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Psychiatry & Psychology--General/Elderly Parent - adult daughter with MDD


I was diagnosed with Major Depressive Disorder (recurrent, moderate) with Anxiety in 1994 at age 34.  After several years of trial and error my Psychiatrist and I finally found a medication combination that would work.  SSRI's gave no response or a slight response that faded quickly.  Wellbutrin was the first help- it gave a partial response that did not fade.  Ritalin was added which seemed to give a total response but it faded.  It was replaced with Adderall.  Wellbutrin and the Adderall together made  the antidepressant.  I also had problems with general anxiety that occurred from the very beginning with the depression. He prescribed Ativan which works well.   My Depression is not curable but it is medically manageable and I accept this.   There is a Genetic Component with my Depression which is through my Father.  He had a daughter from his first marriage (my older half-sister) that committed suicide after several attempts (age 43). I believe my Father was depressed but self-medicated with alcohol - men of his generation did not see Doctors for mental/emotional problems (he died in 2002 at age 69 from  lung cancer.

To keep this brief here are a few things I want you to know. Then I will ask my question:

I had the same Psychiatrist almost 15 years.  He did all the hard work with meds to finally help me find a medication combination that works. We had an excellent rapport and he knew me well.  He retired in 2008 - moved to another state to be near his children and grandchildren.   I do see a Psychiatrist 4 times a year for medications.  There is no real Doctor/Patient relationship - he writes prescriptions but does not ask much about how I am doing in my life. Eventually I will try to find a Dr that is a better fit for me.

My Current Medications are (this combination works):
Wellbutrin XL 300 mg one in AM
Vyvanse 70 mg one in AM (replaced Adderall XR by current Dr)
Gabapentin 300 mg one in AM, one at 6:00 PM and two at bedtime
Ativan 2 mg one at 6:00 PM one at bed time (note I take half a pill at bedtime most nights)
Seroquel 25 mg at bedtime to go to sleep (tried many sleep meds this works)

I will be 54 years old in October.  I am Post Menopausal.  I have been married 22 years. We have no children.
I was unable to finish my Bachelor's Degree or work since my Depression started.

My Parents were married in 1954. They had two children a son and four years later I was born. They were divorced in 1985.  My Mother did not marry again. My brother died in 2006 from complications of M.S. I am my Mother's only living child.

Mom is 79  years old.  She has been declining slowly over the last few years.  Basically her health has been good.  Her High Blood Pressure in under control with medication. She has had a few memory problems for few years which appeared to be normal aging. In the last couple of years she has developed personality changes, mood swings and more than regular aging short term memory loss. She can get agitated and angry with no warning.  Her Moods are unpredictable. Tests have been run and nothing seems to be wrong.  For Primary care she has a Physician’s Assistant who I feel has done a good job of caring for Mom over the last several years. This is a very rural area of our state (my medical care is in a populated area where my husband has his job. I was living there most of the time and coming to this area where Mom lives to be in a quiet and natural environment.  We bought a house here in 2009. Mom lives in our the house full time , me part time and my husband is here on weekends that I am not with him and holidays).  The PA has prescribed Mom Aricept for "Memory Issues - Dementia".  Mom's personality has been changing and she is not the person I have known all my life.  I see my Mother sometimes but much of the time I only see shades of the person I have known.  She can be very difficult to deal with. She can get outrageous and loud in public places towards anything or anyone (except little children, babies and dogs - those things have not changed :)  ).  Same thing at home but at home she will find a subject and start complaining working herself up into full blown anger... cussing and swearing (she was NOT like this).  Example: She has a physical complaint that is persistent.  I suggest perhaps she might go see her primary care giver. More times than not Mom will get very angry and say "No Fucking Way am I going there, you got it. All of you (the PA, the health clinic and me) can go to Hell and stay there".
I have considered taking Mom to a geriatric internist (no geriatric psychiatrists for over 200 miles) to get a second opinion. I recently found 3 within 40 miles that do take her insurance. They are affiliated with the regional medical center for our area and it is a good hospital. I do not feel it is too far to drive.  
I have made her PA aware of my Mental Illness.... perhaps it is the case of my looking fine on the outside so everything is fine on the inside. I hoped she would keep my illness in mind but as Mom gets worse the PA looks to me to see that Mom follows through.  Example: she wants Mom to get an Ultrasound or CAT Scan ... I am with Mom at an appointment to see her PA. The PA talks with Mom directly during our visit with her but she tells me in front of Mom about the test and hands me the paperwork for the test that she is ordering. Days to a week or so later when it's time for the test to be done Mom gets very angry and says she's "not Fucking going".  This is my Mother not my child - it's a bit hard to tell my own Mother what to do - she is an adult.  When Mom gets in one of these moods - no amount of calm quiet reasoning works.  

As Mom's condition worsens I have started to have a few problems (that experience tells me not to ignore).  Example: In my body I shake (shaking inside) last week I started to shake on the outside (hands and voice). Took her shopping and I was a nervous wreck to the point of almost not being able to think. At times I feel like I have no control over my life, a couple times felt overwhelmed plus the "classic" feelings of hopelessness/helplessness.  These things have appeared in the last three weeks and have not been too intense or long lasting.  But I am not foolish enough to think I am immune to having another depressive episode again and/or that ignoring little warning signs means I won't get depressed.
My Mom was the best Mother a person could ask for.  I am the only child she has and if you knew me you'd understand I feel honor bound to care for her.  I believe in God.  But how far or long can I take care of her before I start to get sick myself?  More to the point where or how to I set boundaries and limits with this situation for both of our best interests?  
 I am also looking for a counselor that works with our insurance (my husband's medical insurance from his job).

Thank You

But how far or long can I take care of her before I start to get sick myself?  More to the point where or how to I set boundaries and limits with this situation for both of our best interests?

Well, your mood will be the best judge of that, and it looks from the question that your have already passed the point the care is effecting your mood.  You need to get someone to help with your mother: even a caretaker for a few hours here or there so you can get away to a movie with a friend, or whatever.

YOU HAVE NO OBLIGATION TO TAKE CARE OF YOUR MOTHER.  I tell that to people, they tell me I am wrong, I ask them to point out the law, they point out religion (I am religious also), I point out that is their interpretation of their religion, we go back and forth.

YOU HAVE NO OBLIGATION TO TAKE CARE OF YOUR MOTHER.  If you decide to do so as a GIFT, much like she took care of you as a GIFT when you were young (Surprise! Parents abandon children all the time and she could have abandon you, but she CHOSE to stay).  She may be reaching the stage she needs to be put in a nursing home.  

Is you mother competent?  If not, you can get guardianship and simply make decisions.  If she is competent, then it is her choice not to get test and die early.  It is either one or the other.

So, you need to go about living your life -- if she makes you a nervous wreck when going shopping, don't bring her shopping.  "I can't leave her alone," you say.  Well, you can't care for her 24/7 either, so then she needs to be placed somewhere, if only in day care.

The problem is YOU> YOU are putting undue pressure on yourself.  Stop complaining about your mother, and start enjoying your life.  

Psychiatry & Psychology--General

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Daniel S. Harrop, M.D.


Dr. Daniel S. Harrop received his B.A. and his M.D., both from Brown, and his M.B.A. from the Edinburgh Business School, Scotland. Board-certified in adult and geriatric psychiatry, he is a past president of the R.I. Psychiatric Society and a member of the Committee on Medical Quality of the American Psychiatric Association and the Committee on Continuing Medical Education of the R.I Medical Society. He serves as a consultant to four of the top five major medical management companies, including OptumHealth/United Healthcare, Magellan Behavioral Health Services, ValueOptions and APS Healthcare, and maintains a private practice in Providence, R.I. He also serves as chief psychiatric consultant on the Medical Advisory Board at the R.I. Workers Compensation Court. He was formerly on the faculty at the medical schools at both Brown University and Harvard University.

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