, and I'm not lazy or indebted to my pharmaceutical rep.

Issues of my own surfacing from childhood? DEFINITELY. I'm aware of that and trying hard to not let it color my actions. But I could really use some advice, and I welcome hearing about experiences from those who have been through a similar situation. Thanks so much.
posted by SockPuppetOfShame to Health & Fitness (18 answers total) 2 users marked this as a favorite
 
What about a psychiatrist? They would know better than any GP about antidepressants anyway. If you have a local or state senior help line calling may put you in contact with resources that you don't know about. But it's Arkansas and I know that care is what you can get.

Most antidepressants take six weeks to get a full effect and she lives with you so she does have observation. An appointment in a month is appropriate unless she experiences severe side effects. With anti depressants is mostly a lottery to see which one works the best. There is no test that says one is better than another for a particular individual.
posted by AlexiaSky at 11:28 AM on August 4 [1 favorite]


Also note that moving is a huge transition and she could just be legitimately unhappy. She left friends, resources and familiar places and things to live with you. The little things like her favorite restraunt have all changed. She could just be having a hard time and not talking about it with you.
posted by AlexiaSky at 11:30 AM on August 4 [4 favorites]


She does not live with me. She lived with my brother a few hours away from Hellhole, and made his life so miserable that he dropped her in a senior housing in her hometown. The woman I refer to as my sister is actually my mom's best friend's daughter, we were raised together and she is the closest thing I have to family there.

No pychiatrists, I have checked.
posted by SockPuppetOfShame at 11:35 AM on August 4


Also, and I promise not to threadsit, she has ALWAYS been unhappy. And made everyone else unhappy as a special bonus.

I really would just like responses to stick to specific prescription medication anti-depressant/dementia resources for seniors, please.
posted by SockPuppetOfShame at 11:36 AM on August 4 [1 favorite]


Seconding the suggestion that you try a psychiatrist for her.

Failing that, maybe she doesn't necessarily need to see a gerontologist, but a better GP. How far is Hellhole from Little Rock? Or, say, Bentonville? Both are likely to have more competent GP doctors. Heck, it sounds like you could even get a better GP in East Hellhole.
posted by tckma at 11:36 AM on August 4


My partner's mother is in her 80s, and went on Aricept a few months ago for her memory problems (it's helped modestly).

My partner went through a similar struggle to get his mom's largely uninterested, vaguely hostile 70-something family doctor to take it seriously, but given that he didn't even take my partner's father's severe dementia seriously in the last year of his life, it was ultimately futile. It was only when my partner got his mom to a gerontologist, who administered the necessary testing, that there was any movement forward.

I agree that, in lieu of waiting till December, try to get her to a different GP (maybe a woman? And/or someone under the age of 50 or 60?) or a psychiatrist; I think the chances of convincing her present doctor that he's wrong and you're right are quite low.
posted by scody at 11:50 AM on August 4


Is she still living in the senior housing? Might the staff there have recommendations for better doctors?

One place I looked online for suggestions about medications for my grandmother (depression, then Alzheimer's) was AgingCare which is has a caregiver section; more of a user-to-user forum than a resource for professional advice, but you may find it useful.
posted by sm1tten at 11:51 AM on August 4


Oh, also: are there any gerontological nurse practitioners in the area? If so, you might be able to get her an appointment with an NP much earlier than December.
posted by scody at 11:52 AM on August 4 [1 favorite]


It's anecdata, to be sure but: my mother (who was miserable most of her adult life) improved markedly on Celexa (citalopram). This article discusses pharmacological options for older adults in great detail.
I was concerned about her taking it, because it sent me spinning off into the worst manic episode I've ever had but it worked wonderfully for her.
posted by ApathyGirl at 11:58 AM on August 4 [1 favorite]


My gramma was on Wellbutrin for her Alz-related depression but I'm not sure how long it took to have an effect. In her lucid periods she seemed much better with the Wellbutrin than before.
posted by elizardbits at 12:23 PM on August 4


FIL has diagnosed Alzheimer's and depression/anxiety. Probably has bipolar disorder and could have used a diagnosis 60 years ago, but the past is the past. Currently seeing 2 neurologists in L.A. He is on seroquel (very very tiny dose for anger and agitation) and Lexapro. His moods have improved 10 fold.

Having said that, every single patient is different. If zoloft is not the answer, try another and then another and then another. Most drugs do take a while to work, so give it 6-8 weeks. But if you're not happy with the results, then try another drug.
posted by Sophie1 at 1:09 PM on August 4


I am so sad that all of us who have no medical degree have to figure this out for ourselves. Shame on the American medical system for putting us in this corner. Argh.

That said, what about finding a GOOD doctor, in the city, who would be willing to talk to your mother over Skype?
posted by cda at 1:25 PM on August 4


Your mother's doctor may well be a jerk, but at least in this instance he seems to be acting appropriately. Zoloft (sertraline) has been studied for efficacy in the elderly (patients over 60), and a 2002 NIH study found it to be both effective in treating depression AND less likely than some of the other SSRIs (fluoxetine in particular) to cause problematic interactions with other meds. Sorry I can't link, I'm on my phone.

As sertraline has been off patent and available generically for quite some time, there's little chance that your mother's doctor has a drug rep golf buddy influencing him in this matter. Call him and advocate for your mother as you see fit, but there is a good chance sertraline may help her.

Source: I am a nurse working exclusively with geriatric patients and see sertraline widely used in this population.
posted by little mouth at 1:49 PM on August 4 [12 favorites]


Here is a resource that you may be able to useArkensas 211. I know that they are inpatient units but they have to link up to outpatient services.
posted by AlexiaSky at 2:50 PM on August 4 [1 favorite]


Respectfully, your degree of animosity towards this doctor may be justified based on your own personal experiences, but you provide no facts to support your bordering on irrational upsetitude with the care he is providing to your mother at this time. To wit, the patent on sertraline expired in 2006, so you can rest assured that if he does in fact spend his spare time playing golf with drug reps (is that point supported by everything you have read?), they would prefer that he prescribe something else.

FWIW. I'm an academic physician; I hate golf and drug reps. I see nothing wrong a priori with sertraline as an option in the elderly, though the best choice in her specific case would depend on a number of factors unknown to us. I also see nothing wrong with his follow-up plan. Here is the first link in a google search for "sertraline elderly."
posted by drpynchon at 4:29 PM on August 4 [1 favorite]


She's 87 years old, crabby, unhappy, probably bitter and complaining. Son has no more interest - he's burned out; daughter feels the obligation but no pleasure in taking care of her. She's just moved into a different situation and that means she's been through a recent loss of the rut she was living in, if nothing else, and she's really just floating. Her memory is going, and that frightens her more than you might know. Now she's seen a doctor who's supposed to help her, but her daughter is thoroughly disgusted with this doctor and wants to overrule him, which may or may not make sense, but it's nothing but confusing and frustrating for mother.

I live in a building with 150 apartments for seniors only; it has private pay apartments and HUD subsidized apartments, which are incredibly reasonable, and all units include all utilities. No matter how cranky you are, there's someone here who's just like you. Most everyone here has had difficulties with their children over the years and many, many of them find it a relief to live free from their kids (and the kids feel the same way). We have a social service director who is a whiz at lining up resources for whatever you need. If you have trouble cleaning or doing laundry, you can get help; you'll have to pay for it, probably (unless you can qualify for state aid), but it's not too costly. I pay about $35 a month for a lady who comes twice a month and does my laundry, changes my bed, vacuums, dusts, mops my kitchen and bathroom floors, and if I need something else done, she's happy to do it and charges next to nothing. Our social service lady can help with filling out papers for insurance or qualification for assistance, finding a dentist, getting Meals on Wheels, getting her set up with grocery delivery or volunteer trips to the grocery, and a kazillion other things.

Everyone in here, I would guess, is on multiple medications, and most of us are on some sort of antidepressant or anti-anxiety meds. I'm on Lexapro, which is the only one of several that reallly works well for me. My next-door-neighbor is on Zoloft and I doubt she's the only one. Oh, and they're both generics now.

You might consider something like this for your mother. It may take her a few weeks to get settled and comfortable with the idea, but she will. I put out a phone/birthday/pet name list every few months and new people are usually wary of having their name on the list, but by the next time I publish one, they're eager to be listed, so that's a fair gauge of how well they adapt to our anthill.

I understand your anger with the doctor - I have a sleep study doctor/group that has the same effect on me. They're bound and determined to put me on Ambien and I will NOT take that medicine - I don't need it in the first place, and it's very dangerous, particularly for the elderly. So we go round and round. And golf bonuses wouldn't surprise me one bit in this case - it really does happen.

But - considering the comments from those who are familiar with the use of sertraline/Zoloft in geriatric patients, you might let it happen and see if it has a benefit for your mother. It would be helpful to you, as well as to her, if she could begin to see more clearly and find something to enjoy.

Yours is a hard row to hoe and I wish you the best.
posted by aryma at 5:12 PM on August 4 [5 favorites]


MeMail me. I live in Arkansas, work in the psychiatric field, and may be able to give you some names of psychiatrists near Hellhole, AR (if you tell me where that actually is). UAMS also has some outreach clinics throughout the state and also does some telemedicine appointments so that may be an option.
posted by MultiFaceted at 11:27 PM on August 4


Just want to highlight/agree with littlemouth and drpynchon with their not-your-medical-practitioner answers. I often see elderly folks on SSRIs including sertraline. One other thing to be aware of: depression in the elderly may present with symptoms of memory loss/similar to the onset of dementia, which can mean it makes sense to try to treat the depression first and see if memory symptoms improve.
posted by treehorn+bunny at 1:30 AM on August 5


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