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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I am wondering if the doseage of antideppressants and antipshycotics

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I am wondering if the doseage of antideppressants and antipshycotics should be reduced an individual who has been on the same meds for 20+ years ages?She is now almost 70 years of age and has not had a doseage evaluation ever in this time. I worry about how her body is metabolizing the meds (she is on antipshycotics as well as an antedepressant) total 6 meds. I can't help but wonder that as we age,we metabolize them slower. She is totally afraid to alter the doseages as she fears going back to the state which got her on the meds.I don't think she has had any blood levels done in a number of years either. I am a close friend & a nurse and I have encouraged her to seek a follow-up with the Pshychiatrist who finally got the meds right as she was unstable until the combination she is on suited her.I appreciate your opinion. Thanks

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

Yes you are very much correct that as we age, especially past 60 years of age, we metabolize most medications, including antidepressants and antipsychotic medication at a slower rate, which leaves more medication being present in the body

Dr. Z :

Now it really depends on what antidepressants are being used and what antipsychotic medications are being used, but sometimes the combination of these two can lead to something called Serotonin Syndrome, which can be fatal. Now usually a low dose antipsychotic combined with a SSRI antidepressant will not cause this Serotonin Syndrome, but if your friend is metabolizing these medications at a slower rate, then that could mean more Serotonin being present in her system allowing for a possible chance of Serotonin Syndrome. This is just one example.

Dr. Z :

Also most antipsychotics at higher dosages can cause more adverse effects with the elderly and this can also be possible at standard dosages with someone with someone who is elderly as well due to the slow metabolizing factor.

Dr. Z :

This is why most elderly (individuals above 60 years of age) are carefully monitored by a psychiatrist and usually given lower doses than the standard dose.

Dr. Z :

Sometimes psychiatrists will go at a higher dosage if the benefits outweigh the risks

Dr. Z :

For example, studies show that a popular antipsychotic called risperdal can be increased gradually to around 1 to 1.5 mg for maximum effectiveness in the elderly. Higher dosages than this are not shown to be more effective and can increase the risk of side effects. In addition, there should be blood labs to monitor the glucose and prolactin while on risperdal. Also Risperdal can also increase the risk of stroke.

Dr. Z :

So I would agree with your concern and recommend that your friend at least get an evaluation from a geriatric psychiatrist, as these specialize in mental health treatment for individuals above 60 years of age, to help your friend get the most optimal dosage of the medications she is one with a minimal risk of side effects.

Dr. Z :

In addition, many antidepressants and antipsychotic medications may accumulate in the body and as the body metabolizes the medication at a slower pace this means more medication is accumulated in the body over time and this can increase the risk of adverse effects, which is another reason why lowering the dosage may be necessary and another reason why being reevaluated by a geriatric psychiatrist is a wise decision for your friend.

Dr. Z :

I see that you are offline or away from your computer right now, but when you get back online I would be very interested in continuing this discussion with you and talking about anything further you would like to share regarding your concern, so if you respond in the chat box I will be able to get back to you as soon as possible.

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