Suspected cognitive decline - could sertraline be making it worse?ine be making it worse?

[NorthernGirlie]

My Mam is 74, always suffered with low moods and MH.

Was placed under the Crisis Team 6 weeks ago. They've put her on sertraline (upped to 150mg this week) and they're transferring her to consultant / community nurse team this week because she's not in crisis and they suspect cognitive decline

She's taken a massive downturn and is blaming the medication. She hates taking it and threw it across the room this morning

She says
-her whole body is tingling
-her ears are ringing
-her pulse is racing (checked multiple times by doctors / nurses and it's not)
-has no appetite
-is constipated (although probably from not eating enough)

The list is endless, literally dozens of new health issues a day. Could sertraline be making it worse?

She's got an appointment on Friday with the new nurse. My poor dad is on his knees, I've been there most of the weekend but I'm back at work 2m

Sorry about the typo in the title, I can't change it

Has she taken it before? I took it for PND, having taken Prozac in the past without problem, and the Sertraline side effects were awful. And that was at a much lower dose than this.

It made me feel dreadful, sick and dizzy, affected my appetite, stomach problems, not sleeping - I narrowly avoided throwing up on my baby at one point! Can you get hold of the patient information leaflet from the box and check the side effects listed on there? I had to split the daily dose into two to make it less extreme. It did start to improve after about a month but it was an awful month...

I don't think she has - if she did it would have been a low dose (she's been on something she called "Happy Pills" for decades but I'm not sure what

They seem to have ramped up her dose massively - 150mg seems so high. I just don't know what is decline and what is sertraline

I've googled the side effects (seem to be worse for women?) But they overlap with possible signs of dementia

Dd was really ill on sertraline, they switched her to a different medication and it worked though she since has stopped and uses non medical methods to cope

I really feel like telling Dad not to make her take them. She hates them so much - maybe they're making her worse

I worry the new team won't be able to assess her properly wither because of the sertraline

It’s possible that all, but the constipation are side effects of the Sertraline not agreeing with her. There are often ‘adjustment effects’ in the first 4 weeks or so of taking an SSRI antidepressant, but they shouldn’t include her whole body tingling and ears ringing. If they are not agreeing with her, tell her doctor. Sometimes a particular antidepressant doesn’t agree with someone and another does. They should be willing and happy to change her medication. Just to add, no adult who can give informed consent should be pressured to take a medication. Throwing them across the room is a pretty clear indication of how she feels about them. Even if she has some cognitive decline, if the Crisis team are not sure about it, then it’s minor, so decisions shouldn’t be taken out of her hands. I hope things improve when she is seen by the other service next week.

Hi, I specialize in older peoples health. Obviously can't advise on your mum specifically but can offer my experiences that may help.

Has she had bloods done and a general health check to check for alternative or contributing causes? Has she had her normal medications reviewed?

Any other changes in life e.g environment?

Has she had her hearing and eyesight tested lately?

What other health issues does she have?

What happened 6 weeks ago for the crisis team to get involved? How did things change from before?

150mg of sertraline isn't unusual, however over 6 weeks may be a little quick. Older people often do not need 150mg and can sometimes find higher doses induce increased agitation/anger/anxiety. It may be worth talking to the team around reducing to 100mg.
There are also other medications that may suit better depending on her predominant symptoms however chopping and changing generally doesn't really help things and things usually settle down with getting dosages right.

However cognitive decline can often present as low mood. 6 weeks is definitely not long enough to then assess re memory and I would think the team will continue to stabilize before going down the 'official' memory clinic route.

What is the predominant issue that makes things difficult to deal with for you and your father?

If things are not getting better or you think things are not right then don't wait until the next appointment, ring the team she's under for review.

I'm not sure where to start. She's always have severe low moods and depression

About 5 months ago, whilst on holiday, she started zoning out and pretty much stopped eating. She said things were getting stuck and she was "choking" she's had all the tests possible (bar the camera up which she refused) and everything is medically fine.

The crisis team got involved when she kicked off, screaming and shouting and said she could see daggers going into her throat. Dad took her to A&E who contacted Crisis.

She's developed massive health anxiety over the last few months - around 15 ailments / things hurting on rotation every few minutes.

She has excess saliva and is constantly spitting. This is really unlike her. Again - lots of tests have ruled out anything medical.

She's often lucid but is struggling to remember names, couldn't describe a simple walk to the shops yesterday (said you had to trek fields, climb hills, force through dark garages etc to get there)

She won't shower- has had a couple of sink washes but no bath or shower for 10 days.

The list is endless really.

She's had bloods done, eyes and hearing (blocked - trying to soften with olive oil before her appointment to remove it) only other health issue is high BP which she's medicated for and has been for years

UTI perhaps? Has she been tested ?

A lot of people give up Sertraline because of the side effects. Sounds like she needs a new option.

Definitely water infection. I can't even count the scans, x rays, blood tests, urine tests she's had

Definitely NOT a water infection **

Dad's been onto the crisis team. They've said for her to stay on the sertraline 🙈

Ok, so sounds like some hallucinations etc, any paranoia? I ask this is quite often if older people have psychotic symptoms (be that within a depression or other cause) paranoia can be quite well hidden as of course, if your paranoid or suspicious about things others are doing your not going to tell them are you?!! This often presents as refusing medications (paranoid that your trying to poison or plant things), refusing personal care (again paranoid re abuse/things being planted/things in hygiene products etc) refusing to eat or being very picky (thinking food is poisoned or planted) but seemingly relatively 'with it's most of the time.

It's a really hard process and really is sometimes a trial and error approach. But please keep shouting up if you cannot cope, there are emergency placements and make sure to involve a social worker, you or your dad can self refer for a career assessment through your local council. You may also access the support fo an admiral nurse of cognitive impairment/memory issues are deemed to be the root.

It's a very hard trying and worrying time for relatives, but it will not last forever. Things will get better xx