Too much medicine?

[Bam-Bam]

My mother in law has been suffering from "chronic clinical depression" since last year.This is what she says her doctor calls it. She has experienced a rapid decline in her ability to function since November. Not sure of any trigger for this, but she has now lost her job because of her inability to function. We had noticed that she would be "zombie like" at times, very confused, asked the same questions over and over again, had problems making even simple decisions, etc. We're talking about someone that has NEVER had problems like this before, was fine and dandy, able to go to work and take care of herself, etc. She was fired from her job the week of July 4th, and this obviously didn't make matters better. She had what sounds like an anxiety attack on 7/31, went to the ER, told them she didn't want to live, but was sent home to f/u with her psychiatrist. She did that the next day was was put inpatient in a psychiatric hospital for 8 days. Her meds before she went in:
Geodon, Lamictal, Wellbutrin 450 mg.. They discharged her on: Geodon 80 mg, Lamictal (not sure of dose), Wellbutrin 300 mg, Klonopin 1 mg, split into 3 doses thru the day, and Cymbalta (not sure of the dose on this).....Do you guys think this is too much medication? What she was taking before she went in didn't appear to be helping at all, so we don't understand why they kept her on it, especially the Geodon. She has had problems with a really bad tremor also. I wondered if it could come from that??? Anyway, sorry for the long post. We are new to this and just concerned about making sure the doctors are doing what's right for her.

 

[Daniel E.]

...so we don't understand why they kept her on it, especially the Geodon.

It may be too much medication if all she gets are side effects. For other people, however, the Geodon/Wellbutrin/Lamictal combo may be a good prescription cocktail for treatment-resistant depression:

Geodon is a wonderful drug! I use Geodon in additon to Lamictal and Wellbutrin XL. My depression has been better since being on the Lamictal and Wellbutrin combination but still had occassional suicidal thoughts. Geodon makes me feel even better.

My psychiatrist warned me of the sedation side effect. Instead of sedating me though, it energizes me. At first this was a problem because I stayed up all night. But after getting used to it, it no longer has that effect.

I'm very glad that Geodon was added to my cocktail.

Anectodes about Geodon for Depression - RemedyFind.com

She has had problems with a really bad tremor also. I wondered if it could come from that???

As you probably already know, antipsychotic meds usually have more significant side effects than antidepressants. Antipsychotic meds including Geodon can cause extrapyramidal symptoms including tremors. Below is the side effect profile from Geodon's prescribing information:

Body as a Whole: Frequent: abdominal pain, flu syndrome, fever, accidental fall, face edema, chills, photosensitivity reaction, flank pain, hypothermia, motor vehicle accident.

Cardiovascular System: Frequent: hypertension; Infrequent: bradycardia, angina pectoris, atrial fibrillation; Rare: first degree AV block, bundle branch block, phlebitis, pulmonary embolus, cardiomegaly, cerebral infarct, cerebrovascular accident, deep thrombophlebitis, myocarditis, thrombophlebitis.

Digestive System: Frequent: vomiting; Infrequent: rectal hemorrhage, dysphagia, tongue edema; Rare: gum hemorrhage, jaundice, fecal impaction, gamma glutamyl transpeptidase increased, hematemesis, cholestatic jaundice, hepatitis, hepatomegaly, leukoplakia of mouth, fatty liver deposit, melena.

Endocrine: Rare: hypothyroidism, hyperthyroidism, thyroiditis.

Hemic and Lymphatic System: Infrequent: anemia, ecchymosis, leukocytosis, leukopenia, eosinophilia, lymphadenopathy; Rare: thrombocytopenia, hypochromic anemia, lymphocytosis, monocytosis, basophilia, lymphedema, polycythemia, thrombocythemia.

Metabolic and Nutritional Disorders: Infrequent: thirst, transaminase increased, peripheral edema, hyperglycemia, creatine phosphokinase increased, alkaline phosphatase increased, hypercholesteremia, dehydration, lactic dehydrogenase increased, albuminuria, hypokalemia; Rare: BUN increased, creatinine increased, hyperlipemia, hypocholesteremia, hyperkalemia, hypochloremia, hypoglycemia, hyponatremia, hypoproteinemia, glucose tolerance decreased, gout, hyperchloremia, hyperuricemia, hypocalcemia, hypoglycemic reaction, hypomagnesemia, ketosis, respiratory alkalosis.

Musculoskeletal System: Infrequent: tenosynovitis; Rare: myopathy.

Nervous System: Frequent: agitation, tremor, dyskinesia, hostility, paresthesia, confusion, vertigo, hypokinesia, hyperkinesia, abnormal gait, oculogyric crisis, hypesthesia, ataxia, amnesia, cogwheel rigidity, delirium, hypotonia, akinesia, dysarthria, withdrawal syndrome, buccoglossal syndrome, choreoathetosis, diplopia, incoordination, neuropathy; Rare: myoclonus, nystagmus, torticollis, circumoral paresthesia, opisthotonos, reflexes increased, trismus.

Respiratory System: Frequent: dyspnea; Infrequent: pneumonia, epistaxis; Rare: hemoptysis, laryngismus.

Skin and Appendages: Infrequent: maculopapular rash, urticaria, alopecia, eczema, exfoliative dermatitis, contact dermatitis, vesiculobullous rash.

Special Senses: Infrequent: conjunctivitis, dry eyes, tinnitus, blepharitis, cataract, photophobia; Rare: eye hemorrhage, visual field defect, keratitis, keratoconjunctivitis.

Urogenital System: Infrequent: impotence, abnormal ejaculation, amenorrhea, hematuria, menorrhagia, female lactation, polyuria, urinary retention, metrorrhagia, male sexual dysfunction, anorgasmia, glycosuria; Rare: gynecomastia, vaginal hemorrhage, nocturia, oliguria, female sexual dysfunction, uterine hemorrhage.

Also:

What are the common side effects caused by Geodon?

Some of the most common side effects associated with Geodon are feeling unusually tired, nausea, constipation, dizziness, restlessness, diarrhea, rash, cough and runny nose, and abnormal muscle movements, including tremor, shuffling, and uncontrollable movements. Geodon is associated with little or no weight gain in most consumers. Geodon also appears to infrequently cause increases in glucose, cholesterol, or triglyceride blood levels.

Geodon (ziprasidone) Fact Sheet - NAMI

Personally, I would not continue to take an antipsychotic medication (even a newer antipsychotic like Geodon) for long unless I was being helped by it or was at risk of having a psychotic or manic episode, etc. If I needed to take an antipsychotic medication and Geodon only gave me side effects, I would try Abilify next. Of course, your mother should consult her doctor if she wants any dose changes or else she may get withdrawal symptoms.

The Cymbalta and Klonopin she was prescribed after her hospitalization may help prevent a relapse and are usually well tolerated. My personal experience with Cymbalta at 60 mg/day was that it made me too tired/sedated to function at my usual level, but most people who take Cymbalta don't have that side effect. With Wellbutrin (300mg/day), Klonopin, and Lamictal, I had no problematic side effects.

 

[ThatLady]

If you don't mind my asking, how old is your mother-in-law? Age can, and should, be a factor in diagnosing changes in behavior patterns, as well as in the dosing of medications.

 

[Daniel E.]

This is probably not directly relevant to your mother-in-law's situation, but there is an FDA black box warning regarding older patients who are given antipsychotics like Geodon for age-related dementia rather than for primary mental illnesses:

Geodon is a type of medicine called an atypical antipsychotic. FDA has found that older patients treated with atypical antipsychotics for dementia had a higher chance for death than patients who did not take the medicine. This is not an approved use.

http://www.fda.gov/cder/drug/InfoSheets/patient/ziprasidonePIS.htm

I think this underscores that a cost/benefit approach ("What good I am getting for these side effects?") is necessary for drugs like these.

 

[Bam-Bam]

Thanks for your replies so far. She is 57. I should mention here too that her mother was diagnosed with Alzheimer's disease in 2002 and it has progressed fairly rapidly, ie--she pretty much doesn't know anyone anymore. My husband left a message for her doctor but he didn't return the call, he wanted to ask him about the possiblity of doing a CAT scan or MRI to rule out something like a tumor or dementia, given the rapidness (is that a word? *L*) of her decline. We saw her over the weekend, and it is like she has no emotion at all. When she laughs it is forced and fake, the same when she smiles. Her eyes are wide, and she hardly blinks. She will play with our daughter, who is 2, and she wants to come see her, so it's not like she's so depressed that she can't get out of bed. I don't know, it's weird.

 

[ThatLady]

If the doctor didn't return your husband's call, call again. If he still doesn't return the call, it might be a good idea to take his mother to the ER. Even though it might seem as though this isn't an emergency, sudden changes in behavior can indicate a number of conditions that need treatment quickly. This could be medication side-effects, or any number of other things. She really needs a thorough assessment and tests.