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What are the mood stabilizers for the elderly?

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I'm starting to get old enough to have some concerns about what meds I'll be able to take when I'm older.


All AAPs come with a warning about causing dementia in the elderly. (The same with benzos.) I imagine some docs won't prescribe over a certain age, and no one would prescribe if you have that problem. So, at some point it sounds like AAPs are off the table.


Is Lithium an option if you don't have kidney problems? I have kidney problems and so do a lot of elderly people.


What's up with the ACs? Are they options? Can old people do them with ADs? I already know that this is not an ideal treatment plan for me, but it sounds better than nothing.


Does anyone know the general treatment protocol for us when we get old? It sounds like at least half our meds go off the table.

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AAP's don't actually cause dementia, they increase the risk of stroke in dementia patients. 


However, I have seen many, many dementia patients on AAP's, usually in very small doses. 


There are many age-related changes that cause drugs to work differently in the elderly than they do in the young and middle aged. Things like, liver size decreases and certain cytochromes in the liver that metabolize drugs may diminish. As well, the older we get, the more fat content we have compared to muscle. This causes a problem with fat soluble drugs being stored longer in the body and affecting the body longer than they would a young person. The elderly are also more susceptible to side effects. 


Another problem with the elderly is the tendency to be on multiple drugs. The risk of side effects increases greatly the more drugs you add to a cocktail. 


For these reasons, older adults need lower doses of drugs, The absolute lowest effective dose is usually used in older adults. 


In my clinical practice (as a nursing student), I have met many older adults with diseases like schizophrenia and bipolar that take multiple psychiatric drugs, just in very low doses. Chances are, the older you get, the lower your doses will become. This will likely be for safety and because you may find that the dose you need to be effective becomes lower. 


This is definitely something to discuss with your pdoc if you're worried. I worry about this too, because my pdoc said I'll need to be on antipsychotics for the rest of my life. I hope to be able to reduce my Abilify soon, cause I certainly won't be able to be on 30 mg of the stuff my whole life.

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I don't know much about the subject, but I have met multiple elderly people on APs, ACs, etc. to treat schizophrenia and bipolar disorder.  I think it's really going to be an as-you-go judgement call on the part of you and your doctors.


There may be some geriatricians with some knowledge of psychiatry, or, even better, some psychiatrists with some experience in geriatrics.  You may want to start casting out nets in your area for those doctors.

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Thanks for the clarification on dementia. Nice to know they don't cause dementia. Thanks for the rest of the input, too!


Below is a quote from the Prescribing Information for Latuda. I think it is similar to most AAPs, but haven't looked at others to double check.


Increased Mortality in Elderly Patients with Dementia-Related Psychosis

Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analyses of 17 placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6- to 1.7-times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. Latuda is not approved for the treatment of patients with dementia-related psychosis [see Boxed Warning]."


So that is a little different than having bipolar or schiz or SZA related psychosis. I wonder if they bothered to do a trial on folks like us. At any rate, with those odds I'd continue to take my AAP. That's good news.




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