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You are here: Experts > Health/Fitness > Pharmacology > Pharmacy > Anxiety in 84 year old mother
Pharmacy - Anxiety in 84 year old mother
Expert: Mary E Scott, RPh, CGP - 11/6/2009
Question
QUESTION: My 84 year old mother has recently plunged into a state of anxiety and depression upon her having give up driving. She was prescribed Zoloft and Ativan. She took 25 mg. Zoloft once a day and 25 mg Ativan 2-3 times a day. After two weeks she was no better, so her doctor upped the Zoloft to 50 mg and the Ativan to 50. Since then her anxiety has increased and she is very weak and lethargic. The doctor cut her back to 25 mg Ativan. She is still very weak and lethargic. How long before the Zoloft begins to take effect? We think she should discontinue the Ativan, but she insists it is the only thing that helps her sleep (only for a few hour). If she does discontinue the Ativan, does she have to taper off? She has been taking it for about 3 weeks.
ANSWER: Hi,Paula,
As far as the Ativan dosage is concerned,I hope you meant 0.25mg,not 25mg!
It usually takes up to a month for the Zoloft to be fully effective,so she may be seeing results pretty soon. It is better to take the Zoloft at night if it seems to make her lethargic.
She can try taking the Ativan at night also, about an hour before going to bed. I would not recommend a sleeping pill; the Ativan should relax her enough to get to sleep. Hope this helps, Mary
---------- FOLLOW-UP ----------
QUESTION: Thanks Mary, we were concerned that the combination of the two drugs were making her worse. She has cut back the Ativan to only a bedtime, so hopefully this will help. Once the effects of the Zoloft are felt, can she discontinue the Ativan? I have read that these types of medications can increase falls in elderly people.
ANSWER: Hi,Paula!
You may be thinking of long-acting benzodiazepines, such as Valium and Dalmane. These have been shown to increase the risk of falls leading to hip fracture in the elderly. Short-acting benzodiazepines such as Ativan and Xanax are much less likely to do this because the drug doesn't accumulate in the body the way the longer-acting ones do.
Other things that alleviate anxiety in the elderly are 1) talk therapy-having someone such as a behavioral counselor to talk about the anxiety with. 2) activities such as bingo,outings,etc., or pet therapy if she likes animals.
Hope this helps, Mary
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QUESTION: Mary - Thanks for the reply. My mother has just this week gone to a psychiatrist and is starting therapy once a week via phone with her. After that initiaa visit, she was markedly better for about one day, and now she's worse again. Ths psychiatrist wants to put her on Seroquel. My sister and I have read awful things about this medication. What do you think?
Answer
Hi,Paula,
I don't think using Seroquel in an 84 year old with a diagnosis of anxiety is the right way to go.
Seroquel is an antipsychotic med and doesn't have an indication for anxiety. Some doctors like to use it for its sedating properties, but to me, it is like using an elephant gun to shoot a mosquito. It also has a black box warning for use in the elderly with a diagnosis of dementia. Just my opinion, hope this helps, Mary
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