Howdy

[DocPixel]

Hi, guys.
I'm really hoping I can find some help for my mom here. Looks like a great community.

She's 92 and she and my dad still live in their house.

She's had generalized anxiety disorder for several years now, up and down, but it's getting worse and she's having panic attacks, so she's ready now to take action.

Her psychiatrist says he let her stay on lorazepam way too long, and he feels that it's causing much of her anxiety. So he's weaning her off, and I sure hope that will help.

Mainly, I want to learn about what kind of cognitive/behavioral therapy could help, at her age. She's doing breathing and other coping steps but she needs more than that.

Hope that's the appropriate type of introduction!
Sarah

 

[ladylore]

Welcome Sarah :welcome2:

It is an appropriate introduction.

I have had anxiety too - breathing and coping behaviours do work for when your in the middle of a panic attack. You are right about CBT. Does your mother's psychiatrist provide that type of therapy?

Welcome again.

 

[David Baxter PhD]

Welcome to Psychlinks, DocPixel.

Is the plan to replace the lorazepam with something else? In my experience, panic disorder is best treated with a combination of medication and therapy (e.g., CBT management strategies). Leaving a 92 year old woman to face panic disorder unmedicated seems to me to be more than a little cruel.

 

[Retired]

Hello Sarah,

Commendations to you and to her doctor for taking your Mom's issues seriously and for working on a satisfactory treatment strategy.

Her psychiatrist says he let her stay on lorazepam way too long, and he feels that it's causing much of her anxiety.

Very interesting! Did the doctor explain the rationale behind this conclusion? (Italics inserted by me for emphasis)

 

[ladylore]

Welcome to Psychlinks, DocPixel.

Is the plan to replace the lorazepam with something else? In my experience, panic disorder is best treated with a combination of medication and therapy (e.g., CBT management strategies). Leaving a 92 year old woman to face panic disorder unmedicated seems to me to be more than a little cruel.

:agree:It would seem to be cruel.

 

[DocPixel]

Thanks, y'all. I'm glad you asked those questions - I wasn't sure how much detail you'd be interested in.

She takes mirtazapine, and he's been trying several other medications to see what helps her, so she can start getting off the lorazepam. Now she is taking Zoloft.

I wish he had been firmer with her several years ago, but she didn't want to stop taking the lorazepam. She has felt dependent on it. She also hasn't been in favor of therapy. She was convinced that her anxiety was physical, so therapy wouldn't help. She just wanted a pill to make it better.

But finally, from getting worse, she's motivated now, and asked him what she needed to do to get better. And he told her that she needed to both get off the lorazepam and see a therapist regularly. And she's finally suffering enough that she's willing to do both.

TSOW, he said, and my own research has agreed, that lorazepam is useful for short-term anxiety treatment. But it also creates a dependency, and after long-term use, it loses its effectiveness and actually starts contributing to anxiety, also causing muddled thinking and physical unsteadiness and some other things too.

And since it's no longer helping her, it does seem as though these things have happened in her case. But I'm no doctor, so I'm open to other information on it by those more qualified.

Her doctor doesn't do therapy, but there are behavioral therapists at the same clinic. Also, I'm really curious about CBT; is it different for elderly and younger adults? Should I try to find someone who specializes in this, or would the therapy be the same in general?

My other question is, if the Zoloft is working, should she still be having the anxiety and panic attacks? Are emotions strong enough to overpower the meds, or does this mean that it's not working well? She's on 150 mg daily. She was on 200, but had to reduce due to diarrhea.

Thank you so much!

 

[Halo]

Hi Sarah and welcome to Psychlinks :welcome2:

I too want to say that I commend you for taking action and for taking care of your mother when she needs you the most especially when she is trying to deal with an anxiety disorder.

While I am not a doctor and can't offer any suggestions or recommendations about medications, I do want to say that I think that your mother is being very brave to want to try whatever is going to work be it medication and therapy in order to get better. That is a real sign of strength and I wish her all the best.

I am sorry I don't have more specific answers to your questions but you may want to check out these sections on the forum which have a lot of great information:

Anxiety & Stress
Panic Disorder

Take care to you and your mother.

 

[DocPixel]

Well, Halo, thank you so much for the encouraging words and for the links too. I will pass along your words to her - she'll like that.

I told her about this community and that members here were concerned about her, and she really thought that was seriously great. She wants me to keep her informed on your thoughts and opinions - keep that doctor on his toes!
Sarah

 

[braveheart]

Welcome!

I get periodic panic attacks and am on mirtazapine. I found I needed to take additional medication in the form of beta blockers when it was at it's worst.

 

[Retired]

Sarah,

Your doctor may already be aware, but to provide you with insight into prescribing medications, especially psychotropic drugs such as minor tranquilizers, and SSRI's in geriatric patients, dosages are frequently considerably lower than in the general population.

The manufacturer's prescribing information does not always indicate the geriatric dose (over 70) but your doctor, in consultation with his/her own local specialists usually is aware of these dose modifications.

The reason is because older patients metabolize more slowly and do not cleat the metabolites from their systems as rapidly as younger people.

The result can be an accumulation in the system, the result being similar to receiving a higher dose, or even an overdose.

Prescribing in a geriatric situation requires clinical experience with the medications and a clear understanding of how each medication is absorbed, metabolized and excreted. This process is referred to as the pharmacokinetics of the medication.

Have you had a consultation with a geriatrician for your mother?

 

[DocPixel]

Steve, thanks for raising that question. Her psychiatrist seems pretty familiar with geriatric drug dosages and their effects, and she has an appointment with a geriatric psychiatric nurse this coming week.

But I'm hearing from you that perhaps I should take her to a geriatric physician too? That sounds like a really good idea, and I'll ask the nurse for a recommendation when we see her.

Boy, it sure takes a village to help the elderly live with the best quality of life, doesn't it...

You guys are great.

 

[ladylore]

It does. I also think it takes a village do to almost anything in this world - especially to provide support.