Post by norbert1 on Feb 8, 2005 15:08:07 GMT -5
These are the basics that relate to dementia. Sometimes the dementia docs will get into more exotic treatments using some meds that are not recommended because that is what works for the individual patient, so there are exceptions to the basic treatments.
The basic rule (that doctors sometimes forget) is to avoid the use of any drug that has anticholinergic properties. One place you can read about this is "Beers Criteria for Potentially Inappropriate Medication Use In the Elderly" from the "Try this" series from the Hartford Institute.
FOR DEPRESSION -
only SSRI antidepressants should be used. The 6 are Zoloft, Paxil, Celexa, Lexapro (a variation of Celexa), and Prozac.
Also there is SSRI Luvox which is approved for Obsessive-compulsive disorder, not as an antidepressant- I never see it recommended)
Zoloft and Paxil also help with anxiety and would be good to use when there is also Anxiety. Paxil is somewhat anticholinergic, so Zoloft seems to be the better med for depression with anxiety.
When a heavy duty antidepressant is needed, Effexor is used. It is like a potent SSRI and is also approved for generalized anxiety disorder. Cymbalta is a new med that is very similar.
FOR ANXIETY -
All the traditional anxiety meds (benzodiazapines) are bad for a person with dementia. Buspirone (BuSpar) is the only non-benzodiazapine med available. It takes a long time to build up and titrate. It can cause headaches and dizziness.
FOR SLEEP -
All the traditional sleep meds (such as Restoril) are bad for a person with dementia (or any elderly person really) No person is supposed to take them for more than a month. They are benzodiazapines also and cause increased confusion in people with dementia - because they have a deficit of the neurotransmitter acetycholine to begin with. The only good use of a traditional sleeper like ambien is for a week or two to re-establish proper sleep pattern. Long term use causes addiction and is inappropriate. That is even on the package inserts.
Ambien or Sonata are sometimes used for sleep- they are similar to a benzodiazapine and do have many of the benzo problems, but they are very short acting (little morning residual) and are not anticholinergic. I have now heard two doctors talk about them as useful for initiating sleep in people with dementia.
Most commonly used is Trazadone. It is a mediocre antidepressant with a very strong side effect - quickly occuring sedation. (Make sure she's in her jamies and ready to go to bed when you give it). It's advantage is that the sedation wears off before morning, reducing the risk of falls. The major side effect is orthostatic hypotension which can cause falls, so this needs to be closely monitored and may even require treatment to raze the pressure enough to keep this from causing dizziness. Trazadone is effective for initiating sleep, but not for sleep maintenance. Some doctors add in a nightime dose of seroquel to increase sleep duration.
A few doctors will also combine trazadone with evening doses of antidepressant remeron (which also causes sleepiness) to achieve sleep maintenance.
A few doctors use a program of alternating meds to avoid having the person developing tolerance to the sleep effect.
Some doctors will use atypical antipsychotics (which cause general sedation) for sleep, but this does not seem to work very well unless the sleep disturbance is caused by disturbing hallucinations.
-----Hypnotic med recap ------
Traditional benzodiazepine sleep pill (hypnotic) -- Restoril® (temazepam)
Non- benzodiazepine sleepers -
Ambien wears off in about 8 hours and has most of the problems at benzo sleepers.
Users are cautioned not to take unless they have a full 8 hours for sleep. The residual effects poses a fall risk for a person with dementia.
Lately ambien has been getting bad press because of the long residual effect of the drug. It is being blamed for sleep walking, sleep eating, and even sleep driving (the person had no recollection of the driving afterward.)
Sonata - wears off in 4 hours so less fall risk from the residual.
Also, the new drug Lunesta - which wears off in 8 hours - but not supposed to lose effect over time as other meds. Side effect - a metallic taste in the mouth.
There is a brand new sleeper approved July 2005
Rozerem is totally different from any of the other commercially available sleeping pills. It is believed that Rozerem works by stimulating the so-called "melatonin receptors" in your brain. (The technical name for melatonin receptors are "the MT1 receptor" and the "MT2 receptor").
These receptors regulate sleep by making sure that your body's internal clock is running correctly.
Takeda (manufacturer) also claims that when you wake up from a Rozerem induced sleep, you will have no after effects unlike other sleeping pills, and that Rozerem is safe for long term use (unlike the others). I heard a doctor on TV explain that Rozerem is effective in helping people to go to sleep, but it does not make them stay asleep.
Rozerem is not a controlled substance like Restoril, Ambien, Lunesta or Sonata.
I have no information about how this med works for dementia patients.
Web resource - “Treatment of Insomnia” at
www.alzbrain.org/quicklinks/practguide/insomnia.htm
(to assist reading this article, Zolpidem = Ambien, Zaleplon = Sonata, Desyrel = Trazodone
Norbert
The basic rule (that doctors sometimes forget) is to avoid the use of any drug that has anticholinergic properties. One place you can read about this is "Beers Criteria for Potentially Inappropriate Medication Use In the Elderly" from the "Try this" series from the Hartford Institute.
FOR DEPRESSION -
only SSRI antidepressants should be used. The 6 are Zoloft, Paxil, Celexa, Lexapro (a variation of Celexa), and Prozac.
Also there is SSRI Luvox which is approved for Obsessive-compulsive disorder, not as an antidepressant- I never see it recommended)
Zoloft and Paxil also help with anxiety and would be good to use when there is also Anxiety. Paxil is somewhat anticholinergic, so Zoloft seems to be the better med for depression with anxiety.
When a heavy duty antidepressant is needed, Effexor is used. It is like a potent SSRI and is also approved for generalized anxiety disorder. Cymbalta is a new med that is very similar.
FOR ANXIETY -
All the traditional anxiety meds (benzodiazapines) are bad for a person with dementia. Buspirone (BuSpar) is the only non-benzodiazapine med available. It takes a long time to build up and titrate. It can cause headaches and dizziness.
FOR SLEEP -
All the traditional sleep meds (such as Restoril) are bad for a person with dementia (or any elderly person really) No person is supposed to take them for more than a month. They are benzodiazapines also and cause increased confusion in people with dementia - because they have a deficit of the neurotransmitter acetycholine to begin with. The only good use of a traditional sleeper like ambien is for a week or two to re-establish proper sleep pattern. Long term use causes addiction and is inappropriate. That is even on the package inserts.
Ambien or Sonata are sometimes used for sleep- they are similar to a benzodiazapine and do have many of the benzo problems, but they are very short acting (little morning residual) and are not anticholinergic. I have now heard two doctors talk about them as useful for initiating sleep in people with dementia.
Most commonly used is Trazadone. It is a mediocre antidepressant with a very strong side effect - quickly occuring sedation. (Make sure she's in her jamies and ready to go to bed when you give it). It's advantage is that the sedation wears off before morning, reducing the risk of falls. The major side effect is orthostatic hypotension which can cause falls, so this needs to be closely monitored and may even require treatment to raze the pressure enough to keep this from causing dizziness. Trazadone is effective for initiating sleep, but not for sleep maintenance. Some doctors add in a nightime dose of seroquel to increase sleep duration.
A few doctors will also combine trazadone with evening doses of antidepressant remeron (which also causes sleepiness) to achieve sleep maintenance.
A few doctors use a program of alternating meds to avoid having the person developing tolerance to the sleep effect.
Some doctors will use atypical antipsychotics (which cause general sedation) for sleep, but this does not seem to work very well unless the sleep disturbance is caused by disturbing hallucinations.
-----Hypnotic med recap ------
Traditional benzodiazepine sleep pill (hypnotic) -- Restoril® (temazepam)
Non- benzodiazepine sleepers -
Ambien wears off in about 8 hours and has most of the problems at benzo sleepers.
Users are cautioned not to take unless they have a full 8 hours for sleep. The residual effects poses a fall risk for a person with dementia.
Lately ambien has been getting bad press because of the long residual effect of the drug. It is being blamed for sleep walking, sleep eating, and even sleep driving (the person had no recollection of the driving afterward.)
Sonata - wears off in 4 hours so less fall risk from the residual.
Also, the new drug Lunesta - which wears off in 8 hours - but not supposed to lose effect over time as other meds. Side effect - a metallic taste in the mouth.
There is a brand new sleeper approved July 2005
Rozerem is totally different from any of the other commercially available sleeping pills. It is believed that Rozerem works by stimulating the so-called "melatonin receptors" in your brain. (The technical name for melatonin receptors are "the MT1 receptor" and the "MT2 receptor").
These receptors regulate sleep by making sure that your body's internal clock is running correctly.
Takeda (manufacturer) also claims that when you wake up from a Rozerem induced sleep, you will have no after effects unlike other sleeping pills, and that Rozerem is safe for long term use (unlike the others). I heard a doctor on TV explain that Rozerem is effective in helping people to go to sleep, but it does not make them stay asleep.
Rozerem is not a controlled substance like Restoril, Ambien, Lunesta or Sonata.
I have no information about how this med works for dementia patients.
Web resource - “Treatment of Insomnia” at
www.alzbrain.org/quicklinks/practguide/insomnia.htm
(to assist reading this article, Zolpidem = Ambien, Zaleplon = Sonata, Desyrel = Trazodone
Norbert
