Just wondering how depression / grief is treated in dementia pantients.

Grief (loss of her son) was the trigger for Mum’s dementia and since then she has also lost her other son.

However with her Dementia, this is manifesting into depression and constant negative thoughts.
She is behaving as if she is being belittled, told off, scolded, ostracised, victimised when the person doing this is HER herself! I.e., she talks to herself, tells herself off and then complains to me that she’s been told off.

Example, she went to go to toilet, then she pulls her pants up and says “Right, I’m not allowed to go”,.. and I’m like huh, what, why?! Eventually I convince her to go, but she is still left with the aftermath of “apparently someone told her off.” She will then sit and appear depressed crying and when I ask her why she says “well, I didn’t even do that right apparently.” And I say “Mum, you went to toilet and all was ok.”

She has a heavy bout of feel sorry for herself and her dementia just confuses her to think that others are actually telling her all this when it’s technically self hatred. She is acting similar to schizophrenia where she also makes up stories of people that have done her wrong. But really these are all her own thoughts.

Even tv shows, she will say they are talking behind her back and want bad for her.

I've been wanting to place her for a while now and I’m STILL waiting for her to be properly diagnosed and have a treatment plan. It keeps being pushed forward and there’s a several month wait again. Her doctor will not prescribe medicine.

Her GP referred her to dementia clinic for them to eventually reject her saying she’d be better going to another clinic that deals with a broader range of issues due to the grief. This place has months wait list and I’m not allowed to place Mum into aged care residence beforehand or it makes Mum ineligible. Sigh!

Really struggling and need her sorted.

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Your poor mom has been through a lot.

Aging is depressing enough without loss of loved ones.

My mom had similar behaviors when she was over medicated. (Many medications have side effects of dementia-like confusion, depression, suicidal thoughts, etc. Although you have nor written anything about suicidal thoughts, the self-criticism you have witnessed may be a lighter version.)

If your mom is already taking several medications, that may explain why her doctor is unwilling to prescribe more.

Check first to ensure any medications are being taken according to instructions (at properly spaced times). It seems like your mom is probably getting help rather than going into the pillbox herself, but regardless, make sure the medications are stored out of reach.

Has she undergone any changes (like weight loss) that could be affecting the way her medicine impacts her?

You don’t need to be a doctor or pharmacist to go through this following exercise. Chart out each medication, vitamin, and supplement with name, class of medication, purpose, dose, recommended dosage for domeone her weight, side effects, warnings snd potential interactions. Get this information from the internet.

When I went through this exercise with my mom’s medications I leaned she was being prescribed medications for conditions that had resolved and for problems that were annoying but not absolutely necessary (bladder control). She was taking “safe” herbal supplements recommended by her doctor that she did not need. She was being prescribed drugs that were extremely dangerous when taken together at dosages that were not appropriate for her weight. Some of the classes of medications were recommended to never be taken together. For my mom, I’m still shocked that the pharmacy alarms were not triggered. Over time the medication had built up in her system. some were prescribed by her Primary, others were added during hospitalizations. My mom had been seeing highly regarded medical experts in a world-class hospital system — this should have never happened.

Mom was complaining of dizziness and she was having falls. She wasn’t thinking clearly. (All associated with normal aging). Her doctors write dementia in her chart.

When I went to her doctor and asked if the medications could be contributing to mom’s health problems I was basically turned away. I was told this was normal aging. I was told I was in denial. I decided to get a second opinion from a new cardiologist because some of her medications were heart related and I didn’t have faith in the highly regarded cardiologist she was seeing.

You should never alter anyone’s medication’s without strict supervision of a doctor. This can be very dangerous. This new doctor listened. He worked with me to slowly wean mom off unnecessary medication and her whole life and mental status changed.

Don’t ever ask your mom‘s primary care provider to prescribe anti-depressants. Seek out instead a geriatric psychiatrist. Even if the psychiatrist adds medication‘s, include them in the chart described above and make sure, even if you’re seeing an recommended expert, they’re appropriate for your mom.

Talking with a counselor about her losses may help her too. Geriatric psychiatrist should have the patience to provide counseling even if she is confused. Unraveling this pain (with someone new) may help. Change is hard, especially loss.
Helpful Answer (8)
Reply to ACaringDaughter
RedVanAnnie Sep 23, 2022
Dizziness and confusion are not "normal parts of aging" although they may show up in aging people for a variety of reasons. Doctors who dismiss symptoms as "normal aging" are reinforcing the stereotype that aging equals dementia and dysfunction. It does not.
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Sounds like the medical practitioners in your country like to 'pass the buck' right down the line until the patient is in her grave, huh? That's unfortunate, to say the very least.

My mother with dementia was on Wellbutrin, the max dose in fact, to treat her depression. Which was increased by her PA while her dementia was moderate to advanced, in fact. She didn't have a 'specialist' or a 'neuro psych' doctor or a Neurologist that I was willing to schlep her to, I saw no value in doing so. Her PA and the GP who oversaw the PA did a fine job managing mom and her various issues. Any doctor of any kind should be willing to write a prescription for an anti depressant for a depressed patient, period.

While your mother's particular case sounds odd and a bit off, SOME sort of doctor should see her, evaluate her, diagnose her, write her SOME sort of prescription to address what's going on, and allow you to get her placed, for crying out loud. To say this is a frustrating situation is a gross understatement.

I don't know where you live, but could you get her to the ER for SOMEONE to take a look at her? JUST the death of her son alone and the ensuing grief is enough of a reason to allow the poor woman to try anti-depressants!
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Reply to lealonnie1
Cappuccino42 Sep 19, 2022
Definitely the buck has been passsed,... and it’s infuriating. And I keep falling through the traps or potholes so to speak. I must say I never liked mums GP (found her too clinical or what’s the word when someone does not show different motions). Mum herself had a falling out with her GP when the dementia was first brought up. She went into denial and then didn’t want to see the doctor. However, every time we did something, they’d refer back to her “own” doctor. Other GP’s would always say, she’s best to go back to her own GP where all her history is. I tried also if another doctor at the same clinic would see Mum and for some reason they didn’t like this. I don’t know if they have some written rule about not taking others patients. We could request to have her history released and go to another clinic all together but I’m not sure if I can request this on Mum’s behalf seem as I don’t have POA/guardianship.
I’m so fricken lost with all this. I don’t want to wait 4-5mths but am told that’s the gov wait time. I’m limited with funds as I don’t get any assistance in caring for Mum and still need to pay my own bills. So I can’t be throwing money out of my own pocket for private fees and even then, all of these require a referral. Sigh. I’m actually starting to think that if Mum needs something, I’ll take her to hospital and maybe they’ll help there. I know a work friend of mine recently took their Mum to hospital and they started arranging everything there on the spot. I hate to think that’s what I need to do but Mum can’t wait several months for help and neither can I. But yes I feel like with the healthcare shortage, they are pushing family members to deal with everything to the brink! Would be a different story if Mum had assets.

to add to that, the few hours respite I receive a fortnight was just cancelled as they are short staffed. Instead of booking for different day this week or next week, I have to wait until next fortnight. It’s honestly not good enough! But I also struggle to have the energy to fight all this.
I'm so sorry you are going through this. My very elderly Aunt does exactly what you are describing -- and has never suffered grief. It is part of dementia. Her grief and the beginnings of her dementia overlapped. Grief can certainly ramp-up dementia behaviors because people with it have a more difficult time understanding and articulating what is going on inside them -- but grief doesn't cause dementia.

Anti-anxiety meds has helped my Aunt when she was crying all the time, yet as her dementia progresses she is increasingly more negative, paranoid, combative, vulgar, having dark thoughts, etc. She is 100 yrs old.

I learned a lot from watching Teepa Snow videos on YouTube. She teaches positive caregiving and also educates on what dementia is, how and why is changes our LOs, and strategies to better engage with them in more productive and peaceful ways. I wish you all the best on this journey.
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Reply to Geaton777

Cappuccino42, you may wait for a very long time (never?) for a better diagnosis than you have now, and you may find that if you luck onto a helpful treatment that relieves some of her symptoms, you will have done the best you can.

My LO entered AL, then quickly went to MC, and was experiencing symptoms that seemed to emerge from her severe anxiety and u dealing depression.

We as her family were also seeing “forgetfulness”, “absent mindedness” and other thought process symptoms.

For purely practical reasons and no particular specific expectations, we asked the social worker at her facility to recommend a specialist in geriatric psychological/psychiatric/cognitive assessment, and they came through for us with a warm, gentle, soft spoken woman who spent time with her over few sessions, and ultimately revealed to us that her “confusion” was actually a part of her depression and anxiety, and that her dementia was much more significant than we’d previously thought. A vicious circle with no starting point and no end.

The specialist prescribed very small amounts of psychiatric medications, saw my LO on a schedule, and ultimately restored LO’s sense of peace. She still had anxiety and depression and dementia with cognitive loss, but she was becoming more comfortable and calm.

When she became infected by COVID her circumstances deteriorated, but she was by then over 90, so there were lots of different things causing her sad decline.

We all hope for something to fix what’s broken in our LOs, but sometimes it’s more complex than we’d planned for.

Hoping you can continue to find ways to help your mum, if only a bit at a time.
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Reply to AnnReid
Cappuccino42 Sep 23, 2022
I was told I can’t place her until she’s properly medicated ... I was ready to place her as is,... the aged care requested care plan and guardianship.
Dementia has no rules or rhymes or reasons. It's a 'new' disease every day.

Some antidepressants will help with the low moods, but honestly, a lot of them are contraindicated in elderly use.

Maybe a low dose of an anti anxiety med.

And don't take what she mutters under her breath as being truly how she's feeling.

But first--a good overall physical and then address the mental status.
Helpful Answer (4)
Reply to Midkid58
Cappuccino42 Sep 18, 2022
She’s just in a general upset / Angry mood 24/7,.. and it’s hard not to react to her mutters as she starts crying / gets agitated. Occasionally she would start hyperventalating
Whether dementia is involved, or not, mental problems are very difficult to deal with. Dementia, of course, complicates matters in making it almost impossible for the practioner to assess what is working and what is not. Dementia and its manifestations as confusion, discomfort, anxiety involves also the person "grieving"their differences, their inability to make themselves understood, the discomfort of others.
I would be certain you are dealing with a good neuro-psyc doctor. The use of medications isn't always indicated, and usually involves low dose if it is. These medications have side effects that hinder balance and a whole group of side effects that often can worsen dementia.
We are each as complicated mentally as our own fingerprint. Adding dementia into the mix, with disinhibition, makes things every so much more complicated and difficult to address. And the truth is that there is NOT ALWAYS AN ANSWER. Some things simply cannot be "fixed" and they must be lived with best you can.
I sure do wish you good luck. Get on the waiting list and explore a second opinion neuro-psych doctor. If you are MPOA try to make your list of symptoms short and succinct. I hope you'll update us.
Helpful Answer (4)
Reply to AlvaDeer

I have never heard of a death of a LO triggering Dementia. If they already have Dementia then it becoming worse yes. I would say that Mom has depression and the loss of a son has caused a mental episode/break but not Dementia.

Has Mom been diagnosed with a Dementia? I think time to find another doctor. She needs labs to rule out anything physical and then a Neurological work up. She may need a Psychiatrist.
Helpful Answer (3)
Reply to JoAnn29
Cappuccino42 Sep 18, 2022
Yes she would have been pre-dispositioned for dementia but the loss of her son brought it on. I can actually pinpoint the exact moment that she went into shock on the plane (on the way to him). She’d been grieving and suddenly looked ok. When I asked how she was doing she responded “who’s funeral are we going to?”. Then she snapped back and recalled after few minutes. She then had trouble ie operating shower etc. I though it was just shock/grief and she’d come out of it all. Instead she was diagnosed with dementia same year 2019 and now she is deemed severe dementia. I have been beating down every wall to get her help but everything has severe wait times or has a road block. So in other words she has been diagnosed with severe dementia but not type of dementia. Have to wait another 4-5mths for that apparently. I can’t even get guardianship before that which just makes things more complex. It’s all been a shamble right from the start. When she was first diagnosed by the dementia clinic they gave he POA paperwork to us but no one was willing to witness it. We kept being told that she needs to be assessed first for her capacity but yet the assessor is the one that had provided us the paperwork. Later the dementia clinic were equally surprised but just said GP’s etc don’t like getting involved. The dementia clinic don’t want her anymore and said she’s better going to another clinic that deals with dementia and other problems. We are limited with funds. Mum does not have private health cover nor assets, so everything is through the public service. She was recently (after 9mths) approved home care but even with that apparently we can only get few hours a week as there’s not enough resources.
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My mom had dementia and was acting out. She was taken to the emergency room, then the psych emergency, and then she was able to go to the senior psychiatric area so that they could evaluate her and find the right medication.

You can't reason with someone with both dementia and depression unless you are a trained medical professional.

I would say she needs to be medicated. Keep at it until you find someone or somewhere that will treat her.
Helpful Answer (3)
Reply to Rabanette
Cappuccino42 Sep 23, 2022
I have considered the next time Mum needs something, I take her to emergency as I’ve heard you can get the evaluation there. It’s crazy if that’s what I need to do but I’m tired of not getting anywhere
Your mother requires professional help that cannot wait. What about a social worker until you find a specialist physician?

What health insurance does she have? These staff shortages are ridiculous. Taking her to the ER might attract some attention.
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Reply to Patathome01
Cappuccino42 Sep 23, 2022
She has no private health insurance. But we have Medicare in Australia. The only thing is it means long wait times! I know she needs help prompto but I’m not getting anywhere. The place she’s on a waitlist to be assessed is not even returning my calls. I just get voicemail. I’m honestly so angry as I feel like no one is wanting to help!
Bcause I'm not familiar with Australia's system, I read a few of the comments. In one, you responded that you've considered taking her to emergency where she would be evaluated.

If you feel you need some kind of excuse, tell them you are concerned that she has a urinary tract infection. UTIs can mimic psychiatric symptoms. If you need a physicial medical excuse, use that and get her care ASAP.
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Reply to MAP2013

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