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why are anti-psychotic and anti-depressant prescribed altogether?
xiaofeng
Posted: Wednesday, October 10, 2018 2:11 PM
Joined: 9/12/2018
Posts: 61


can a dementia patient be both mania AND depressed? if the person is hyper sexual, doesn't that mean he is not depressed? I am puzzled with the combination of the two drugs in treating aggression, anger and disinhibition of sexuality. 

 


jfkoc
Posted: Wednesday, October 10, 2018 3:19 PM
Joined: 12/4/2011
Posts: 17560


Meds are given off label all the time. Each individual will react differently so it can take a while to find  the best. That said drugs are second choice to non-medical treatment when possible.

You need to know about every med (and supplement), its side effects and its' interaction with anything taken. I like to use drug.com for this.


xiaofeng
Posted: Wednesday, October 10, 2018 3:26 PM
Joined: 9/12/2018
Posts: 61


thank you jfkoc and Dolor!

my dad is already on exelon and olanzapine . olanzapine is used since 6 weeks ago for his anger aggression and hopefully hypersexuality . it worked for anger/aggression, but only cut down the hypersexuality by half. 

 


Jo C.
Posted: Wednesday, October 10, 2018 3:51 PM
Joined: 12/9/2011
Posts: 10225


Hello, you mention that the med reduced the hypersexuality only by half.   It may be that the medication dose needs to be adjusted.   This is quite common.  These tablets come in a variety of doses.  There are also other antipsycotics.

Example:  My step-dad was prescribed Seroquel.  Initially he took one dose in the evening.  It helped a bit, but not so much.

Next step, the Neurologist changed the med to be given twice a day; no change.

Then the Neurologist lowered the amount of each dose and had it given three times a day - PERFECTION!   We were fortunate that he had no side effects and did very well which also brought him peace. 

Also, has your father ever had a mental health issue during his lifetime?   Is there any history of bipolar disorder in the family?   It is also sometime surprising to find that there can be a dementia induced psychosis which usually is not on the radar screen until someone manages to think of it as a possibility.

Best wishes,

J.


Misssy2
Posted: Wednesday, October 10, 2018 5:47 PM
Joined: 12/14/2017
Posts: 1727


They don't know what comes first the chicken or the egg.

When the brain is diseased...it can cause Bipolar...when the ALZ acts like Bipolar no one really knows the difference.

Bipolar is a dysfunction in the brain...as is ALZ and dementia..

With me is it Bipolar? I have never been diagnosed with Bipolar till about 4 years ago.

Most people are diagnosed with Bipolar by age of 15.

So my ASSUMPTION on your behalf is that the ALZ came before the Bipolar...For the hypersexual stuff....I don't know..that is disturbing and I am grateful that my Dad has not had that.

It has to be very difficult to deal with this..and I want you to know I read your post and I sympathize with you and have no answer.

 


harshedbuzz
Posted: Thursday, October 11, 2018 4:27 AM
Joined: 3/6/2017
Posts: 1845


Short answer- because sometimes a cocktail of medications works better than a single drug or allows better symptom relief at lower doses. Dad took three psychoactive medications for a time in an attempt to dial back his aggression, manage his depression and try to improve his extreme apathy. Turns out the third medication did nothing for the apathy but did dial back his cravings for alcohol. 

Medications are prescribed off label all the time. Often, a class of medication is used for something outside its original indication for years before it becomes approved for that specific indication. Risperdal, one of the early new generation meds known as an atypical antipsychotic or neuroleptic, was first prescribed for schizophrenia but physicians quickly discovered it works- at much lower doses- on the mood swings associated with bipolar disorder and the irritability/rage/inflexibility that comes with some presentations of autism. These days, both bipolar and ASD are officially indications for the drug.


IME, the hypersexual behavior or disinhibition around sex has nothing to do with mood, it's more a function of organic brain disease- the part of the brain that regulates desire and keeps behavior appropriate is damaged.


Misssy-

Can you share a link to your "most people with bipolar are diagnosed by the age of 15" claim? This is very interesting and contrary to what I see IRL with family and on my special needs parenting boards. While onset of symptoms is often first seen around puberty, IME, unless a kid is being seen by a psychiatrist/psychologist for some other condition (like ADHD, ASD, disordered eating, addiction), they are more likely to go undiagnosed into adulthood.


HB
Jo C.
Posted: Thursday, October 11, 2018 7:41 AM
Joined: 12/9/2011
Posts: 10225


The following is from NAMI, "National Alliance On Mental Illness:"

"The average age-of-onset," (of the diagnosis of Bipolar Disorder),  "is about age 25, but it can occur in the teens, or more uncommonly, in childhood. The condition affects men and women equally, with about 2.6% of the U.S. population diagnosed with bipolar disorder and nearly 83% of cases classified as severe"

Other sites state onset being between the ages of 15 and 25.  Average though seems to be early to mid 20's.   This can be any range from subthreshold to Bipolar 1 or Bipolar II or Bipolar NOS.

Sometimes, it can be very difficult to define a person as having Bipolar Disorder, (BPD), if there is a very low subthreshold BPD, or if the BPD is NOS . . . "not otherwise specified," which means that it does not fit into the defined categories meeting all criteria for a BPD diagnosis.

Some people have more rapid cycling and presentation of symptoms; others can go for a very long time without exhibiting symptoms - up to years for some, but that is not as common.

In my husband's family, there has been BPD in a couple of relatives rather far removed.  However, one instance really astonished me.  One of the relatives in his 50's was a person who upon occasion acted a bit like a jerk, but who was mostly the opposite; very nice, middle of the road.  Nothing hair-raising, just sometimes an impatient sort.  Well . . . . after the death of a close Loved One, he was put on a short-term antidepressant.  What happened in very short order was that for the very first time, he blew into a full manic state . . . . . had to be weaned off the antidepressant.

His diagnosis is, BPD NOS; and is pretty much subthreshold.  Difficult for him to understand and accept which was  understandable under the circumstances.

He had NO prior history of mental illness, just that sort of occasional impatience or low level irritability from time to time.  It was the antidepressant that tipped him into a full-blown mania. 

We later learned that he had indeed suffered a manic state with diagnosis of Bipolar Disorder AND the psychiatrist stated that if there is any BPD in the family, one should NEVER take an antidepressant without seeing a psychiatrist who can evaluate and follow as for some antidepressants can throw a person into a full-on BPD agitated depresssion or mania who had never had an issue before.  The entire family was notified.  I did a little research and consultation and found out that some individuals will have their very first full-blown BPD after taking an antidepressant.   With all my psych training as an RN in both private and state run facilities, this never came up in lectures or in practice.

For those who have a diagnosis of BPD, they are usually not given an antidepressant without being on a mood stabilizer and followed by psychiatry.

Who knew?  Surely not me. What makes this worse, is that most physicians are not informed or educated to this, so it gets to be a sticky wicket when symptoms begin to come to the fore at a later date after an antidepressant is initiated.

If one has BPD, one must be VERY careful about taking other medications which can cause one to cycle into an unwanted state.  One of those meds is as simple as cortisone - prednisone whether it is taken orally, is injected or given IV .. . . . AND this outcome can happen as much as up to three weeks AFTER the med has been stopped.  This I knew from my education and have actually seen patients who have had this outcome.

Any new med, no matter how inoccuous it sounds should be researched first to see if there is a risk for causing a BP state.   Certainly not all meds will do this, but better safe than sorry.  I would imagine (but do not know for sure) that if one is on a mood stabilizer this would not be as common, but good to ask and do a bit of research anyway.

BUT . . . . we need to get the Thread back to the initial intent for xiaofeng who is probably wondering why we went off track.  It is likely that xiaofeng's father probably needs a medication adjustment either in dosage or in changing the med to another antipsycotic.   The doctor will be able to assess this with xiaofeng's input and observations.

J.

 


JJAz
Posted: Thursday, October 11, 2018 11:14 AM
Joined: 10/21/2016
Posts: 2480


As brain shrinks, antidepressants assist in continuing to make the chemical connections.  It’s not just for depression
xiaofeng
Posted: Thursday, October 11, 2018 11:35 AM
Joined: 9/12/2018
Posts: 61


thank you Jo C for sharing your experience!

my dad's brother and one sister had mental disease. some sort of mania. his 4 other siblings don't.  don't think it's bipolar, then again. it was diagnosis 60 years ago where China doesn't have any modern medicine. so I can't really conclude. 

dad is currently on 2.5mg once a day. so i will try divide that into two dose, morning and evening. hopefully the day time sleepiness won't get worse. he has alwasy been sleeping while watching TV. that probably happened since 20 years ago. (there is papers say this is sign of Alzheimers and dementia). 

I will give it a week, if it fails, then I want to try serequel.  if that fails again, anti depressant. it looks like doctors in china (even in Japan) don't use anti-depressent for hyper sexuality. rather, they insist anti-psychotic. 


xiaofeng
Posted: Thursday, October 11, 2018 11:44 AM
Joined: 9/12/2018
Posts: 61


JJaz, HarshedBuzz, Missy,

thank you all so much for your valuable input.  I guess I really have to make a case with the chinese doctor.