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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by fachad on January 30, 2002, at 12:17:44
My 78 yr old mother has been a worrier all her life, but lately it's much worse. She gets panicky and agitates endlessly about every trival thing.
The dr. at her nursing home is going to give an order for Xanax 0.25mg PRN. Is there a better alternative for older people?
Posted by gheld on January 30, 2002, at 21:51:01
In reply to Best Benzo for Anxiety in Elderly?, posted by fachad on January 30, 2002, at 12:17:44
Good question. Certainly medication appropriate for younger people has to be reduced for the elderly because of the rate of metabolism.
You don't want to have her overmedicated and take a chance on falling, leaving the stove on, etc.
My 86 y/o mother has similar problems. Celexa, 20 mg/day, seemed to do the best. She didn't like it because she thought it was only for depressed people. ( I'd probably be depressed if I was 86 and had her problems, so I think she really is depressed.)
Anyway, her doc put her on 10 mg of Buspar per day and it has done no good that I can seee in the 2 months she's been on it.
I'm going to push for going back to the Celexa. At that age, who cares if one of the side effects is loss of sexual drive.
Posted by tammy on January 30, 2002, at 22:09:07
In reply to Best Benzo for Anxiety in Elderly?, posted by fachad on January 30, 2002, at 12:17:44
hi, it all depends on the dr. and her medical history, but if shes being anxious all the time its probably best if she was on a ssri..... cause xanax is a quick fix..... (i know for my panic id rather an ssri then the ativan i have..id rather have something constant then to have to grab a pill when needed cause sometimes im hesitant to take it and try to fight it and makes it worse...........
but again medical history and dr. are the key....
tammy
Posted by 3 Beer Effect on January 31, 2002, at 21:28:33
In reply to Best Benzo for Anxiety in Elderly?, posted by fachad on January 30, 2002, at 12:17:44
>He could put her on a regular dosing of Klonopin (once or twice per day, every day). It has serotogenic effects that would eliminate her worrying better than Xanax could. Also, unlike Xanax or Ativan it is also a fairly subtle medication in that it takes 1 or 2 hours to start working, has a 12 hour duration, and a half-life of 30 to 40 hours. A slow onset & long duration of action means that Klonopin should have less risk of abuse than Xanax which has a fast action w/ "immediate gratification" & short duration which can easily lead to tolerance, & dose escalation by the patient.
I don't know much about Ativan except that it is the strongest of the available benzodiazepines & I believe it is more abuse prone because it has "immediate gratification" properties, & causes more coordination problems & falls in the elderly. My 81 year old grandmother, who worried constantly about everything, was prescribed Ativan. Eventually she started taking more pills than she was supposed to & fell asleep in a wooden chair in the kitchen & fell off, breaking her hip.My 78 yr old mother has been a worrier all her life, but lately it's much worse. She gets panicky and agitates endlessly about every trival thing.
>
> The dr. at her nursing home is going to give an order for Xanax 0.25mg PRN. Is there a better alternative for older people?
Posted by Mr. Scott on January 31, 2002, at 23:37:09
In reply to Best Benzo for Anxiety in Elderly?, posted by fachad on January 30, 2002, at 12:17:44
I honestly don't know if it's still on the US market, but I remember reading it had the least likelihood of building up in the body, causing memory impairment, or interactions in the liver. It is the gentle ben of short acting benzodiazepines.
Posted by jimmygold70 on February 1, 2002, at 11:53:00
In reply to Best Benzo for Anxiety in Elderly?, posted by fachad on January 30, 2002, at 12:17:44
Yes. She should try to be on Paxil. If it still doesn't suffice after she reaches 60mg/day for a couple of months, she can add Xanax. Xanax is a good medication, but Paxil might even give better results.
Posted by Pattisun on February 2, 2002, at 12:40:43
In reply to Re: Best Benzo for Anxiety in Elderly? » fachad, posted by jimmygold70 on February 1, 2002, at 11:53:00
As a 7-yr Paxil user I thought it was okay to let the doctors give it to my 81 yr old mother for her anxiety and depression. Well....until I read the literature that came with the medication. It warns of severe adverse reactions in the elderly! There is NO WAY I am letting the doctors give my mother Paxil.
Brain chemistry in people 70 and older is different than younger adults.
That's my 2 cents!!
Patti
p.s. I have been trying to withdraw from Paxil for years....I finally got down to 10 mg but the doctors had me stop because the withdrawal symptoms were so severe. I regret that I was ever given it to try. Besides, it never did help my anxiety disorder anyway (have to take Klonopin still anyway)
Posted by Geezer on February 2, 2002, at 14:46:34
In reply to NO Paxil for the elderly!!, posted by Pattisun on February 2, 2002, at 12:40:43
Hi Pattisun,
In my humble opinion and for what it is worth. Paxil and Effexor seem to be the most difficult ADs to "withdraw" from. I have not taken these ADs (never will) but to get off Zoloft and Celexa I have reduced my dose gradually until the "withdrawal" symptoms become noticeable then due a crossover to Prozac (10mg/day works for me). Step two is take the Prozac for a couple of weeks then split Prozac pills in half (5 mgs/day for a week) alternate 5mg/day if necessary-then stop. This seems to minimize the serotonine symptoms due to the long half life of Prozac. Elizabeth and others on this board can explain the drug/brain chemistry much better than I.It is a good idea to have a plan as to what drug you are going to after the Paxil. If you plan to change to another SSRI the above mention process may not be needed. This is why the pdoc is important (some are better than others), I have failed at trying to treat my depression on my own.
Wish you the very best,Geezer
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