Extreme anxiety and major depression

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Has she tried a Benzodiazepine? While some doctors are reluctant to prescribe them because they can be addictive, I can’t imagine it would be a concern for an 87 year old. They can work quite well for acute anxiety.

I was just thinking…at 87 can’t you get drugs that might be addictive…but it’s worth it at that age?

OP here. My mom was taking a benzodiazepine for sleep, but not in very high doses, but we took her off it because she had elevated blood ammonia (which has terrible psychological side effects) and benzos can either cause that or make it a lot worse if you already have reduced liver function (which most elderly people have to some degree). Her blood ammonia levels are now normal. For sleep she takes mirtazapine (Remeron) in a very low dose and just started buspar for anxiety.

I also wanted to add that when my mom is in a depressive episode with generalized anxiety disorder she has a completely different personality. 6 months ago she was happy, involved in many activities and not anxious. She was doing well for about 3 yrs. Before that she had another depressive episode that was equally terrible as this one that lasted for 10 months. Prior to that she hadn't had a depressive episode for maybe 15 yrs? It's the contrast that shakes me, and the fact that she came out of the episode 3-4 yrs ago...I think this is triggering a lot of the anger my siblings and I are having. There's also the history from our younger years that my mom basically got better when we finally broke from the stress of taking care of her and told her to f*%* off. Yeah, we realize doing that now would just hasten her death. But we've also talked with our mom about how if she can't shake the anxiety, she likely won't live much longer.[b] Her depressive self honestly repulses me...my pity is all gone and I can't stand the thought of her going out like this.

If this is the best you can do, maybe you all need to take a step back and let paid caregivers be more primary in her life. Shaming her for being unable to “shake” a lifelong mental health condition is not going to work. It is especially not going to work when the threat is “or you will die”; she is 87 and will be dying regardless.

If the benzodiazepine was working, she could consider going back on it. Elevated ammonia in someone who is 87 is not like elevated ammonia in a 47 year old. Cutting her off from treatments that worked for the benefit of her long-term health is insane. She is 87; there is no long term.

Have you gotten treatment for your trauma? It sounds like you could use it. Good thoughts to you.

[Anonymous]

Anonymous wrote:

If this is the best you can do, maybe you all need to take a step back and let paid caregivers be more primary in her life. Shaming her for being unable to “shake” a lifelong mental health condition is not going to work. It is especially not going to work when the threat is “or you will die”; she is 87 and will be dying regardless.

If the benzodiazepine was working, she could consider going back on it. Elevated ammonia in someone who is 87 is not like elevated ammonia in a 47 year old. Cutting her off from treatments that worked for the benefit of her long-term health is insane. She is 87; there is no long term.

Have you gotten treatment for your trauma? It sounds like you could use it. Good thoughts to you.

Her potential death from mental illness isn't a threat, it's a fact. She is aware and acknowledges that nearly all her decline in the past 5 years of so is because of her mental health problems. Rather than threatening what we are doing is telling her the consequences we are observing. It's a last plea for her to have some agency in her recovery, if she still has it in her.

Stepping back will just trigger further downward spirals. Now she's calling me telling me she's frightened and begging me to come over. We're refusing to come over more than once per day. She's also not in assisted living so there's no paid caregiver to depend on, though that may come in the near future.

The benzodiazepines are not coming back, because they increase the risk of falls and cognitive impairment and also increase the likelihood of high ammonia levels. Have you ever seen an elderly woman with high ammonia levels? In my mom she went from being her normal self to within 2 weeks not sleeping at all, having major tremors, being confused and disoriented with red-rimmed eyes and looking terrified...it is the worst state I have ever seen her in. It's a neurotoxin with major neurological symptoms that are way worse than the anxiety and depression.

If my mom could shake the anxiety and depression she could absolutely live another 10-15 yrs...she has had many relatives live between 95-99 yrs old. It's absolutely not worth it if she remains in her currently state, but I'm not exactly ready to leave her to die now (since you're concerned about my trauma!).

[Anonymous]

Anonymous wrote:You children need to step back. Very loose hold on the rope. You do not have to fix this . She is in a care facility. YOU DO NOT HAVE TO FIX HER. OR CURE HER. OR EVEN MAKE HER FEEL BETTER. IT IS NOT YOUR JOB.
Stop looking for a cure or fix. Just stop. Live your lives. Nor orbit angrily around her.
Let her be. See how she does. It cannot be worse for you than your micromanagement is. It may be no different for her.
I suggest you look into AlAnon because you children are enraged codependent. You need to live as faults not overburdened terrified children.
Love to you all.

NP here. Thank you for this. Sometimes I think there is really something wrong with me because I don't see a need to treat my parents' physical and mental declines with massive time and resources. So many people are like OP that I wonder if I'm supposed to be insisting on more, when all I really think people in their late 80s need is a gentle passing on. We are living way past any quality of life in this country. Stop all the medications and die naturally--this is nuts.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Very very gently, she is 87. You say that the endpoint is going to be dying if you don't break the cycle... maybe that's her natural course. Maybe for her it's not cancer or a stroke or heart disease, it's mental illnesses with physical side effects. You and your siblings are making her exercise, taking her to doctors, giving her medications, supplements... You talk of magnetic stimulation and electroshock therapy and ketamine as a nasal spray (?!). There is no correct answer to this, but when is enough enough?

At this point, there could be some mental decline that is boosting the anxiety. My dad did not have a history of depression and anxiety but did develop a hefty amount of anxiety + some OCD habits + some ADHD symptoms as his dementia began. This was before he was officially diagnosed, but in hindsight we can see how it's all connected.

One recommendation I do have is to see a geriatric psychiatrist. Some medications are not effective for the elderly. Their mental pathways are changing, and what once used to be effective treatment may no longer work. Geriatric psychiatrists will be much more aware of this plus other possible issues.

Good luck OP.

Yes, I think you're likely absolutely right. Her mental health issues are the drivers of all her decline. All the alternative therapies are basically hunting for a silver bullet that probably doesn't exist. And at this point she would probably be made even more anxious.

I think you are getting PP backwards. Your mom’s mental health decline could be caused by physical health (or physical neurological) problems, and not the other way around. My elderly relative became extremely anxious and depressed shortly before she died—she had a brain tumor. I’m sure it went both ways—maybe the anxiety made her physical health worse. But the literal deterioration of her brain also caused her mental health problems. There was no way to comfort her. It was just part of her path.

[Anonymous]

I mean this gently, but it sounds like her mental health has caused problems for her and you/your siblings for her entire adult life. It isn't likely to be solved at 87. I would leave this to her doctors/nurses/aides and try not to get involved on the medical side.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

If this is the best you can do, maybe you all need to take a step back and let paid caregivers be more primary in her life. Shaming her for being unable to “shake” a lifelong mental health condition is not going to work. It is especially not going to work when the threat is “or you will die”; she is 87 and will be dying regardless.

If the benzodiazepine was working, she could consider going back on it. Elevated ammonia in someone who is 87 is not like elevated ammonia in a 47 year old. Cutting her off from treatments that worked for the benefit of her long-term health is insane. She is 87; there is no long term.

Have you gotten treatment for your trauma? It sounds like you could use it. Good thoughts to you.

Her potential death from mental illness isn't a threat, it's a fact. She is aware and acknowledges that nearly all her decline in the past 5 years of so is because of her mental health problems. Rather than threatening what we are doing is telling her the consequences we are observing. It's a last plea for her to have some agency in her recovery, if she still has it in her.

Stepping back will just trigger further downward spirals. Now she's calling me telling me she's frightened and begging me to come over. We're refusing to come over more than once per day. She's also not in assisted living so there's no paid caregiver to depend on, though that may come in the near future.

The benzodiazepines are not coming back, because they increase the risk of falls and cognitive impairment and also increase the likelihood of high ammonia levels. Have you ever seen an elderly woman with high ammonia levels? In my mom she went from being her normal self to within 2 weeks not sleeping at all, having major tremors, being confused and disoriented with red-rimmed eyes and looking terrified...it is the worst state I have ever seen her in. It's a neurotoxin with major neurological symptoms that are way worse than the anxiety and depression.

If my mom could shake the anxiety and depression she could absolutely live another 10-15 yrs...she has had many relatives live between 95-99 yrs old. It's absolutely not worth it if she remains in her currently state, but I'm not exactly ready to leave her to die now (since you're concerned about my trauma!).

With respect: you aren’t making sense. There is no “shaking” anxiety. There is treating it. In an 87 year old person, that treatment may be terminal. It may still be better quality of life than she has now.

She is, as you say, not her normal self now. She is in a state so bad that a significant part of you sees death as preferable to it. You also say that you understand that her disease process may be terminal—not because of her medications, but because of her disease.

So on some level you do get that telling her to bootstrap her way out of a disease that is this intransigent is not effective and it’s not kind. Why are you doing it?

[Anonymous]

Why am I doing it? Because every time she’s been in a major depressive state before she’s come out of it and become her regular not-depressed and not-anxious self again. The last episode was when she was 84 and lasted 10 months and she had 3 good years following. She’s 7 months into this episode. I don’t know if she’ll come out of this or not. That’s what makes this so hard. I’m pretty certain if we let go and walk away she won’t come out of it and will die a miserable death relatively soon. I also have no certainty that if we focus hard on her recovery that it will work.

[Anonymous]

OP here with an update. It's now 11.5 months since my mom's extreme depression and anxiety began, and it has FINALLY lifted. She's her normal self again...still very elderly (she's 87) and still very frail, but the depression and anxiety is GONE.

What happened since I last posted...
The main thing is she started seeing a new psychiatrist who diagnosed her with bipolar depression and started her on lamotrigine. We also continued the other treatments:
- CBT for insomnia (she started sleeping normally for her about 6 months in to this episode)
- therapy - she started seeing a therapist weekly, also about 6 months in
- exercise - slowly over past 8 months she has been increasing her exercise. For the last 2 months we have been walking together at a faster pace than she walks on her own - about 2.5mph for 15-20 min. I had read so many studies emphasizing the benefits of exercise for depression.

I think everything we were doing in addition to the medication was helping, but the bipolar depression diagnosis and new medication probably were the game changers. Lamotrigine is supposed to be better at preventing recurrence of depression than lifting someone out of depression...but here we are. I can't believe that with about 10+ lifetime severe depressive episodes that have each been up a a year in duration it took until age 87 to reach a diagnosis and find an effective treatment...but here we are, and we are all so thankful.

[Anonymous]

That's fantastic news!

[Anonymous]

She got better when your sibling cut her off????

There's a message there. Step back. This is codependency you have going on. She's miserable, gets attention. Try dropping the rope.

[Anonymous]

Anonymous wrote:She got better when your sibling cut her off????

There's a message there. Step back. This is codependency you have going on. She's miserable, gets attention. Try dropping the rope.

Both of my siblings stopped coming multiple times a week - they each live about 45 minutes away and the time was overwhelming. But they still came once a week spending at least half a day with my mom. So no abandoning, more setting a boundary that my mom couldn't call with an anxiety emergency. I also set the same boundary and stopped coming over on call when my mom said she was frightened, etc. I saw my mom more like 3x per week plus taking her to doctor/psychiatrist appointments and occasionally running errands. But this was all planned ahead.

Now that she's feeling better she says she's not frightened at all. The depression is gone. She signs up to run errands with the shuttles at her assisted living facility. We've cut back somewhat on the number of visits but she still sees at least one of us at least twice a week and I talk to her on the phone every day.

[Anonymous]

Anonymous wrote:That's fantastic news!

Yes, I can still barely believe it! I wanted to share the update so others would hold out hope. It's really tough getting the right kind of psychiatric care, and even with it, getting better can take a long, long time. But it's worth keeping trying!

[Anonymous]

I am so impressed your mom was receptive to the meds, therapy, exercise!! My mom is younger and will only go back on meds or try a different med and therapy when she hits rock bottom. As soon as she feels better, she gradually goes off, against doctor's orders. I hope your mom continues to do well! It's good that your siblings stopped enabling, but still check on her.

[Anonymous]

OP, I am truly so happy you took the time to update this thread. My heart was breaking for what you were going through, and hearing this outcome, better than I'd even thought possible, is just wonderful.

Wishing you and your family all the best.

[Anonymous]

Anonymous wrote:My mother is 87 and has had major depressive episodes her whole adult life, but once antidepressants (SSRIs) became widely available she stayed well for very long stretches. But now that she's become elderly the major depression and extreme anxiety is back and is driving all of the declines in her health. An episode in 2022 lasted 10 months...she lost 40+ pounds, stopped driving and moved into a senior living facility, which finally broke the depression and she became her usual self again. Now we're 6 month in to another episode and nothing is helping. She had insomnia, but 3 months ago she started sleeping well again...but her anxiety and depression are as terrible as they ever have been. We've been trying everything - SSRIs, therapy, exercise/physical therapy - while treating all the physical health symptoms that one after another turn out to be caused by her anxiety/depression, such as issues swallowing/eating, tremors, weakness, etc. She doesn't have dementia although at this rate she's going to ruin her health until everything starts shutting down. Her physical health has always been good...she only takes medication for her blood pressure and assorted vitamin supplements (vitamin D, B vitamins, magnesium) and famotidine for reflux and occasionally takes Nexium for short periods when her anxiety makes the reflux a lot worse.

Please let me know if you have dealt with this with your elderly parents. Our family, especially my siblings, are continuously stressed out and are getting to the point where we are getting very angry at all of this self-inflicted misery. We have some childhood/young adult trauma from dealing with my mother's depressive episodes as well.

Does anyone have any recommendations for what to do when medications stop working? I've read about everything from TMS (transcranial magnetic stimulation) to electroshock therapy to esketamine (ketamine nasal spray)...but I'm not sure if any of this makes sense at her age. She honestly is likely to die from depression if we can't find a solution, but increasingly I'm wondering if that is the solution since she seems to be so invested in it. She actually is not suicidal - I think a lot of this is anxiety about aging and dying - but honestly the end result IS going to be dying if we can't break this cycle.

No. Found your problem.