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Is Excessive Screaming After Taking Sertraline And Seroquel Normal?
Question: Yes I have a 87 year old dementia mother. She has been placed in a memory care unit. 2 wks after being there she was too affectionate they said so they took her off her paxil and put her on sertraline 50 mg and seraquel for night time sundowners problelms.. THe first two weeks she was great adjusting a XXXXXXX to us. Now she is behavioral hitting screaming. Side effects on both mention the latter syptoms and we see these problems have accelerated. Her brother is in same care unit and we feel he is part of her behavior problem because she is overly protective of him of course she thinks he is her son or husband. SHe has always been an overly anxious women and worrier. Even b4 dementia. This change of meds is upsetting to us children ...they threaten to send her to ER next time and away for eval. Good grief. We pay good money for them to give the care she needs. Baffled as to what to do for our mother in her vulnerable state. On top of that I discovered a terrible fungal yeast infection under her breasts it was so rancid smelling I almost fell over...seriously. So they cant have been caring carefully for her to have missed that.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Patients with dementia can have fluctuations of their state, which makes it difficult to distinguish if symptoms are related to medication changes. I do not believe Seroquel is responsible for her worsening, actually it would be one of the recommended medications for her hitting and screaming. At most one can say it is not effective enough so a raise of dosage or use of alternative antipsychotic is recommended.
As for Sertraline, I do not see it as a likely culprit either, it has a very similar efficacy and side effect profile to Paxil on which she was on, belong to the same SSRI class. It remains a little difficult to understand why a switch was necessary and why a SSRI is necessary in the first place, it is used for treatment of depression. I also wonder if other therapeutic options for dementia like memantine, donepezil or rivastigmine have been tried.
So to conclude I do not think the medications are directly responsible for the worsening although the regimen should be reconsidered. The fact her brother is in the same facility may contribute as well.
As for the yeast infection you are right in saying it was the responsibility of the facility personnel to notice and prevent/address it, patients with dementia aren't able to take care for themselves that is what the duty of such memory care units is, to assist them in that. It should be pointed out to the administration.
I remain at your disposal for other questions.
Read below.
Detailed Answer:
I read your question carefully and I understand your concern.
Patients with dementia can have fluctuations of their state, which makes it difficult to distinguish if symptoms are related to medication changes. I do not believe Seroquel is responsible for her worsening, actually it would be one of the recommended medications for her hitting and screaming. At most one can say it is not effective enough so a raise of dosage or use of alternative antipsychotic is recommended.
As for Sertraline, I do not see it as a likely culprit either, it has a very similar efficacy and side effect profile to Paxil on which she was on, belong to the same SSRI class. It remains a little difficult to understand why a switch was necessary and why a SSRI is necessary in the first place, it is used for treatment of depression. I also wonder if other therapeutic options for dementia like memantine, donepezil or rivastigmine have been tried.
So to conclude I do not think the medications are directly responsible for the worsening although the regimen should be reconsidered. The fact her brother is in the same facility may contribute as well.
As for the yeast infection you are right in saying it was the responsibility of the facility personnel to notice and prevent/address it, patients with dementia aren't able to take care for themselves that is what the duty of such memory care units is, to assist them in that. It should be pointed out to the administration.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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