The doctor at the memory care facility said Mom should be on Paxil, but I disagree. Am I wrong?


My 85-year-old mother has been in memory care for 5 months. She is negative and has for many, many years complained at the drop of a hat -- if there's a listening ear, she's going to complain. Before moving her to MC she did not have a primary care physician -- my mother rarely saw a doctor in her life. The MC doc visits once a month. Last week the doctor called me and said that my mother should be on a low-dose of Paxil for her depression. She said that in her monthly visit with my mother the latter complained of feeling "worthless" and "wanting to die." I told the doctor that my mother loves to complain and I didn't want her on Paxil. The doc got upset with me, called me "Honey" a couple of times, and said I was withholding treatment for my mother. I am sure that was registered in her file on my mother. BTW: the nurse manager at the facility agreed with me, but privately. I really like this facility for my mother, but a doctor who comes around once a month and bases giving my mother a drug on a 10-minute conversation, I feel is problematic. Am I wrong? Any advise?



Are you wrong? Uhm, maybe.
You say your mother has "always" been depressed and negative, that doesn't mean she might not have had a better quality of life and a more positive outlook with the help of an antidepressant (and perhaps still could). Suppose your mom avoided going to the doctor because she didn't respect their opinions and didn't want to follow the advice she was given - do you feel the same way?
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Reply to cwillie

I thought her mother was a complainer not a lifetime of depression? My 90 old mother is a habitual complainer, nothing has ever been good enough for her, I grew up like that. She convinced her doctor by complaints she was “stressed” from living with me. She’s lived with me 28 years of her own choice. Her expectations are that everyone needs to make her happy. She had xanax ex’s for years until a geriatric neuropsychologist took her off. She is on an ativan once per day now as needed if she gets agitated in the evening. The doc also said mood stabilizers and antidepressants might make it worse and offered us seroquel for when her agitatio, paranoia, and wandering become heightened. It was a game changer for us. She is less angry and doesn’t exhibit as many sundowners symptoms on seroquel given at night.
There are othings to try but a geriatric psych appointment is a good start.
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Reply to Elliza

If your mother has rarely seen a doctor for her entire life, then she should get a geriatric psych evaluation. The doctor should not have called you "Honey," but let it pass as the primary goal is the wellness of your mother.
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Reply to Llamalover47

Is there another doctor who makes the monthly visits that could see your mother instead? If so, I would request a change and clearly state it was because of the doctor's unprofessional condescending and angry communications followed by an intimidation attempt. You cannot help but question the judgment of someone who reacts so negatively to any questioning of her recommendations.

If there's not another MC doctor, can you avoid the monthly MC doctor visits if your mother gets her own PCP?

Even though your mother is a complainer, I would encourage you to seriously consider whether she also may have some level of depression. It's possible depression is long standing and has contributed to her always being a complainer. If you think that's possible, I would suggest finding a geriatric psychiatrist and having a full evaluation before considering medications.
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Reply to TNtechie

Perhaps your mother needs to see a geriatric psychiatrist for a second opinion.

The fact that she has always been depressed doesn't mean that she won't respond to an SSRI .
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Reply to BarbBrooklyn

Constantly seeing the glass as half empty can be a sign of chronic low level depression, especially if accompanied by "stress" and anxiety. I'm not saying every negative person is depressed or needs medication but I wouldn't be unwilling to try something if a doctor felt it may help.
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Reply to cwillie

I agree with you! These docs don’t know their patients like you do. They take the easy way out for the staff. My Mum was in rehab twice last summer after UTI with delirium, and she was so drugged up she couldn’t participate in PT or OT, and wasn’t eating or drinking enough. My brother was her HCP at the time and I had no power to change anything. The attending doc said I had to realize she was “93 and failing”-no, he was failing her! I was finally able to get her released to my care at home, where she wanted to be(I know your situation is different)-and her PCP took her off all the crazy meds. Today she is coming up 95 and happy, healthy and enjoying life again! Keep doing what you know is right and don’t let these part-time docs take complete control! Prayers...
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Reply to Nopushover

Thanks for all your answers and input. This is why I like to get other ideas. The funny thing about my mother is that at 85, in a memory care facility, she's pretty much the same mother I've always had, as long as I can remember. I am certainly not against drugs for my mother -- they have her on a very low dose of Seroquel -- I think it keeps her "level". Because she's getting around and seems to be fine, I don't want to "take her over the edge" with another drug...then she has to re-adjust. And, I agree with Elliza -- complaining isn't depression. Some people are just, plain negative -- negativity is not depression. Thanks all for your thought, ideas, opinions!
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Reply to ArtMom58

When my mother was in the nursing home, the facility’s doctor came to visit every Wednesday but only saw patients who were in need of a doctor. He “kept tabs”on other patients I guess, but didn't see them regularly unless they were in pretty dire shape. There were 200 patients in Mom’s facility and he also made the rounds of other facilities on different days.

I agree that the doctor who saw your mother needed more than ten minutes to diagnose  her. My former doctor was what we call “a pill pusher” as well and I wound up on anti-depressants for over 20 years. I tried them all and finally realized that none really worked. IMHO, they only work if used in conjunction with therapy.

My mom was the queen of negativity, drama and paranoia. She also had dementia and all that stuff really kicked in. When the staff doctor recommended Effexor for her, to be honest, I said “Sure. Why not.” They are started on the least dosage and even that takes a few weeks to kick in. It’s trial and error and in very few cases does it seem to make much difference.

If you can trust Mom’s facility to closely monitor Mom’s behavior and watch for side effects, maybe give it a try. But I predict you truly won’t see much difference.
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Reply to Ahmijoy

The doctor put me on Paxil when my husband had cancer. It is very mild. I couldn’t even tell I had taken it. Just an opinion from someone who’s been there.
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Reply to BeckyT

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