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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by maryhelen on December 9, 2006, at 13:44:25
I hope that it is not inappropriate to ask about my mother and what is going on with her and the medication she has been prescribed. I certainly have enough problems with depression myself, and find pyschobabble invaluable, even if I do not post often I certainly read with amazament at the research and knowledge that babblers share.
My mother is 89 years old and will be 90 in January. She has raised 9 children and life has certainly not been easy (poverty being ever present). For some reason my mother has never been depressed, at least not obviously so to keep her down. A remarkable vital women, who bowls, plays euchre, is always out walking or having coffee with her friends. She had a bad fall down a set of wooden steps, (about 15 of them) almost four months ago. She was at my sister's cottage and passed out for 5 minutes. My sister and niece thought she was dead. As they were calling 911 my mother woke up and told them that she will not go to hospital 'up north' so far away from home and that she was fine to get home. They ended up driving her home, and finally she agreed that she needed to be in hospital. She had a large laceration at the base of her skull, five broken ribs, a broken shoulder and various cuts and bruises, black an blue all over her body. Unfortunalety, all of the injuries could not be treated, even the shoulder could not be set. My mom is only about 95 pounds. They helped her with pain management and then moved her to a reabilitation centre after three weeks. She was there a few weeks and they sent her home. She did seem to recover quite well from her injuries, and again this very vital women surprised all of us by resuming her life..... bowling, bridge, euchre, walks, etc.
I am sorry for running on and thank you for your patience. Then out of the blue, she became depressed. No energy, no appetite, not sleeping, no interests, no reading or going out ..... well we all know how it takes a hold on us. She is so unused to feeling this way that I also think that she is in a bit of shock. Her blood pressure was going up and down alarmingly and she had to be taken to hospital a number of times, but was always sent home.
Her family physician decided that she needed to be put on an antidepressant and has prescribed her to take 10 mg. of cipralex at which time now, she has taken for about 2 weeks. We all know that these pills take time. I, myself, have been on so many antidressants, including cipralex and have become treatment resistant. How do the doctors pick and choose what med to try? Is it different depending how old one is? Does a women her age have special needs towards the type of drugs she takes? Unfortunaley, her women family physician is very short, unpleasant, and seemingly not greatly interested. She has always had one of my brothers or sisters with her at the time to witness this. One of my brothers called my cousin who is a nurse, to see if she could find a well respected geriatic practicioner, which she has. Her appointment is not until mid January.
This is so breaking my heart. In particular that I have gone through this depression for so many years and I cannot bear my mother going through this.
Does anyone have an opinion as to the cipralex, her age, and what more we can do to be proactive in her care, besides the obvious. She lives alone in her own apartment and has always been very independent and greatly admired by all of her children and friends. Of course there is enough of us to take turns being with her.
She is not in pain from her injuries and had recovered remarkably well from them. I wonder after 4 months why this has happened to her.
Any suggestions would be more than appreciated and I am sorry for making this so long.
maryhelen
Posted by madeline on December 9, 2006, at 16:42:38
In reply to Worried about my mother (long)....., posted by maryhelen on December 9, 2006, at 13:44:25
I'm curious about her pain managment regimen. What did she take? How long did she take them and how long has she been off them.
The fluctuating blood pressure could easily be opiate withdrawal, it also sometimes precipitates depression especially in someone her age.
Also, I would watch her closely for awhile. Watch her for wincing and grimacing with certain movements. Sometimes people can fool you about pain, they can claim they are fine, when, in fact, they hurt.
Thank you for sharing your story - absolutely nothing to apologize for here.
Maddie
Posted by Quintal on December 9, 2006, at 18:57:02
In reply to Worried about my mother (long)....., posted by maryhelen on December 9, 2006, at 13:44:25
My own grandmother was prescribed Celexa by her GP when she started suffering panic attacks and became depressed after my mother died. She seemed to do reasonably well on it. She did start to lose a *lot* of weight over the last year of her life, but I don't know that this was due to the Celexa - it was never satisfactorily explained though.
There was a story similar to this in Andrew Solomon's book "The Noonday Demon". His grandmother was a very sprightly, active lady well in to her nineties until she suffered a fall and then suddenly became depressed. I think she was given Celexa by her doctor too if I recall correctly.
Perhaps she'd like to feel in control of her own treatment if that's been her style for most of her life? I wonder if having some literature etc on the subject and generally being well informed about what's going on might help?
Q
Posted by maryhelen on December 9, 2006, at 18:57:17
In reply to Re: Worried about my mother (long)....., posted by madeline on December 9, 2006, at 16:42:38
Hi Maddie:
My mother started out in hospital with the morphine drip that you should press the button when the pain got bad. I am not sure, but I think she may have used it more than she should have because it also made her feel that there was a lift in her mood, although I cannot be sure. I cannot criticize her because at almost 90 years old she has been through quite a trauma She was in hospital for 3 weeks before they sent her to the rehabilitation nursing home. I am not too sure what they gave her for pain their. In fact, at the beginning whe was in terrible pain. I do not believe that it was the morphine drip, but many form tylenot 3 or percocett. I think she found the change made her feel crummy.
When she went home after 2 weeks, they sent her with 15 percocetts which she did not take for at least 3 weeks. Do you think, even though she wasn't taking opiates at the time it could still effect her blood pressure. I guess at her age any changes would be difficult to metabolize. Strangely, after about 3 weeks she would take a perc, not for the pain which she did not have, but because it helped her mood and she was able to do all of her socializing. Very quickly, this stopped working for her.
I really do believe that if my mother was in pain, she would tell us. I am just praying that the ciraplex will work for her, although as we all know that the waiting when we feel so lousy, it can seem to take forever.
We will take good care of her. I cannot picture this world without my mother in it.
Maddie, thank you so much for responding. That was very sweet and kind.
maryhelen
Posted by Honore on December 9, 2006, at 19:24:43
In reply to Worried about my mother (long)....., posted by maryhelen on December 9, 2006, at 13:44:25
Hi, maryhelen.
I was wondering if anything that happened might either have exacerbated your mother's injury, or have caused her to feel less safe or stable.
Does she talk at all about why she feels depressed? There might be some emotional factors that could be worked through, if the fall or any subsequent events troubled her. Especially if she's not used to feeling ill or dependent, maybe some issues have come up that she isn't sure how to handle.
She sounds as if she's doing a remarkable job at her age. I'm glad you've found her another doctor. Even if the appointment isn't right away, that may give her a lot of comfort.
Older people do take ADs. The only issue is usually that of dosage, which in some cases, needs to be lower. Often medications will discuss any changes in usage for older people on their PDR pages, or on many online sites that have similar information. You might be able to check on it in that way.
Honore
Posted by maryhelen on December 9, 2006, at 22:15:02
In reply to Re: Worried about my mother (long)....., posted by Honore on December 9, 2006, at 19:24:43
Hi Honore:
Thank you so much for taking the time to post about my mother.
I do not believe that my mother would feel less safe or stable. She has her 9 children making sure she does not spend too much time alone, and a lot of good friends in her apartment building who check in with her regularily. She feels guilty when people are visiting as she is so used to entertaining, but all she can do right now is lie on the couch. Of course it doesn't matter to anyone but my mother. I am the master of guilt so I really do understand.
She doesn't seem to be able to talk about her feelings, never has. You have a problem in life you simply deal with it.... and she has had many problems in her life. I guess if she hadn't gotten so much better and was back to most of her 'normal' activities, it would be easier to undersand. You hit it right when you say that she is not used to feeling ill or dependent, and she cerainly would not know how to handle any issue as she would just feel like a burden or that she should not complain because others are so worse off than she.
I am sorry to show my ignorance but was are PDR pages. I wonder how a doctor decides what med to put us all on. I was also prescribed Cipralex but soon after was hospialized. I guess a lot of it has to be trial and error. I am glad that she has the geriatric doctor to go to. I know my Mom is nearly 90 but it breaks my heart to see her sad and depressed.
I thank you all very much for your responses. It means a great deal to me. Thank you all of your kindness.
maryhelen
Posted by Phillipa on December 9, 2006, at 23:39:07
In reply to Re: Worried about my mother (long)....., posted by maryhelen on December 9, 2006, at 22:15:02
What a remarkable woman your Mother is. Is it possible she's taking pain meds and they were keeping her mood stable and now she's not? Can you take or one of your brothers or sisters to her regular doctor on Monday? I think she needs to be seen. At that age I wouldn't wait. Best of luck to you and your Mom. Love Phillipa
Posted by maryhelen on December 10, 2006, at 13:06:27
In reply to Re: Worried about my mother (long)..... » maryhelen, posted by Phillipa on December 9, 2006, at 23:39:07
Hi Phillipa:
Thank you for the kind words about my mother. I always wished that I could be like her, instead of this pathetic person I have turned out to be.
You are right about the pain meds. Of course they were giving her some in the hospital. She came home with 15 percs, but she did not take one for 3 weeks. Then I think this must have been when she started to feel her energy and her interests go. As things got worse for her she took a perc and within an hour she felt like a brand new person. So, she was saving them if she had a social event to attend and would take one. Well, all of a sudden they stopped working and she has just become more and more depressed. Do you think that the pain meds has changed her brain chemistry? Do you think that there could be a delayed reaction to the fall that she took?
I am praying that this antidepressant, Cipralex will work. My brother did take her to the family doctor on Friday and will take her to the new geriatric doctor in January. Of course, if there is any trouble before that we will get her to the doctor. My mother will know if she has trouble with her blood pressure, whether it be to low or too high, and we will take her to hospital. She has already had to go 3 times but they just send her home. If she cannot be with her family at Christmas, this will devastate her. Thank you for listening.maryhelen
Posted by Honore on December 10, 2006, at 19:37:57
In reply to Re: Worried about my mother (long)....., posted by maryhelen on December 9, 2006, at 22:15:02
maryhelen, it sounds as if your mother is being very well taken care of by you and your brothers and sisters.
The PDR is the "Physicians' Desk Reference," that oversized, red book you sometimes see in physicians' offices-- it has extensive, basic drug-related dosing, contraindication, and safety, effectiveness, etc information.
I looked around quickly online, and the information on most sites, including epocrates, which I think is a reliable site, as well as wikipedia (and others) agreed, so I feel safe in repeating it. It seems that older people (over 65) should probably be started at a low dose, but in any event, shouldn't be taking more than 10 mg/ day of lexapro (cipralex).
The usual dose is about 20mg/day. So it sounds like your mother shouldn't take more than she is now.
With any luck, your mother will respond soon.
It's very hard when a parent suffers and you can't help. I hope you remember that, and aren't hard on yourself for having a tough time.
I was thinking, too that maybe the doctor would have cancellations. You might possibly speak to the nurse of office manager about letting you know if that occurs.
Honore
Posted by maryhelen on December 10, 2006, at 20:26:59
In reply to Re: Worried about my mother (long)....., posted by Honore on December 10, 2006, at 19:37:57
Hi Honore:
I guess it does come in handy to have nine children, in good health, at my mother's time of need.
Thank you for explaining what the 'Physicians' Desk Reference' is. I do know the book now that you desribe it.
It is so incredible that you would take your time to check on line to get information for me and my mother. My mom is on 10 mg. of cipralex which I gather is also called lexapro. I will certainly tell my brothers and sisters this in case they are the one at the doctor with her.
Thank you for wishing my mother well. Over the last two days she has had a breakthrough and was able to attend a Christmas get together at her apartment. Although she didn't seem so great this morning, perhaps it is a start.
Having suffered with depression for so long, I have found that after so many years, so many people have said to me that they wish they could help and I know that it has been hard on my family as you start to get worse and isolate yourself. It is particularily hard for my daughter and of course my mother also feels helpless, even though I try to reassure them that there support has meant more than anything.
That is a good idea about the possibility of a cancellation. I will call my brother tomorrow as he is the one who will be taking her.
I cannot thank you enough for the time you took to help us. It used to be, before my depression got so bad, that I would be able to do more and gather information. It is great to know that you have friends here at babble who are willing to go the extra distance.maryhelen
Posted by dessbee on December 11, 2006, at 15:15:59
In reply to Worried about my mother (long)....., posted by maryhelen on December 9, 2006, at 13:44:25
Your mother may be suffering from PTSD (Post Traumatic Stress Disorder). An accident that needs hospital care can be quite stressful especially for an older person.
Take care
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