Should My Loved One Be Placed On An Antidepressant As Has Been Recommended By Their Physician?

There are so many things that can be discussed in reference to psychotropic medications.  I am going to focus on questions that you, as family members, can ask yourself in deciding if antidepressant medication therapy is the right choice for your loved one.  Hopefully after reading this article, you will have the information available to assist that doctor and / or facility in making the best determination.

First we must define what types of scenarios necessitate the consideration of antidepressants to be prescribed in the first place.  Essentially, the presence of a Major Depressive Episode needs to have occurred and / or be presently occurring to even consider the necessity of psychotropic medication use.  The following is a list of the types of symptoms that must be present in order to justify a Major Depressive Episode: (keep in mind that at least five must be present during the same two week period)

  1. depressed mood most of day, nearly every day
  2. marked diminished interest or pleasure in all, or almost all, activities most of day, nearly every day
  3. significant weight loss when not dieting or weight gain
  4. insomnia or hypersomnia nearly every day
  5. psychomotor agitation or retardation nearly every day
  6. fatigue or loss of energy nearly every day
  7. feelings of worthlessness or excessive or inappropriate guilt
  8. diminished ability to think or concentrate, or indecisiveness, nearly every day
  9. recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Now let’s take a look at many scenarios where antidepressants may not be appropriate.

Could symptoms be happening as a result of a medical condition?  Considering the many medications being used to address medical conditions, the person may, for example, be losing or gaining weight in response to side effects of a medication already prescribed.  Many narcotic pain medications can cause sleep difficulties.  Physiological effects of medications cannot be underestimated as possible causes.

Has your family member recently experienced the loss of a loved one?  Bereavement causes a depressive state that is natural and expected.  We should be more concerned if our family is NOT affected by such events!  I cannot tell you how many times I have been consulted within nursing homes where a staff member has approached me and said, “Mrs. Smith has been so depressed over the past few weeks after her son passed away.  She really needs an antidepressant.  Which one do you suggest?”  I have so many times had to explain that depression following a death of a loved one is not a scenario where medications are appropriate.  Love, support, understanding, and most importantly patience are the best prescriptions in this case.  We must wait at least two months to see if symptoms decrease to assess if medications may be helpful.  It is not as if we can tie a specific timeframe to how long it takes a person to “get over” a loss.  We can though wait 2 months to see if someone is still experiencing five or more depressive symptoms at once.  In most cases, the number of symptoms decreases and even though Mrs. Smith may never completely “get over” the loss of her son, she may very well get through the initial adjustment period where we must allow her to greave without bringing medications into the picture.

While we are speaking of the adjustment periods, it is an excellent time to talk about the correlation between adjustment to nursing home placement and medications to address associated depressive symptoms.  Often people have a very difficult time adjusting to living in the nursing home.  Many times I have worked with people who lived in their homes for 40 or 50 years in the same house and now suddenly and unexpectedly find themselves living in a nursing facility.  I cannot even imagine that feeling.  So why so many times do people feel that an antidepressant is necessary in this case?  It is understandable that one be depressed.  As was applied in the aforementioned subject of grief, we should wait a couple of months to see how a person adjusts before exploring use of medications to address symptoms. Information about a person’s personality should be conveyed to social services staff at facilities upon admission as to avoid such confusion from occurring.

Anxiety should always be considered as a cause of depression.  Depression can cause anxiety and anxiety can cause depression.  As a clinician I am always keeping a close eye on person’s symptoms because both conditions are so closely related.  The key thing to keep in mind is that if the primary problem is anxiety, than treat the anxiety and see if the depressive symptoms cease.  If the problem is depression, treat the depression and see if the anxiety ceases.  Too often medications are given for both conditions at the same time and all the medications were not needed.

Now that we have listed the scenarios where antidepressants are often unnecessary, let’s take a look at when they can be a great alternative to improving quality of life for the ones we love.

Anytime where a person is experiencing suicidal ideation, either with a specific plan or without, it is my feeling that antidepressants be strongly considered.  Close assessment of these situations should be completed just as in all cases though.  Suicidal statements can sometimes be made during attention seeking type behavior and other times may be expression of going through a time in life of dealing with feelings about death and dying.  The person that is 93 years old and states, “I just wish god would just go on and take me home” is not necessarily in need of antidepressant therapy.  But the person that states, “If I could get my hands on my shotgun that hangs over my bed at home, I would kill myself”, should be seriously considered for assistance through medications.

When plenty of adjustment time has been given in either a scenario where someone is grieving a loss or is having trouble adjusting to placement, this is a time to consider if medications can help.  The underlined issue here is that if someone experiences five or more symptoms of a Major Depressive Episode for longer than two weeks and it continues for a long period, they will more likely become physically ill as a result.  If the depression can be treated successfully, then other problems may be less likely to arise.

Many antidepressants have appetite stimulating properties to them.  If someone is depressed and this is thought to be the cause of their weight loss, then antidepressants have the capacity to be highly effective in activating appetite, both in alleviating depressive symptoms, and stimulating appetite through mechanisms within the medication.

Those diagnosed with dementia are great candidates for antidepressants.  Especially those persons who have just been diagnosed with the disease are often appropriate.  People in the mild stages of dementia are often much more emotionally affected by the disease during the early stages rather than at the moderate or severe stages because of the fact that later in the disease progression they may not even recognize that they are affected by the disease at all.  In early stages one must deal with acceptance of the disease and they are aware of their many faculties deteriorating.  During this time in their lives they can benefit greatly from medications not only to help cope with the situation, but in the fact that depression actually causes dementia to progress faster.

The dominating theme throughout consideration of the appropriateness of antidepressants is to assess the situation thoroughly.  We must consider all the factors that may be contributing to depression in order to best address the root of the problem.  The root of the problem is not always clinical depression, though when it is found to be, antidepressants can be a great way to improve the quality if life for your loved ones.

–  Here are some thoughts from fellow Twitter users when asked, “Do you feel that antidepressant medications are under-prescribed or over-prescribed within the geriatric population?”…

wayneguerra@wayneguerra –  ER MD working on iTriage, an iPhone App that gives users medical information, transparency around price and quality, and access to healthcare.

“My subjective opinion is antidepressants are overprescribed.  Many of the elderly we see in the emergency departments come from living situations where they are disenfrachised and lonely.  Not surprisingly they are depressed, and it is easier to prescribe medication rather then work on the social issues behind their depression.  Many times it is more situational than true organic disease.” Wayne Guerra

ElderCareRN

@ElderCareRN – Registered Nurse, writer, caregiver for my father, offering Encouragement, Education, Empathy & Effective strategies to Enrich the lives of eldercare giver.

“My official position is that anti-pressants are under prescribed & anti-psychotics are over-prescribed. This generation of elders come from the depression era and don’t often seek help for such things as ‘feeling down today’ “. – Shelley Webb

MrMedSaver

@MrMedSaverFounder and president of MrMedSaver.com, an online consulting company that helps people save money on their medications.

“Way overprescribed…I think many doctors prescribe antidepressants at the drop of a hat.   The problem’s even worse with antipsychotics.”  – Jake Milbradt PharmD

drkathyjohnson@drkathyjohnson – CEO and founder of Home Care Assistance. PhD and CMC.

“The problem with all medication use in the elderly is that adverse effects of medication are often misinterpreted as a new medical condition.  It takes a Geriatric MD or Senior Care Pharmacist to identify and prevent medication-related problems.  In terms of anti-depressant medication, the potential for interactions with other drugs is of concern, and vertain antidepressants have been shown to worsen anxiety in some seniors.  So prior to starting any antidepressant medication, potential medical, medication and environmental precipitants must be thoroughly investigated.” – Dr. Kathy Johnson

caregiving@caregiving – Certified ElderCare Coach, Author, Speaker.  Founder, Caregiving.com.  Interested in Social Media, Biking, Sports, Travel. Glad to connect!

“Under-prescribed.  I think depression in the elderly is an over-looked problem.  I wish we did more to help w their depression.” – Denise M. Brown

onerusty@onerusty – Be the change you wish to see in the world.  Fan of theseniorlist.com.  Empowering seniors and those who love them.  Let’s live, love & learn!

“Antidepressant’s underprescribed in general population, over in nursing homes.” – Frank Clark

daccarte@daccarteInterested in all things that enhance the quality of life in the elderly

“As a daughter of an elderly mother and from what I’ve read, I think anti-depressants are probably under-prescribed.  Although I don’t think depression is inevitable in the aging process, I do think there are a number of factors that make the elderly more susceptible.  Health problems, disabilities, hospitalizations, isolation in their homes, major transitions.  I imagine many elderly are like my mother.  They try to cope in silence. While I don’t believe drugs are a quick fix, I do believe the drugs play a role in the treatment of depression, especially in the elderly.” – Dale Carter


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