Mother is in a Very Depressed State, Have You Heard of These Symptoms?
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Q:  Mother is in a Very Depressed State, Have You Heard of These Symptoms?

Dear Dr.,

My mom is 80 years old. Been diagnosed with bipolar many years ago. She is in a very  depressed state so severe that I had to put her in a nursing home for a while (still there, it is 2 weeks) what is weird to me is her symptoms are not familiar to me. She is not eating, won't use bathroom, won't walk, talk or co-operate with anyone to get help to get better. She won't tell me what she is thinking. She doesn't respond when talked to. She answers with nods both yes and no when asked a question. She is on Lamictal 200 mg, zyprexa 2.5, depakote 20 mg. I don't know if this is actually depression or some sort of stress disorder or if she just plain gave up on life. Have you ever heard of these types of symptoms? 

Sincerely concerned,


Dear Lynda --

Here are some considerations which come to mind based on the paragraph you wrote here.  Just how to proceed in regard to each of these possibilities is tricky, and that you will have to be working with your mother's physician(s) and they may or may not be open to consideration of these ideas.  If you need it, here it is an essay about talking with doctors that might help. 

Let's start with delirium.  This is a different condition than "dementia".  It is usually caused by medications that interfere with the activity of the central nervous system, but can also be associated with recent surgery, serious medical illnesses, and other major stresses to the brain.  It is generally identified by "shifting levels of consciousness". People can be alert and even understand what is going on at one point in the day, and then completely disorganized (putting the telephone in a wastebasket, for example) only hours later.  In the confused phase, they may have no understanding of where they are or why they are there.  They may have delusions and even paranoia.  This is extremely common, and is very important to identify because it usually does not get better by adding more medications; usually the trick is to try to decrease the amount of the most likely candidate medications that could be causing this. 

In that respect, you gave the dose of Depakote as 20.  That would be very unusual, in fact I do not know of any told me that small.  If there is a chance that the real dose is 2000 mg, which is a dose we occasionally used in young healthy adults, then this might be worth considering as regards delirium.  2000 mg would be a very large dose for an 80-year-old. 

Next, you will want to learn about a phenomenon called catatonia.  In my experience, this would be unusual for an 80-year-old.  But it is part of what can happen in bipolar disorder.  It would explain me "not responding when talked to".  However, nodding yes/no in response to questions would not be typical in catatonia.  Nevertheless, learn more about this one because it too has a potential solution (although the standard approach in young adults, using a medication called lorazepam, could be really tricky in an 80-year-old, so this is not exactly straightforward). 

Depending on where you live, you may have access to a geriatric psychiatrist skilled in ECT (electroconvulsive therapy).  At your mother's age, ECT is one of the most effective antidepressant tools, and it is also effective in catatonia. 

In general, the first step in figuring out how to approach your mother's situation is to get an accurate diagnosis.  Unfortunately, I am more than a week behind on letters at this point and I fear that much of this information may be too late.  Hopefully, things have sorted themselves out already.  I hope you and your mother's physicians have already had success if not, perhaps some of these ideas will be of use.


Dr. Phelps

Published October, 2008


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