HEALTH LINE

Questions and Answers

Subject: Overmedicated parent

My mother is currently in the hospital for depression? I think she is overmedicated but can't seem to convince the doctors to really look at it from this point of view. She was hospitalized two months ago for depression and sucuidal feelings. She is taking the following drugs daily:

			7:30am    Buspar 1/2 of 15mg
			9:00am    Acebutolol 200mg
			          serzone 50mg
			          synthroid  .025
			1:00pm    propacet   100mg
 			          alprazolam 

			9:00pm    propacet 100
			          buspar   15mg
			          Serzone  50mg
			          alprazolam

Prior to this she was very active and happy. It all started with the propacet prescribed 4 years ago for diviticuliticis and each doctor added to this list. Any suggestions? She fell apart yesterday and that is why she is back in the hospital. Thanks for your time.

Hi Paulette ... sorry to hear about your mother's problems.

You mention her treatment with Propacet (propoxyphene) for 4 years. While it has a place to play in the management of mild to moderate pain during an acute attack. such attacks usually subside with appropriate therapy; continuation or recurrence is usually a good indication for surgery. An important consideration is caution in its use with antidepressant drug(s), and if so used, care in the spacing of doses is recommended for geriatric individuals.

Antidepressant therapy - three drugs of entirely different types are being given. Buspar (buspirone) has the reputation of producing less sedation than others - Serzone (nefazodone) is a fairly new serotonin reuptake inhibitor, you'll likely be more familiar with 'Prozac'.

These latter produce side-effects more commonly which may include gastrointestinal upset and decrease in central nervous system functioning - despite this, they are still valuable and effective drugs. Alprazolam, a well tolerated benzodiazepine (derived from Valium); the dosage is usually reduced when given with Serzone since there is a drug interaction.

In addition, she's getting a beta blocker, acebutolol, presumably for hypertension, and synthroid (liothyronine) for a thyroid condition. It would seem unlikely that these latter two have much, if any, connection with your mother's problems.

One might question the long-term use of propoxyphene - the usual dosage for analgesia is 30 - 60 mg. every 2 - 4 hours. Diverticulitis is either episodic or, if continuing, a candidate for early surgery.

You might be justified in asking referral to a psychiatrist skilled in the diagnosis of depression and the optimal (benefits/disadvantages) of more likely mono-therapy rather than the poly-therapy your mother is being given now.

Best wishes to you and your mother.