Elderly mother has recent major depressive disorder w/ psychosis. I need advice.

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My mother, 73, was recently hospitalized in a psychiatric hospital for approximately two months. Prior to this she was living by herself in her home, though we were concerned about her depression and that she was so isolated. There were two separate psych hospital stays of about 20-30 days each with a chaotic week in between with two ER visits. She was diagnosed MDD or major depressive disorder, classified as severe with psychotic features. One time they said Psychotic Depression or Dementia Depression or something like that. She’s been “better” for only a week or so now, and discharged once she began taking her medications, eating and drinking water again, after a court ordered her to. She’d been refusing all of these things for most of the rest of her stay, lost 30+ pounds in 2 months, and was very difficult to handle. She’d been planning self-harm before being hospitalized also, and actually laid out her plans specifically to me of what she would do. So, it’s a fragile situation. Obviously we’re concerned with her being on her own, and possibly falling into another deep depression or worse. We think she needs to be in possibly independent living or something she can afford, where she’ll be safe and closer to us. However, she keeps saying she wants the chance to prove she can be on her own. She’s been suffering with depression and anxiety for over 30 years. The new wrinkle is this worsening of her depression and possibly some age-related dementia and the delusions and suicidal tendencies. Also, she’s always had an OCD- type A personality and is obstinate and wanting to go back to living alone at her home, though we’re really concerned about it. We, her only close relatives, live in another city about 2 hours drive away and have school-aged children, other medical issues, and jobs, etc., so can’t be there to help her full time. I’ve gone down there 3 times over the past two months, and it’s weighing heavily on me trying to deal with this stress. What are the options to help us and her make the transition to her life after this hospitalization and diagnosis? Can she live alone safely with this diagnosis- whatever it is exactly? Since she’s on a small fixed income, what are the options for living arrangements? We’re thinking of independent living, but she’s balking at that idea. I’m not even sure she’d stay if we got her in somewhere, as she changes her mind frequently. She can’t live with us permanently, as it’s stressing our family and honestly, my marriage. She’s driving me a bit crazy with her obstinance, anxiety, delusional behavior and OCD tendencies. Also, she’s not the same! It’s almost as though she’s a shell of the person she once was. It’s very hard to deal with and so sad for me. Keeps asking me the same things, and gets fixated on one thing and can’t let it go. This is all new to me and my whole family. I apologize if this is scattered and rambling. Please, I need advice and help on how to proceed.

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Top Answer
Seewell; I have to disagree with you. Depression is a serious illness caused most often by chemical imbalances in the brain. Evidence based studies demonstrate that a combination of meds and therapy are often the path towards better functioning. While it is certainly true that social isolation can be a risk factor for depression, have a better social life does not constitute a cure.
If she was diagnosed with being a danger to herself i am shocked they discharged her to living alone. ....have you considered memory facility that would specialize in keeping her healthy and safe and is she also still capable of caring for her home and financing? I would speak to her primary care doctor as well as consulting a recommended elder care attorney for guidance as well because it sounds like a catastrophe in the making with her alone. ...such severe disorders need monitoring closely
So, who is managing her care right now, her regular PCP or a geriatric psychiatrist? Is she going to her followup appointments?

When she was discharged this last time, did the doctors say that she was competent to live on her own? We're you part of that conversation? We often hear that parents tell discharge " oh, my daughter will be taking care of me".

I think I would call the local Area Agency on Aging and ask for a needs assessment. Be there when it happens. They can tell you what level of care your mom needs and what aid she qualifies for.
Depression is oftentimes a life-long illness.
Seewell, there is no simple way out of depression. Being with loving people and doing socially active things may help lift a blue mood or be a comfort during mourning. And it certainly is better than being with crabby and mean people no matter what. But depression is a serious disease, often life-long. Depression with psychosis is not a do-it-yourself project. And if dementia is involved, as it sounds like it might be, this is definitely not going to have a simple fix.

indigoant, I agree with the others who advise you NOT to bring her into your home. That will just add another layer of anxiety and stress, and spread it to more people.

A needs assessment is a good start.
indigoant, I am by no means the best one here to advise you, but I can speak from my own experience of dealing with my Mother's early onset dementia with psychosis and depression. Keeping this as short as possible; Mom started having hallucinations after the sudden death of her last sibling. She lives in Alabama and my brother and I live in 2 other states. After so many phone calls from her to local police stations, we had a family friend who works for DHR to check in on her. She took her to the hospital and Mom was admitted on the geriatric psych ward. She stayed for 3.5 weeks before they "stabilized" her on quite a few meds. (they try different combinations to see what really works for each patient) Mom returned home, insisting she was capable of taking care of herself. She was wrong. Few months later, her Dr made a call to the local department of human resources and had the state check in on her. They took her straight to the hospital again. 2 week stay and upon release she HAD to be placed in assisted living or must have in home care. She went to assisted living. If you can get your mom to do a POA, do it as soon as possible. If you have a regular hospital where they can treat and diagnose geriatric patients, I'd suggest having her do that first. Find someone reliable and trustworthy to do in home assistance a few hours a week maybe? Have your Mom add you to her bank account so you can manage her money for her and pay her bills. I'm hoping the others here will see this and help you. I've read so much helpful information since joining because there are so many who are going through and have gone through the same situation. I wish you the best.
Get your mother to a neurologist for a work-up. Delusions are indicators of Lewy Body Dementia and some antipsychotics can make a patient suicidal. Someone with psychosis cannot be left alone. Call the Agency on Aging (this may have a different name in your state) to see what services may be available at your mother's income level and a lawyer to get POA. (An eldercare specialist is best). Good luck. I have been through this and it's terrifying. You'll feel better with a solid diagnosis. Then find a local support group for yourself.
I wholeheartedly agree with Barb. Mental illnesses are often caused by chemical imbalances in the brain & benefit from medication therapy.
Seawell, I am curious whether you feel a diagnosis like high blood pressure or diabetes fall into the same category you describe above where you’d refuse BP medication or insulin for diabetes treatment?
Medications used to treat HTN or diabetes are similar in they can change metabolic imbalances (diabetes) or meds that mimic substances produced by the body for high blood pressure.
Depression can be debilitating. People with depression often have loving, caring people taking care of them already  but that doesn’t make the person’s depression go away. 
We’ve come along way with pharmacology to treat many diseases mental illness being one of those. I think a person should take meds for their depression if the meds help. If not, their providers can prescribe another medication- like in BP or diabetes control. 
So sorry for what you, your Mom and the whole family are going through. Many of us here know the NIGHTMARE! I agree with all the previous posts. I’m glad they were able to stabilize your Mom on meds well enough to discharge her. I don’t think there’s any way that she will be able to manage her meds properly.
Ask her physician. Whoever diagnosed her is the best one to advise you about what to do.

I learned that with my Dad and his heart doctor.

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