Medication Use for an Elderly Relative's Mental Health

Q: Medication Use for an Elderly Relative's Mental Health

1. <br>Indications for each medication are as follows： <br> 1. <br>Quetiapine： Used for the treatment of schizophrenia, depressive episodes in bipolar disorder, manic episodes, and mixed episodes. <br>It can be used as an adjunct treatment for major depressive disorder (MDD) p

I would like to understand my mother-in-law's medication usage?

Consulting a physician: My mother-in-law is currently 82 years old.
She previously received treatment at the Tzu Chi Hospital in Tanzi for mental health issues.
Two years ago, other family members transferred her to China Medical University in Taichung.
Shortly after the transfer, she attempted suicide by overdosing on medication, so we are cautious about changing doctors.
Her condition has not been optimistic in the past six months; she frequently repeats questions, is reluctant to bathe, spits phlegm everywhere, and sleeps excessively throughout the day.
Previously, she was taking Stelazine (trifluoperazine) at a dose of 1 tablet.
A month ago, she fell while going for a walk two hours after taking her medication, and she still has no memory of that incident.
I would like to understand her medication regimen.
She is currently taking Quetiapine 0.5 tablets at noon and 1 tablet at bedtime, Trazodone 0.5 tablets in the morning and 1 tablet at bedtime, Estazolam 1 tablet at bedtime, and Mirtazapine 0.5 tablets in the morning and 1 tablet at bedtime.
Thank you.

edith, 80~89 year old female. Ask Date: 2017/02/09

Dr. Gu Zhenting reply Pharmacology

1.
Indications for each medication are as follows:
1.
Quetiapine: Used for the treatment of schizophrenia, depressive episodes in bipolar disorder, manic episodes, and mixed episodes.
It can be used as an adjunct treatment for major depressive disorder (MDD) patients who do not respond adequately to monotherapy with antidepressants.

2.
Trazodone: Used for the treatment of various forms of depression.

3.
Estazolam: Used for the treatment of insomnia.

4.
Mirtazapine: Used for the treatment of depression.

2.
Dosage information is insufficient to provide recommendations.

3.
Due to your grandmother's advanced age, it is important to pay attention to medication dosages.

4.
Given the patient's poor insight into their illness, please be mindful of medication adherence (ensure that all medications are being taken).

5.
Since the patient is already on three antidepressants and symptoms have not improved, it is recommended to return for a follow-up discussion with the physician.

6.
Quetiapine and Trazodone may cause significant sedation due to their side effects; please return for a follow-up to discuss dosage adjustments or medication changes with the physician.

7.
Antidepressants are only one aspect of treatment; combining them with psychosocial therapy is necessary for better efficacy.
It is still recommended to return for a thorough discussion with the physician.

Reply Date: 2017/02/09

More Info

Understanding the medication use for an elderly relative, especially one with complex mental health needs, is crucial for ensuring their safety and well-being. In the case of your 82-year-old grandmother, it appears she has been prescribed a combination of medications that are commonly used to manage symptoms of depression, anxiety, and sleep disorders. However, given her history of suicidal behavior, memory issues, and the side effects of these medications, a careful review and monitoring of her treatment plan are essential.

Overview of Medications
1. Quetiapine: This is an atypical antipsychotic that is often used to treat schizophrenia, bipolar disorder, and major depressive disorder when other treatments have failed. It can help stabilize mood and reduce anxiety but is known to cause sedation, which may contribute to her excessive sleepiness.

2. Trazodone: Primarily used as an antidepressant, Trazodone is also prescribed for insomnia due to its sedative effects. While it can be effective for sleep, it may also lead to drowsiness during the day, especially when combined with other sedative medications.

3. Estazolam: This is a benzodiazepine used for short-term management of insomnia. Benzodiazepines can be effective for sleep but carry risks of dependence, particularly in older adults, and may exacerbate cognitive impairment.

4. Mirtazapine: This medication is an antidepressant that can also help with sleep due to its sedative properties. It is often used in elderly patients because it can stimulate appetite, which may be beneficial if your grandmother is experiencing weight loss or decreased appetite.

Concerns and Recommendations
Given your grandmother's symptoms—repetitive questioning, lack of personal hygiene, excessive sleepiness, and a recent fall—there are several concerns regarding her current medication regimen:
- Polypharmacy: The combination of multiple medications can increase the risk of side effects and drug interactions, particularly in elderly patients. It is important to regularly review her medications with her healthcare provider to assess their necessity and effectiveness.

- Cognitive Impairment: The medications prescribed, especially Quetiapine and Trazodone, can contribute to cognitive decline and sedation. This may explain her memory issues and increased confusion. It is crucial to monitor her cognitive function and consider reducing or adjusting her medication dosages.

- Suicidal Ideation: Given her history of a suicide attempt, it is vital to maintain close communication with her healthcare provider. Any signs of worsening depression or suicidal thoughts should be addressed immediately.

- Medication Adherence: Due to her cognitive state, ensuring that she is taking her medications as prescribed is essential. Family members may need to assist her with medication management to prevent missed doses or accidental overdoses.

Next Steps
1. Consultation with a Geriatric Psychiatrist: It may be beneficial to consult a specialist in geriatric psychiatry who can provide a comprehensive evaluation of her mental health and medication management.

2. Regular Monitoring: Schedule regular follow-ups with her healthcare provider to monitor her mental health status, medication side effects, and overall well-being.

3. Non-Pharmacological Interventions: Consider incorporating non-drug interventions such as cognitive behavioral therapy (CBT), social engagement, and physical activity, which can improve mental health outcomes in elderly patients.

4. Family Support: Encourage family involvement in her care. Providing emotional support and ensuring she feels safe and valued can significantly impact her mental health.

In conclusion, understanding and managing the medication use for your grandmother requires a collaborative approach involving healthcare providers, family members, and possibly mental health specialists. Regular reviews of her treatment plan, attention to her mental and physical health, and open communication with her healthcare team will be key to improving her quality of life.

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