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Depression

Question
Posted by: Molly | 2019/08/23

Q.

Resnia en alzheimers

My moeder het alzheimers en is op Cilift en Serpex maar sy bly maar onrustig, huilerig ens. Die dokter het nou ook Renia voorgeskryf maar nou sien ek op die pamphlet dit word nie aanbeveel vir Dimensia pasiente nie. Risnia 1 MG Tablet is not approved for use in patients with dementia-related psychosis due to the increase risk of death. So wat doen ek nou??

Expert's Reply

A.

Depression expert
- 2019/08/23

Hello Molly,
This is a sad and complicated situation.  I know about it both from my experience as a doctor and psychiatrist, and from tragic personal experiences in my own family.
Cilift is an antidepressant, and might be useful if the person is depressed, without changing the underlying major problem.  Serpex I don't recognize in this context  : I think there a drug with that name used to treat high blood pressure.
Risnia is a trade name for the drug Risperidone.  I have used it in a much-loved family member who was suffering awfully from restlessness, very distressing delusions arising from the dementia, to the extent that it was profoundly distressing for her and everyone who loved her, and this in itself increased her risk of death.  There were times when she evaded people caring for her, and went wandering the streets looking for relatives who died 30 years ago, and she was at a high risk of being run over or falling. 
Yes, there is a relatively small but significant risk of an increased risk of death by heart attack or stroke,  in dementia patients taking Risperidone, and maybe even more so some of the alternative anti-psychotic and tranquilizing drugs available.  But all drugs have risks, and one has to balance the risks of otherwise effective treatment with the risks of not treating the problems effectively.
This is an issue I would always discuss with the family, and work with them to make the decision.  In our case, we decided to use the Risperidone, and we're very glad we did.  Fortunately she had been able to agree to this during a lucid period earlier in her disorder.  We were able to use a liquid form of it, which I liked because one could vary the dose more flexibly than with tablets,  and adding it to her beloved coffee,  she became calmer within minutes.  Her severe fear and distress was relieved,  and she became far more of her real self than the agitated and suffering person she had been. More of her typical and lovely self became visible again.  I have absolutely no doubt that it greatly relieved her suffering and brought her more peace and more capacity to enjoy her remaining life and relationships.  Did she die earlier than she might otherwise have done ?  Maybe, though I'm not sure, and I was there throughout. 
I have no doubt that, had she been able, well before this awful illness began, to know what would happen, and had the choice, it is what she would have chosen to take the drug.  I know for myself,  I'd rather live for a year on Risperidone and at peace, than for 10 years without it, but terrified and miserable.  It greatly enhanced quality of life, for which any possible  reduction in quantity, was for us a price worth paying.
But that was our choice, and our experience.  Individual situations vary,  and we each have to make our own decisions

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