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She is 97 yrs old and talks about she is old and weak and ready to die, all the time. She is on paxil now and has been on this for years

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Hmm its a toughy isn't it antidepressants or not antidepressants. Here are 2 things people hve said about them:
Antidepressants helped to lift the fog and the feelings I had of hopelessness, and have helped me to feel less like an outline and more like a coloured-in person.
The trouble with this is that in lifting the fog the person can see that they are not gettting better and that can in some people mean the depression is replaced by severe anxiety.
It took me years to find antidepressants that worked for me. Every time I had to change them it was a frustrating wait to see if the next lot would work.
The trouble with this is that as demetia increases so the signs of the results become more about observation than anything else and that is very subjective in some cases.
So while antidepressants certainly have their place - Mum is on them - hey are not the be all and end all and it can be very much a trial and error situation with side effects which can be much harder to deal with.
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I agree with Pamstegma,
Antidepressants are extremely dangerous for the elderly and can make them dizzy, more "depressed", and can make them fall or just become a zombie. She can also take sublingual B-12. Studies have shown it's as effective as shots and costs a h*ll of a lot less. Be sure she's getting adequate supplementation to a healthy diet, including 2-3,000 MG D, calcium and magnesium, etc. Find a local CNC or Certified Health Educator with experience in Geriatrics for advice.
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@Wintersun - I totally agree with you. For my mother it was olanzapine, mirtazapine, and Effexor. She was 89 years old and had suffered depression her entire life. These drugs definitely lifted her mood. Unfortunately, she was in a doctor's office and missed the step going onto the examining table and fell hitting her head and fracturing her pubic bone which landed her in a hospital bed and in rehab where she remains in skilled nursing care. Unfortunately, nothing can be done for her progressing memory loss. She is now in her 92 year.

IF you believe your mother would benefit from antidepressants, I say at least try. Nobody is saying the elderly don't deserve to be happy. Absolutely not true. They deserve the medical care given to everyone. But at some point, we all have to know and understand nothing can be done and we need to allow age to take it's course.
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My mother was on one antidepressant, I believe Lexapro. When they added Remeron, her mood lightened considerably. Some folks needs more than one med for a specific problem; my mom and husband both take more than one bp med.
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I want my mom to be as comfortable physically and mentally as possible. If antidepressants take away the sadness of being old and sick and if all the people she knew and loved have left her, leaving her to feel so alone, then I am all for it. Just have to find the right meds.
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What has her doctor suggested?

Jude and a few others have the right idea...and if I come off as sounding less than compassionate, I'm sorry.

Death is part of life. And at this age, I believe it's totally appropriate to be actually talking about it, not dismissing it. If you continue to tell her not to talk about it, she may just withdraw into herself and not talk at all.

She may need you to help her through this phase in her life...she may just need someone to actually listen to her and her thoughts about death. Perhaps you could ask her what she thinks about death next time she brings it up.
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I agree with dana55452, I would try to get her involved in activities and other things that would get her mind off dying, before I tried another med. There can be a lot of side effects while adjusting to a new med, and at her age that might be hard to take.
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Good grief, I have to agree with JudeAH53 and TooYoungForThis. Between my 86 year old Mom and 89 year old Mother-in-Law, I've heard it all. When the elderly's quality of life (what THEY feel not what WE feel their quality of life is) is such that they feel "tired" of living, you can't blame them. My Mother-in-Law (MIL) is a realist. She's told me over and over in the last year, "I'm tired. It's getting harder and harder for me to get around, hear people (she's lost a lot of her hearing), etc. Dying is a lot of work." Wow. But she's right.

She's done a lot in her 89 years -- raised 5 kids, grandchildren, great grandchildren and great-great grandchildren! Good Lord, the woman needs a rest and she's telling us about it! (smile) I love my MIL dearly and I get what she's saying. She's tired and ready to go. Her ailments are basically that she's old -- no underlying illness to speak of -- just old. I get it.

My mother, however, (age 86), is also hard of hearing (with 2 hearing aids), moves at the pace of a snail, barely eats to sustain her weight, can't see very well, can't hear on the phone, depends on my brother and myself to drive her places, won't give up the check writing duties to me, and she wants to live FOREVER! Her ailments are basically the same as my mother's --- old age creeping up on her. My MIL was quite active all her life; my Mom -- not active at all -- so she can barely walk now because she's never exercised during her life, never worked a job, her friends are all dead (same with my MIL), so exactly what are they living for they're thinking. It's not depression, it's not being fatalistic --- it's being REALISTIC in their minds.

I don't know, bm0508ps, what I said is probably not what you wanted to hear and I apologize if I've offended you, but at 97 years of age, you don't say what your Mom's health status is, but how much longer do you think she has? Just love her and try to be as upbeat as you can. Is she living with you? Is she in a nursing home? Assisted living?

As someone else said on another thread, "I didn't put my parent in a nursing home to die." Well, unfortunately, that's exactly what's going to happen. You try to care for your parents as best you can. When you can't do it anymore, you enlist the assistance of home CNAs, visiting nurses, or get them placed in a nursing facility or assisted living as appropriate. We can only do the best we can, try to not feel guilty about it (boy, THAT'S hard), and love them while they're here. Hugs to you.
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Nutritional approaches to mood balance, are gaining in knowledge and use.
For instance, deficiencies in B12 + Folic are very common, especially in elders.
a B-vitamin form called "5-HTP" can be very good at mood-balancing, as it helps balance neurotransmitters, particularly serotonin...yet it lacks the common adverse effects of the anti-depressant drugs. It's still a good idea to do this under a doctor's observation.

When SSRI's first came out, drug reps told Doctors:
"IF your depressed patient has sleep difficulties, give them the older Tricyclic antidepressants [like Elavil] at bedtime, instead.
Give the SSRI [like Prozac] to the patient who gets good sleep, and have them use it in the morning."
After about a year or two of that, drug reps stopped giving that advice. Most Docs now prescribing antidepressants, probably never heard that, or foot about it by now, it's been so long ago.

Keep in mind, it's OK for an elder to express their feelings about death and dying. They need to be able to talk about it with someone they trust and love.
Death is part of Life.
One of my G'ma's had firm, life-long beliefs in the afterlife; but once she was nearly there, was afraid everything she'd believed was wrong.
She needed someone to be with her, reassure her, touch her, be supportive.
It's kinda scary to be in that position.
Think: How might you reassure anyone who was scared?
She needed to be reassured that she'd be remembered lovingly as part of our lives always.
She needed to know that once her body died, her Spirit was free, therefore would never "miss anything".
I encourage you to talk with her, listen carefully with your heart open, to learn what she's most concerned about.
Then proceed in the conversation as she needs. It can be a gift for both of you!
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My mother was on Paxil for 15 years. She has dementia and was experiencing sundowners syndrome during the later afternoon hours. She used to get very angry, sad and upset. She was very unhappy and also wanted to die. The first time she went to a geriatric psychiatrist, he said that she was on Paxil for a long time and it no longer is helping her. He prescribed an antidepressant. We had to try different ones because of the side affects, but my mother is now on Fluoxetine (Prozac), which is helping her with her moods. She is much happier now.
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Well, is she old & weak & ready to die? At 97 years old, I'd have to say she's lived a very long life. Sometimes, very elderly folks just want to die. Their siblings, friends, spouse, etc. are already dead. It is frustrating for the ones that are around her to constantly hear this. I don't think I'd necessarily call this "depression", though.

Everybody makes a big deal over living to be 100 years old. People say "I want to live to be 100 years old". I sure as heck don't want to live to be 100 years old. What quality of life would somebody have at 100 years old? I don't think sitting around in a chair all day long, looking out the window, a good quality of life.

I'm not sure a doctor would even venture into territory to prescribe a 97 year old woman a new anti depressant.

I'd say tolerate it as well as you can. Don't egg her on to continue talking about wanting to die, but remind her of the good things in her life right now. Tell her that you love her & spend some time with her. At 97 years old, what's she got left at this point? When life turns into getting up in the morning, eating breakfast, brushing your teeth & washing up, getting dressed, sitting in a chair until lunchtime, eating lunch, sitting in a chair until dinner, eating dinner, sitting in a chair until bedtime & going to sleep, only to do it all over the next day, it can't be all that motivating to want to live.

I don't think this was an answer or advice in any way. I can just understand how she feels.
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Good for you Debi.
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I am in agreement with JudeAH53. Sometimes our elderly loved ones are just expressing that they are ready to go. My Mother really does not want to take her medications any longer - we are seriously considering all but the comfort measure drugs at this point. Best wishes.
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I believe people have the right to decide how they want to live and how they want to die. Dignity is what matters. Your mom has led a dignified life and is making her wishes clear to you. Now is the time to get her paperwork in order. For example, does she have a DNR? Now also is the time to spend as much time as you can talking to your mom and recording her memories so that you can celebrate her life while she's still with you. I hope you find peace in her decision.
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I agree with Jude, she is tired and wants to go to sleep. provide for her physical needs, and involve her Drs If she is clinically depressed, of course a trial of an antidepressent would be reasonable but otherwise let her do as she wants.
I totally disagree with Ferris about her description of the uses of anti depressents. Shoet periods of depression will usually resolve but people in continual stressful situations such as long term caregivers may need the medication for as long as they are suffering the stressful situation then carefully weaned over time. People diagnosed with a clinical depressive illnesses such as bipolar need the suport of probably lifetime medications.
I would be interested to hear cmagnum's input on this area.
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At 97 I'm not sure if she should start another anti depressant or not but no matter how much longer she lives, her days should be happy and peaceful. My mom is only 73 but struggles with depression and has for years. After trial and error on a few different anti depressants her doctor put her on Zoloft in January. They started with 25 mg and then raised her to 50 mg ( she is very petite too). She definitely had to endure some of the initial side affects but she is doing SO much better now. Happier and more peaceful and even some of the pain she used to complain about has subsided. So, if you do decide to add or change something I recommend asking her doctor about Zoloft. I know decisions like this are tough to make but also understand that a lot of elderly people will say that they are ready to die. One of the ladies at my mom's A.L. says that all the time but she's actually one of the more active ones. That may just be how they deal with the realization that their time on earth my be coming to an end. Best of luck to you!
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I also have a different view. Does she have a reason to get up every day? Does she have anything to look forward to? Does she see friends? Does she spend time around little kids or pets or things that are very much alive? Does she go out to lunch or dinner or to a show or concert? Does she listen to music? These are the things that make life enjoyable and interesting. Can you spark up her life for her before going to drugs?
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Paxil is already an antidepressant. If she has been on this med for years, better talk to the doctor about a change in med. Medication to help clinical depression is really meant to be taken for short periods of time to correct the chemical imbalance. Research shows depression will cure itself if given enough time, so perhaps she needs to stop taking Paxil. Have her talk with her doctor or psychiatrist because at 97 yrs. she is old, and she will die and that is a depressing thought to most. Love her patiently for the remaining time...
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Hmmm See I have a different point of view to everyone else on this. She may just actually have lived long enough and feels its her time. Of course the professional will prescribe antidepressants - its their job to but is she depressed or just a realist. She knows at 97 there is not a great deal of time left - perhaps she is just expressing her prefernce over a long drawn ailment with failing everything and total dependency on people she never wated to have to depend on. Tough call ....if you asked me how I wanted to die I would say exactly the same thing. And I cannot for one second imagine that will change - when I have to depend on others then ...for me... and I stress for me - we are all individuals so all have different views...but for me once I cannot do for myself then let me shuffle off my mortal coil and learn how to haunt all those devils that I have met over the years
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My 91-yr-old mom frequently used to talk about wanting to die. After a long bout in the hospital and skilled nursing last year a case mgr. came over to finish out her case and see how she was doing. He asked her what short term goal she would be willing to commit to, to improve any aspect of her life important to her. She replied by saying, Well I'd really like to go to sleep sometime very soon and not wake up. Poor guy. He's a mandatory reporter and took that as a possible suicide wish vs. my mom not really getting the question and saying how she felt. Not that she'd do anything about it. Anyway, I spoke to her doc about it and he put her on a low dose of Zoloft since she's so small now. I've seen a fairly substantial positive change. She winks and me and smiles more, wants me to take her for a walk, etc.
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Wellbutrin might be a better fit. It perks you up without weight gain in most people.
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Paxil is an SSRI, but if it is not working, ask the MD to try something else. There are many newer drugs available. Some SSRI's lose effectiveness over a long period of time. Also ask about a monthly B12 shot for her.
Last but not least, sunshine and fresh air are good for everybody. Get some.
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