Anonymous wrote:My mom is 87 and has recurrent severe depression and GAD. It’s terribly hard for family to manage this so you have my sympathy.

I would try to find a good geriatric psychiatrist or psychiatric nurse practitioner. It can be so hard to find someone good…my mom’s last major episode was during Covid and it was impossible. You need someone to be available when you need it.

First, watch the UTIs - they can cause liver enzymes or blood ammonia levels to be abnormal and high ammonia levels especially have psychological effects. My mom regularly has bloodwork to check - now just the regular panel. It can be hard to distinguish physical from mental symptoms and my mom is always having some physical effects of her anxiety - trouble swallowing, insomnia, tremors, weakness, fatigue.

Seeing a therapist is also really important…manly for us it’s talking about how to manage her anxiety and break out of anxious thought spirals when they happen.

Regular exercise, outdoors if possible, too - I go on walks with my mom maybe 4x per week now and she goes to the exercise class at her senior living facility on the other days. (She’s in independent living). When I’m with her we link arms and walk at a faster pace than she can manage on her own. Getting your heart rate going and being a little out of breath is especially helpful for the mental health benefits of exercise.

For meditation my mom takes sertraline (an SSRI - generic Zoloft). I don’t think it does much. We are going to work on possibly changing medications. It’s so individual what works and what doesn’t.

We also tried Buspirone, one of the only anti anxiety meds considered safe for elderly people but my mom would get so anxious about taking it we eventually dropped it. That was beyond frustrating.

Last, if your mom isn’t living in senior living, consider it. The daily activities with other people is key and can really help. It brought my mom out of her last depression.

Last - if she isn’t sleeping well this is very foundational to anything else being able to work. My mom had terrible insomnia and we followed a book on cognitive behavioral therapy (CBT) for insomnia. It worked like a charm. Now my mom goes to bed & wakes at the same time every day. Without this she’s so miserable it’s impossible to work on anything else.

In sum since this was long:
1. See a psychiatrist/psychiatric nurse practitioner for medication management and diagnosis
2. Exercise
3. Daily activities with other people
4. Get regular sleep/treat insomnia

We are 10 months in to this current episode. It’s a lot better than it was, but it’s still a work in progress. Best of luck to you.

Agree with all of this especially the bolded. Having people to dine with and activities at senior living makes such a difference. Between my own parents, inlaws and other realtives, when they age at home alone even with caregivers and visitors the descent into depression/anxiety/rigidity/anger is so pronounced and painful to watch, but once moved to a more appropriate setting after the initial protest, fury, anxiety or whatever, it's like they age backward a little. Peers push you to grow/bloom in a way your own family can't. They cann you on your BS and make you shape up-get out there, take meds if you need to do and live life! A new friend can open a whole new world.

My mom is 87 and has recurrent severe depression and GAD. It’s terribly hard for family to manage this so you have my sympathy.

I would try to find a good geriatric psychiatrist or psychiatric nurse practitioner. It can be so hard to find someone good…my mom’s last major episode was during Covid and it was impossible. You need someone to be available when you need it.

First, watch the UTIs - they can cause liver enzymes or blood ammonia levels to be abnormal and high ammonia levels especially have psychological effects. My mom regularly has bloodwork to check - now just the regular panel. It can be hard to distinguish physical from mental symptoms and my mom is always having some physical effects of her anxiety - trouble swallowing, insomnia, tremors, weakness, fatigue.

Seeing a therapist is also really important…manly for us it’s talking about how to manage her anxiety and break out of anxious thought spirals when they happen.

Regular exercise, outdoors if possible, too - I go on walks with my mom maybe 4x per week now and she goes to the exercise class at her senior living facility on the other days. (She’s in independent living). When I’m with her we link arms and walk at a faster pace than she can manage on her own. Getting your heart rate going and being a little out of breath is especially helpful for the mental health benefits of exercise.

For meditation my mom takes sertraline (an SSRI - generic Zoloft). I don’t think it does much. We are going to work on possibly changing medications. It’s so individual what works and what doesn’t.

We also tried Buspirone, one of the only anti anxiety meds considered safe for elderly people but my mom would get so anxious about taking it we eventually dropped it. That was beyond frustrating.

Last, if your mom isn’t living in senior living, consider it. The daily activities with other people is key and can really help. It brought my mom out of her last depression.

Last - if she isn’t sleeping well this is very foundational to anything else being able to work. My mom had terrible insomnia and we followed a book on cognitive behavioral therapy (CBT) for insomnia. It worked like a charm. Now my mom goes to bed & wakes at the same time every day. Without this she’s so miserable it’s impossible to work on anything else.

In sum since this was long:
1. See a psychiatrist/psychiatric nurse practitioner for medication management and diagnosis
2. Exercise
3. Daily activities with other people
4. Get regular sleep/treat insomnia

We are 10 months in to this current episode. It’s a lot better than it was, but it’s still a work in progress. Best of luck to you.

She's 83. It's past her time anyway.

Anonymous wrote:Work out an agreement. You will shut up about medication if she follows a sound hydration routine and does not dehydrate.

I would not suggest this because it's a promise that may not feel right to keep. When our own mom went off medication, she wasn't just creating problems for herself, but for innocent people. Her anxiety and controlling behavior turned into rage at doctors/nurses/staff/aides/neighbors. She wasn't that way right away, but that's the direction it went-outright abusive toward others.

A promise I would consider is backing off if she allows a geriatric expert to work with her. They are trained to talk to challenging elderly and help them feel safe and heard in the hopes of guiding them toward taking the right steps for their health.

Anonymous wrote:

Anonymous wrote:OP here- it is not dementia, she’s been tested several times and when I get her to take anti anxiety medicine (Ativan) she acts perfectly normal again.

Who is prescribing her Ativan at 83?!

Not OP but two well-regarded internists prescribed this for my elderly ILs in their 80s.