Mailbox Response

The question was submitted 15 March 2010

Subject: What is her problem?

My mom is 75 years old and is being treated for high blood pressure, high cholesterol and poor eyesight. She was prescribed Zoloft about a month ago for depression, but does not seem to respond to it. She shows irritability and compulsive behaviour that seems to occur on alternate days. On her good days, she is almost normal, but her bad days can be very bad. On her bad days, she keeps mumbling about what she is going to do, sometimes repeating the last few words of the sentence, says she does not care about various things that others are concerned about, keeps cleaning the floor, clearing trash, filling water bottles and checking her belongings. She has bad sleep many days per week. Her symptoms seem worse when she does not sleep well. Other symptoms: speaks softly sometimes, almost whispering, walks slowly, appears tired and directs her anger mostly towards my dad, very impatient on the phone, falls asleep in the car, does not appreciate schedules or priorities. More absent minded than before, but can remember events and appointments.
What could her problem be? We are so puzzled.

Answer from DementiaNet

Since your mother has been prescribed Zoloft, or sertraline, her doctor probably suspects a mood disorder that she is suffering. The irritability, poor sleep, anger, and even the need to obsess about things (cleaning floor, clearing trash etc) all lend support to that diagnosis. Her ability to remember events and appointments also does not suggest a Dementia problem. However, her erratic behavior is not completely typical of a depression and may some times suggest other form of dementia such as Fronto-Temporal type or other diagnosis like Obsessive Compulsive Disorder.

My suggestions would be:

(1) to allow the medication enough time (usually takes longer for the elderly) to work and allow adequate dose to build up. Monitor to see if there has been any change at all. The behavior may persist but has there been any decrease in frequency of the problematic behavior and increase in the "good" time?

(2) bring her back for a review by her doctor for further evaluation: consider more thorough investigations eg brain scan and memory testing if not already done.

The answer was published on DementiaNet 26 March 2010