QUESTION:

Dear Dr. Heller,

My question is about my 72 year old mother. She was first treated for a clinical depression on the anniversary of my father's death. She stopped eating, bathing, and became very paranoid before she was hospitalized. Prior to this, she had always seemed nervous to me, irritable, and sometimes depressed. She never took any medication before her first depression.

She had excellent care by a geriatric psychiatrist who prescribed lithium and Pamelor, and for a short time in the hospital, an anti-psychotic. She recovered and did quite well until about a year or so later when she stopped taking her medicine. She lived alone and I finally moved her to Florida with me and was hospitalized again. Her doctor wanted to try different medications and they did not appear to be working after several weeks. I convinced him the Lithium and Pamelor had worked before and when he gave her these, she did recover. She had a third clinical depression when she again stopped taking her medication and was also involved in a stressful relationship with a possessive, controlling man. Well, this third time she has conceded that she has to take medication, and for about two years she has religiously taken her pills everyday. She has done very well. Her life is full, she has many good friends, and takes care of herself. My question is that the lithium and Pamelor have side effects, weight gain (although she's not overweight, but has gained some, she's 5'8", 150 lbs.), possible kidney problems, and who knows what else. I'd like to see her change medications but I'm scared she could have a relapse.

Her psychiatrist is not very proactive in addressing our concerns. He is content that her moods are stable and that she sees him for fifteen minutes every three months. I would appreciate your thoughts on this, as I know you are a thoughtful, compassionate doctor with much success in your practice.

Thank you so much.

ANSWER:

To me there is little difference between children, adults, and seniors in their treatment. The differences revolve around dosing, potential side effects and drug interactions, different presenting symptoms, and the reality that the BPD is not present in children.

Your key phrase was "prior to this, she had always seemed nervous to me, irritable, and sometimes depressed."  Since many of these diagnoses are genetic, there’s a high chance you and your mom share many diagnoses. I highly encourage her to do the screening test I use for my patients.