- Last edited on February 9, 2024
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geri:dementia:alzheimers [on February 9, 2024] psychdb [Deprescribing] |
geri:dementia:alzheimers [on February 9, 2024] psychdb [Depression] |
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| ==== Depression ==== | ==== Depression ==== | ||
| * For depressive symptoms, if a patient had an inadequate response to the nonpharmacological interventions or has a major affective disorder, severe dysthymia or severe emotional lability, a trial of an [[meds:antidepressants:home|antidepressant]] //could// be considered.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980908/|Herrmann, N., Lanctôt, K. L., & Hogan, D. B. (2013). Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimer's research & therapy, 5(1), S5.]])] | * For depressive symptoms, if a patient had an inadequate response to the nonpharmacological interventions or has a major affective disorder, severe dysthymia or severe emotional lability, a trial of an [[meds:antidepressants:home|antidepressant]] //could// be considered.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980908/|Herrmann, N., Lanctôt, K. L., & Hogan, D. B. (2013). Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimer's research & therapy, 5(1), S5.]])] | ||
| - | * However, the response rates are low. | + | * However, the response rates are low and possibly lower than non-pharmacological interventions.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988455/|Watt, J. A., Goodarzi, Z., Veroniki, A. A., Nincic, V., Khan, P. A., Ghassemi, M., ... & Straus, S. E. (2021). Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis. bmj, 372.]])] |
| ==== Deprescribing ==== | ==== Deprescribing ==== | ||
| + | <alert type="info" icon="fa fa-book fa-lg fa-fw"> | ||
| + | See also: **[[https://pubmed.ncbi.nlm.nih.gov/20849673/|Herrmann, N. et al. (2011). Discontinuing cholinesterase inhibitors: results of a survey of Canadian dementia experts. International psychogeriatrics, 23(4), 539-545.]]** | ||
| + | </alert> | ||
| + | |||
| * Consider [[geri:1-giants#polypharmacy|deprescribing]] medications that may worsen cognition, including [[meds:toxidromes:anticholinergic-cholinergic|anticholinergic medications]]. | * Consider [[geri:1-giants#polypharmacy|deprescribing]] medications that may worsen cognition, including [[meds:toxidromes:anticholinergic-cholinergic|anticholinergic medications]]. | ||
| + | * Deprescribing can be safe and effective.[([[https://pubmed.ncbi.nlm.nih.gov/26482056/|Herrmann, N., O'Regan, J., Ruthirakuhan, M., Kiss, A., Eryavec, G., Williams, E., & Lanctot, K. L. (2016). A randomized placebo-controlled discontinuation study of cholinesterase inhibitors in institutionalized patients with moderate to severe Alzheimer disease. Journal of the American Medical Directors Association, 17(2), 142-147.]])] | ||
| * If deprescribing does not go well and there are increased behavioural symptoms, restart the medication at the //lowest// dose and **not** back to the original dose, as patients may develop prominent GI symptoms including nausea and vomiting! | * If deprescribing does not go well and there are increased behavioural symptoms, restart the medication at the //lowest// dose and **not** back to the original dose, as patients may develop prominent GI symptoms including nausea and vomiting! | ||
| ===== Resources ===== | ===== Resources ===== | ||