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scallywag

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  • Moderator Emeritus

Sweet scallydaddy is in the hospital after falling then being confused. He is uninjured but has been hospitalized for several weeks because recovery from the fall is complicated by previously diagnosed early or middle stage dementia. While in the hospital, the dementia sometimes results in confusion about where he is and he gets "agitated." The first instance of agitation resulted in the "as needed" administration of zopiclone and trazodone. After an extremely unproductive cycle of late night PRN dosing that left him slurring his words well into the next day and too weak to do the brief physio recommended exercises, I asked that they pick one medication and provide it regularly. Thank you to all here at SA who helped me educate myself about this. 

 

Somebody (I've yet to find out who <grrr> ) started him on trazodone with dinner and citalopram with breakfast. WTAF?? Major interaction effects which include confusion, fever (dangerous for someone with a diagnosed arrhythmia), and increased risk of arrhythmia.  Fortunately he's been stable on that for 10+ days until a confused agitation episode today. 

 

After the early "cocktail," I knew enough to ask about PRN (as needed) meds in the event of agitation.  The PRN med that will be administered is halo-effing-peridol which, imagine your surprise, interacts in major ways with both trazodone and citalopram. It's beyond me how anyone thinks that's going to help him recover to a condition for safe discharge. I anticipate talking with his doctor about next steps and will ask, "Sometimes medications interact with each other. Are there effects we should be concerned about with Dad's prescribed meds?" 

 

Not sure what I need from other members of SA or the moderators. I guess the good news is that I've learned a few things and that it's early enough to interrupt predictable negative outcomes. Teasing out which symptoms are dementia progression and which are iatrogenic might not be possible until he's off all the meds.

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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I’m so sorry, Scallywag.

https://www.survivingantidepressants.org/topic/16629-rosetta-ct-may-2011-too-fast-taper-feb-2017/?page=25

2001-2011 Celexa 10 mg raised to 40 mg then 60 mg over this time period

May 2011 OB Doctor's Cold switch Celexa 60 mg to 10 mg Zoloft sertraline (baby born)

2012-2016 - Doctors raised dose of Zoloft up to 150 mg

2016 - Xanax prescribed - as needed - 0.5 mg about every 3 days (bad reaction)

2016 - Stopped Xanax

Late 2016- Began (too fast) taper of Zoloft

Early 2017 - Trazodone prescribed for bedtime (doseage unknown)

Feb 2017 - Completed taper/stopped Trazodone

Drug free since Feb 2017

2017 - Unisom otc very rarely for sleep

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  • Administrator

This must be terrible for both of you, @scallywag 

 

Why citalopram on top of trazodone, they're both antidepressants? Can you complain to the authorities?

 

The hospital pharmacist may be a deprescriber, deprescribing is based at McMaster University.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 5 weeks later...
  • Moderator Emeritus

Thanks Rosetta & Alto.

 

He's out of the hospital now and in a dementia care community. No more calls for security guards to hold him down while haldol is injected. So some good news.

 

@Altostrata :

  • My best guess on why citalopram was added was typical polypharmacy -- he was a bit dopey from the traz so instead of reducing the traz dose, (he's only taking the minimum "baby dose") let's give him a "baby dose" of cit to "brighten him up a little." 
  • Thanks for mentioning the practice of "deprescribing". A quick search yields something from Université de Montreal at deprescribing.org, with info in English and French; I'll keep looking for the McMaster info.

Since my initial post in this thread, I discovered that he was prescribed risperidone 0.5 mg twice a day as well as as .5 mg "as needed." FFS. Settle his emotions my fat-a$$ (I do have one, a notorious one at that -- it once was the cause of a fight in a dive bar).

 

Current psych med list:

Trazodone 25 mg with dinner 

Citalopram 10 mg with breakfast/lunch

Risperidone 0.5 mg x 2 ("q12" - every 12 hours )

 

Fortunately the community doctor thinks the risperidone is unnecessary. I need to find out when that off-label prescription was first administered before anyone yanks that from the CNS of a man over 80 years old.

 

When I let myself, I feel very guilty for not asking questions, for not pushing for answers about how he would ever improve cognition and mobility while being administered drugs that affect cognition and mobility, and for not getting him out of the hospital once infections causing delirium were resolving with antibiotics. This screwup is going to take some time to unscrew.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here


scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

Link to comment

Thanks for letting us know.  I know it’s hard to not blame yourself, but the doctors would not have listened to you.  What you do now is most important, and thank goodness you know about this issue! - Rosetta

https://www.survivingantidepressants.org/topic/16629-rosetta-ct-may-2011-too-fast-taper-feb-2017/?page=25

2001-2011 Celexa 10 mg raised to 40 mg then 60 mg over this time period

May 2011 OB Doctor's Cold switch Celexa 60 mg to 10 mg Zoloft sertraline (baby born)

2012-2016 - Doctors raised dose of Zoloft up to 150 mg

2016 - Xanax prescribed - as needed - 0.5 mg about every 3 days (bad reaction)

2016 - Stopped Xanax

Late 2016- Began (too fast) taper of Zoloft

Early 2017 - Trazodone prescribed for bedtime (doseage unknown)

Feb 2017 - Completed taper/stopped Trazodone

Drug free since Feb 2017

2017 - Unisom otc very rarely for sleep

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  • Moderator

I'm sending lots of prayers/good vibes for you and your dad.

 

It sounds like hopefully things are looking up.

 

Please don't blame yourself for any of this. 

 

Just take care of yourself.

PREVIOUS medications and discontinuations: Have been on medications since 1996. 

 Valium, Gabapentin, Lamictal, Prilosec and Zantac from 2000 to 2015 with a fast taper by a psychiatrist.

 Liquid Lexapro Nov, 2016 to 31-March, 2019 Lexapro free!!! (total Lexapro taper was 4 years-started with pill form)

---CURRENT MEDICATIONS:Supplements:Milk Thistle, Metamucil, Magnesium Citrate, Vitamin D3, Levothyroxine 25mcg, Vitamin C, Krill oil.

Xanax 1mg 3x day June, 2000 to 19-September, 2020 Went from .150 grams (average weight of 1 Xanax) 3x day to .003 grams 3x day.

19-September, 2020 Xanax free!!! (total Xanax taper was 15-1/2 months-1-June, 2019-19-September, 2020)

I am not a medical professional.

The suggestions I make are based on personal experience.

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  • 5 months later...

@scallywag

How are things? 

 

 

 

 

1996-2018 - misc. polypharmacy, incl. SSRIs, SNRIs, neuroleptics, lithium, benzos, stimulants, antihistamines, etc. (approx. 30+ drugs)

2012-2018 - 10mg lexapro/escitalopram (20mg?)    Jan. 2018 - 10mg -> 5mg, then from 5mg -> 2.5mg, then 0mg  -->  July 2018 - 0mg

2017(?)-2020 - vyvanse/lisdexamfetamine 60-70mg    2020-2021 - 70mg down to 0mg  -->  July 2021 - 0mg

March-April 2021 - vortioxetine 5-10mg (approx. 7 weeks total; CT)  -->  April 28th, 2021 - 0mg

supplements: magnesium powder (dissolved in water) as needed throughout the day; 1 tsp fish oil w/ morning meal; 2mg melatonin 

August 1, 2022 - 1 mg melatonin

 

Courage is fear that has said its prayers.  - Karle Wilson Baker

love and justice are not two. without inner change, there can be no outer change; without collective change, no change matters.  - Rev. angel Kyodo williams

Holding multiple truths. Knowing that everyone has their own accurate view of the way things are.  - text on homemade banner at Afiya house

 

I am not a medical professional; this is not medical advice. 

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