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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?

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If you are able to transport mom to an outside dr then I would highly recommend it - early on I had a less than desirable experience with meds prescribed by the visiting nurse practitioner at mom's memory care

Now that she can no longer get in my car, I still transport her via the facility van to her own outside PCP and neuro and I monitor her meds very closely

Mom barely ever took an aspirin and didn't take any prescription meds til her 80s, and so I always bear that in mind - I still offer her the choice of taking Tylenol rather than just giving it to her
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"Depression being the inability to move through the day."

That's what you believe depression is? Oh boy.

Depression manifests itself in many different ways, to many different people. Your definition is one symptom, sure. But so is sadness, lasting more then two weeks. Over eating, under eating ,sleeping too much, not sleeping, seeing the dark side in everything and everybody, loss of sexual desire, over sexed, short tempered, weepy, crying, feeling unloved, ugly, unworthy, less then, better then others, listless, under achiever, over achiever, abusing alcohol and/or drugs, and the list goes on and on.

Youve already done what you felt was right anyway. However, it's always wise to educate yourself as much as possible before shooting down a trained professional.

Growing up with your Mom's negativity is all you know. It is YOUR normal. Kids that grow up with abusive parents think that's normal too. Why, because that's all they know.

You were too close to mom to see something was/is off. Again, if she was always like that you think it's normal. But Dr saw clearly. He's looking from an objective point of view.

It would be really smart to keep an open mind. You just might be able to put a little sunshine in Mom's dark world

Good luck
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I don't think you are wrong. The medical staff at my mother's ALF talked me into trying Zoloft for my mother because she was crying all the time (which she has been a crier her whole life, and in some instances for good reason). Well, it worked for about two weeks, and then she started cussing a blue streak and upsetting the other residents. So they wanted to add to her meds. I did some research, and one big side effect is aggression and hostility. So I told the medical staff that information (sad that I have to do their jobs) and said instead of giving her more drugs, lets just stop this one, as it is the only new factor in the entire equation.

Now she is in hospice care, and they had her on another low dose antidepressant to try to get her to eat, and Xanax for anxiety and paranoia, which was probably brought on by the antidepressant (which has been discontinued because it did not increase her appetite one bit). I was hesitant to try the new antidepressant due to our bad experience with the first one, but guilt over not trying everything to get her to eat won out.
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BarbBrooklyn -- why do you think negativity and depression ARE the SAME? Lot o' people just aren't positive about life -- they see only the problems, or the glass as half empty, as the saying goes. Growing up, going to camp, for example, was seen as negative -- costs too much; tick bites. She was the only one on the road who knew how to drive -- that sort of thing is what I mean as negative.... Depression being the inability to move through the day. My mother was a very successful biz-woman -- depressed, no, negative, yep.
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My mom is on Paxil, to try to help with her despair-caused-by-fatigue. She was on another SSRI (low dose) and the palliative doc switched her to Paxil because it also helps with itchiness. We upped her dose to 40mg/day and I don't know that the despair is any different - it is really hard to tell. The one unfortunate side effect I notice that is tremors in her hands - makes it hard for her to eat independently.

I am leaving it as-is for now, but will discuss with the doc to see if we should go back down to a lower dose.
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If I'm recalling correctly, one of the things that Paxil is useful for is reducing rumination--the habit of replaying and rehashing old wounds, insults and experiences.

Why do you think that negativity is not depression speaking loud and clear? Distorting one's experiences so that one is always a victim, never successful or satisfied can certainly be a symptom of depression.

Certainly you are within your rights to refuse a trial of this med, but it might make your mom's last years more peaceful and fulfilling. She can't be making many friends in her facility.
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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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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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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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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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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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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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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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The hospice doctor just put my mother on paxil for anxiety and now shes having hallucinations. Her hospice nurse comes tomorrow. The dr gave them to her on friday. Last night i told her not to take them again until she sees yhe nurse. She already takes lorazepam for anxiety. Who knows.
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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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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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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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