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My mom is in an assisted living. She is 91 and in pain for a host of issues and has anxiety. The Psychologist prescribed an SSRI. I know they have a host of side affects and neither my mother nor I want her on any SSRI at this age. If she was younger yes, but not at 91. I feel there are other drugs that could be prescribed. Can I as her Medical POA say no to the SSRI? Can I ask the pharmacist not to fill the prescription?

If your mother doesn't want to take an SSRI, then that's that. She doesn't have to take it.

Having said the above with all the emphasis at my command... If you (or anybody else) are not happy about a practitioner's prescription or recommended treatment of any sort, the thing to do is talk to the practitioner.

Your mother is suffering pain and anxiety. The relationship between pain and anxiety is close - one feeds the other, and your poor mother is the victim. SSRIs do have side effects, this is true, but I imagine her psychologist has taken the potential risks into account and has concluded that the potential benefit of relieving your mother's anxiety outweighs those risks.

Her age has no relevance at all. Why would it become okay for her to live with pain and anxiety because she's 91?

But the psychologist, or any other prescribing practitioner whose patient she is, can tell you far more about this as it applies to your mother than we can. You as MPOA have concerns, questions and reservations - so talk to the psychologist about them, ideally with your mother, and decide together what's best.
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jacobsonbob Apr 18, 2021
The OP could also talk to the pharmacist about the side effects of the drug--not asking "should my mother take this drug?" but "please tell me more about this drug". Then armed with this knowledge, you could have a more informed conversation with the prescriber.

A few years ago, my sister and BIL had a PCP who, in addition to his MD, also had PhD in pharmacology, and he provided excellent care, but unfortunately is no longer available. He was also trained in acupuncture.
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My mom, at 90, suffered from increasing anxiety due to her cognitive issues. Her geriatric psychiatriat prescribed a low dose of anti-anxiety medication which worked well.

Then mom had a stroke, which resulted in a diagnosis of vascular dementia. My mom's level of anxiety skyrocketed. She wept, wrung her hands and seemed to be in a near- constant state of dread and fear.

We consented to a trial of Lexapro, an SSRI. I was concerned about side effects, as are you, in part because mom had tried Zoloft once and it hadn't gone well. (In retrospect, I think she read the package insert and developed side effects listed there due to suggestibility).

Lexapro was a lifesaver for mom and for us. As her brain deteriorated, another antidepressant, Remeron, was added and she tolerated that as well.

I think of dementia as having a "broken brain". The chemicals that maintain good mental health are sometimes in short supply and need supplementing. Not sure why you wouldn't give this therapeutic medication a try.
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Countrymouse Apr 15, 2021
There have been questions about prescribing SSRIs to people with heart disease - the clinical psychologist we saw at the memory clinic raised his eyebrows when he saw mother was taking Citalopram. Alarmed, I consulted my SIL (psychiatrist with a degree in pharmacology) who said: "oh yes, a prolonged QR interval on ECG. But not on the dose she's taking."

And if I hadn't happened to have had SIL on speed dial? I might well have been chewing my nails off for fear I was poisoning my mother!
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Not knowing why your mother has pain and anxiety, a possible solution is palliative care. The following is from the site listed. You would contact your local Hospice for an evaluation. These are a multidiscipline team who are experts in symptom control. Good luck.

What Are Palliative Care and Hospice Care? | National Institute on Aging (nih.gov)
Who can benefit from palliative care?
Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson's disease, and many others. Palliative care can be helpful at any stage of illness and is best provided from the point of diagnosis.
In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life. Palliative care can be provided along with curative treatment and does not depend on prognosis.

A palliative care consultation team is a multidisciplinary team that works with the patient, family, and the patient's other doctors to provide medical, social, emotional, and practical support. The team is made of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains.
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Have you or your mom in your presence voiced your concern to the doctor prescribing this medication? Before simply refusing it I would recommend making sure you have a clear picture about why that particular drug is being prescribed and what he or she hopes your mother will gain from it. There are several antidepressants that are used for their side affects because they block pain receptors. That said I think it’s a valid concern that at her age trial and error with these meds seems more difficult and time consuming. It also seems like the wrong specialist if the goal is her pain relief so if indeed that is the goal along with her anxiety (which could be very interconnected) I would ask that a specialist in geriatric care/pain be consulted as well. Maybe together with the psychologist (who probably works with a psychiatrist that actually prescribes) they can come up with a plan and explain it to you and Mom so it makes sense to you. It’s also of course possible that is happening behind the scenes given the medical care is being done through her AL facility and a good discussion with her medical team, including this prescriber, will shed some light on why this drug now for you.

You and mom if she’s capable have every right to understand and agree with treatment but don’t go in with an advasrial approach, skeptical sure but start by just making it clear you want to understand the thinking, the choices and why this is the plan rather than refusing the plan right off the bat. Hopefully this will also establish a relationship that will put you in the loop from now on. Good luck!
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I didn't think psychologists could write prescriptions, I thought that was only psychiatrists and M.D.s. Correct me if I'm wrong, but SSRIs are for anxiety, but maybe she would have less anxiety if her pain is relieved. You don't mention if she takes anything for the pain.
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What other meds would you like to see prescibed for your mom?

Have you discussed your concerns with the person who is doing the prescribing? In general, psychologists don't have prescribing priveleges; many work with an MD or Advanced Practise Nurse to do the writing of the prescription.

I find that, in general, doctors are willing to let you follow their thought process in why they are chosing a certain med, or class of meds for a particular issue. So for example, a straight anti-anxiety med might be prescribed for a younger person in this sitation, but they often lead to falls in an elder, making an SSRI with antianxiety properties a better choice.

I am curious why you don't want your mom on an SSRI. Is it due to a heart issues, as CM describes?
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Reply to BarbBrooklyn
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I do not understand why you want to play doctor. Are you refusing because of a known reaction? Then talk to the doctor. If the medication is for behavior issues and it puts stress on the facility, then she could be evicted or recommended for escalating care.
Can you afford this? Would an eviction make it difficult to find a psychiatric facility?
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WyldUnknown Apr 18, 2021
I believe she indicated it was for pain. Not behavior issues. As far as "playing Dr" she has 1 "patient", who she stated does not want to be on the drug.
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Wow! So you ask for something for pain and then you want to refuse it? I would suggest you discuss it with a pharmacist if not the psychologist first! Some of the antidepressants have been shown to be a good pain reliever, not addictive and have the benefit of helping improve the mood of someone depressed (you might become depressed if you were in chronic pain). So I suggest that unless you have been educated on the drug by someone knowledgeable, that you don't have a negative reaction...
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Reply to Nursebja1982
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You should go directly to the prescribing doctor. I am uncertain why you are unwilling to "try" something that may help your Mom. Often low dose anti-depressants help with pain and anxiety. If it isn't working, then you can ask it be withdrawn, and again, speak to the doctor. A psychologist cannot order drugs in most areas. Only a psychiatrist or MD can. Speak to the person ordering this. Let the facility where Mom lives know what she is taking and that it is new and ask them to be on the lookout for any increase in anxiety, and drowsiness or difference in gait, any falls. Tell them you are worried about a mind altering drug in an elder this old.
Wishing you good luck. If your Mom is in distress something should be done. See if you can make an appointment with her psychologist, taking your POA papers with you, and tell her you are very worried, and why.
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Reply to AlvaDeer
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GREETINGS BABA777,
AS A RETIRED NURSE AND A CAREGIVER, I SAY THAT YOUR MOM, AT 91, DOES NOT NEED AN SSRI TO ADD TO HER BUCKET LIST OF MEDICAL PROBLEMS. IF SHE WAS SUFFERING FROM A UTI, THEN I WOULD SAY, OF COURSE TREAT HER WITH THE APPROPRIATE ANTIBIOTIC AND FLUIDS. SINCE YOU HAVE HER POA YOU DO HAVE THE RIGHT & RESPONSIBILITY TO CONSULT WITH THE PHARMACIST.
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