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My mom is in an assisted living. She is 91 and in pain for a host of issues and has anxiety. The Psychologist prescribed an SSRI. I know they have a host of side affects and neither my mother nor I want her on any SSRI at this age. If she was younger yes, but not at 91. I feel there are other drugs that could be prescribed. Can I as her Medical POA say no to the SSRI? Can I ask the pharmacist not to fill the prescription?

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Many drugs treat various symptoms.

I would discuss the purpose of this drug with her doctor.

It could very well help your mom. Of course, some people experience side effects but not everyone does, plus you have to look at if the benefits outweigh certain side effects.

Dosages can be modified specifically for your mom or another drug can be substituted.

Best wishes to you and your mom.
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I recently had my mom(79) taken off of three meds and within 24 hours she was making remarkable strides with her cognition. There was a series called “Awakening from Alzheimer’s” where the first episode was about brain fog and meds. I requested moms med list, met with the DON, and it’s done wonders.
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I have attended every medical appointment with my mom (90) for 5 years. I am in the room with her geriatrician, and am consulted at the time when a new Rx is suggested - before it is prescribed.

Over the years, my mom has gone on 1 long-term medication - which we tried increasing, briefly, with negative side effects - and the occasional short-term Rx (such as an antibiotic). With every medication my mom and I have been intricately involved in the discussion with the doctor. And, when we did stop the trial increase, I called the Dr's office to report returning to the former level of the drug.

Personally, I would not simply call the pharmacist to stop a Rx from being filled. It strikes me that a conversation with the Dr is in order so that your mom gets the relief she needs with the intervention that is right for her. IMO, simply stopping the one medication is not serving the full roll as POA because you haven't addressed the symptoms - just rejected a medication.
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I would say yes, as I have had to make a decsion with my brother being the POA. I ask the primary doctor to do an assessment on his medications and see what meds he's taking and what meds is not necessary. We found out he was taking several medicines for the same problem and it had to narrowed down to him taking only a few. What happened is that the primary doctor he was seeing, and his other doctors he sees, there was no collaboration between them on his meds, so I was the watch dog. once the primary doctor reviewed his medicine intake, his meds were changed drastically. He felt so much better. While my brother was in assitant living I usually did a check up to see what meds they were giving him. They really don't have the right to change his meds or give new meds, at all unless they get a signed consent from you and your mother to sign. Those places are not good for medication management when it comes to prescribing any medication for the resident, only their doctor. You have that right also to make a call to stop medicine you feel will harm your mom or make matters worst. Any change in her medication tthey must notify you for approval.
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My mother was prescribed an SSRI late in life (90s) and is doing well on them, with minimal, if any, negative effects. The side effects described are detailed and the drug companies must reveal them to avoid lawsuits. People often have a more jaundiced view of medications for mental health than they do for other physical reasons. Would you be as hesitant to offer your mother a prescription for a medication for diabetes or liver or heart function, though all these come with negative side effects? Anyway, the short answer is as her healthcare proxy you are able to make medical decisions for her....but I would speak with her doctor about the risk v. benefit of an SSRI. If they can help with anxiety or depression, why not allow them to help her?
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What do you think would be better than the experts suggest
Sometimes it is better not to read up on side effects and then expect them
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TaylorUK Apr 2021
Perhaps I should have said I am a Pharmacist, and well meaning people interfering with prescribed medications with a little knowledge and no discussion with the experts is one of the main reasons elderly people end up with too many drugs because the Dr is unaware that what was prescribed is not being taken in the expected way so something else gets added in. In general I believe elderly people are on too much medication but a lot of it comes down to misuse unfortunately
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The short answer here is Yes.
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I said, "Yes," but I feel I must explain in more detail. As your mom's medical POA, you are entrusted with her medical care decisions: medications, treatments, doctor's appointments, hospitalizations.... Your duty is to act on your mom's behalf in accordance with what you know to be her expressed wishes. So in that sense, you can decide not to fill a prescription.

Before you go that route, there are a few things to consider. If your mother is in constant pain and anxiety, she obviously needs relief. She should have a doctor who is managing her pain. Her anxiety is appropriately managed by a psychiatrist. Since the SSRI is being prescribed by a psychiatrist, you need to talk to this doctor. Ask the reasons for giving your mother this medication and the expected outcomes. Ask about side effects (your main concern) and how they would be addressed. Ask if there are other medications that could be considered instead of the medication in question and their benefits and problems (every drug has side effects). You may find that this medication may be the most reasonable one to try to help your mother's intractable anxiety.
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Imho, I do not advocate that you decide what medication(s) that your mother should be taking since you are not a medical doctor. I suggest that you speak to your mother's physician and not a psychologist, who does NOT prescribe medications, regarding your concerns. While you could, for all intents and purposes, ask the pharmacist not to fill the rx, what is going to happen when your mother's physician asks how she is doing on the medication if YOU decided not to receive the medication? Bottom line is that you speak to the prescribing physician with your valid concerns. Again, psychologists do not prescribe medications.
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Llamalover47 Apr 2021
caroli1: Thank you for your post.
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SSRIs, as opposed to say benzos, are fairly safe, though I know that is not the point of the question.

Even with benzos, my own dad suffered agitation in his first year or two of ALZ.

The MD prescribed a benzo, I cannot remember which one and that helped a whole lot. The MD said use it very limitedly, as you can get addicted.

I said hes a 92 yo man. So what if he gets addicted, isnt comfort better for him? The MD said the other issue was how it effected balance. That resonated with me more.

But as people get into ALZ,shoudlnt anything that provides comfort be OK? I knwo this sounds cold, but ALZ is basically terminal.
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Dosmo13 Apr 2021
Good point about the comfort issue, but remember all medications have side effects. There may be some that affect balance, elimination or other important factors. These effects could also impact comfort. Check with the MD about this.
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While you have a POA this does not necessarily give you card blanche to refuse medication or medical treatments on behalf of your mom. If your mom is still considered competent, she can refuse treatment, and you need to accept her decision to take or refuse any treatment options. Be careful not to overstep your position as a POA as you don't want to be accused of coercion either. I would consider contacting an elder law attorney and asking if you have the rights you suggest you have under your POA authority. A POA is not the same as a guardian of mom's healthcare.
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TouchMatters Apr 2021
This is correct in California. Thank you for letting others know that 'just' being a POS for health care does NOT give that person the right to make decisions for another who is medically considered COMPETENT. I am in this situation and did not know until I was in a situation what my role, obligations, and boundaries are, legally, as the POA for healthcare.

The only way the POS for healthcare can make decisions is if the medical provider deems the person incompetent to make their own healthcare decisions.
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AS a palliative care nurse practitioner, I can share this: the SSRIs have been found to help pain, especially nerve-related pain, in some people, in ways we don't fully understand. It is NOT through their sedating effects but a sort of nerve-calming that actually treats the pain and allow for the use of much less narcotics. With dose-adjustments, these can be safe in very elderly patients. I echo those that recommend palliative care and those that recommend a conversation with your provider about the regime that they are prescribing.
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The hospitalist - not her regular doctor who knew her - wanted to put my mom on Sertraline for anxiety and dementia. I looked it up and saw that it could make the dementia worse, so I refused ( the hospital nurse said, good for you!) You want someone who understands the elderly and doesn't just push the most popular drug on them. Sometimes the cure is worse than the disease. In my experience, Palliative care is also big on sedation - this is my only complaint about them. Hospice is, of course, REALLY big on sedation and most elderly want to reduce pain but not end up lolling out of their chair in a coma. My aunt in nursing home made the mistake of yelling fire one day - from then on she said, why can't I stay awake. Oh, I knew....
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If she starts taking an SSRI, be very careful about taking her off. My mom was taken off Paxil cold-Turkey and suffered seizures and permanent brain damage. It needs to be weaned off very carefully.
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Even if the doctor calls in the prescription, you do not have to pick it up. The suggestion to ask the pharmacist for advice on alternative drugs is an excellent idea. Pharmacists often have the best knowledge and advice about drugs, side effects and interactions. Sometimes doctors pass along what the latest drug rep has pushed without having much awareness of side effects.
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TouchMatters Apr 2021
To not pick up a medically prescribed prescription may be illegal.
The POA for healthcare needs to know the legality of making this decision to 'not' pick up a prescription or somehow insuring that the person it is intended for gets it. This advice seems to put the POA for healthcare in a very precarious legal position. Be careful what you write, be careful what you do. Being a POA for healthcare is a tremendous legal responsibility. It is important that the POA get everything in writing to 'back-up' their decisions. And, know in advance what you are legally obligated to do.
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Talk to the dr about the side effects that concern you. Ask about other drugs that may have fewer effects. Then make your decision. Mom has a right of what and what not to take.
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Yes, you should tell her Dr and the Pharmacists that you and your mom have decided that she will not be taking these meds.

All meds have side effects and you need to decide if the benefits out weigh the side effects.

MY 96 yr old Dad is in his own home with 24 7 Caregiver Care and has Nurses and a Nurse Practioner visit him.

I have told them more than once regarding different Rx's that I don't feel comfortable with him taking and he doesn't take them nor do I have them filled.

It is totally up to you and your mom.

One of the bad things about Old Folks Homes are any time a person is the least causing them what they consider trouble, they get the Dr at the Living Facility to prescribe a Rx.

Mout all Seniors are on way too many meds.

Do what you think is right but besides a gut feeling, ask the Pharmacist and look up on line the benefits and side effects.

Also, ask the Pharmacists what would be a good option with less side effects.
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TouchMatters Apr 2021
It isn't 'you and your mom.' It is the decision of the mother, solely. If the mother is deemed competent, it is her decision. The POA doesn't make these decisions.
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SSRIs are work well for pain relief. I have been on Cymbalta for 10+ years to manage my pain. My mom as well takes it and without it she complains of pain. As a nurse, I see more and more patients on SSRIs for pain. The side effects to alternative pain medications, in my opinion, can be more severe in the elderly. SSRIs have made a huge difference in my Mom’s life as well as my own. It is worth a try for you Mom. If she were to have side effects that she were unable to tolerate then she could just refuse to take the medication. That is her right as well as yours. I hope this helps in your decision, and if you decide to try it, I hope it helps her pain. God bless.
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GREETINGS BABA777,
AS A RETIRED NURSE AND A CAREGIVER, I SAY THAT YOUR MOM, AT 91, DOES NOT NEED AN SSRI TO ADD TO HER BUCKET LIST OF MEDICAL PROBLEMS. IF SHE WAS SUFFERING FROM A UTI, THEN I WOULD SAY, OF COURSE TREAT HER WITH THE APPROPRIATE ANTIBIOTIC AND FLUIDS. SINCE YOU HAVE HER POA YOU DO HAVE THE RIGHT & RESPONSIBILITY TO CONSULT WITH THE PHARMACIST.
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SORRY
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Any drug that alleviates anxiety can also help with pain. My Dh is on Zoloft for (among other things) for restless legs syndrome, anxiety, and pain. I'm pretty sure he takes it about half the time, or less.

I add my query as to why you took mom in to see a doc and then don't choose to follow the treatment. I mean, you definitely have that RIGHT, but what a waste of time.

Personally, seeing my mom's anxiety ramping up, up, up over the past year, I WISH she would get something for anxiety. But she is now a high fall risk and no dr will give her anything for pain or anxiety. At 91, it frustrates me that they will not help her out. She faked a few too many falls and that made her a 'risk' even though she truly had not 'fallen'. Geriatric patients can be hard to work with!

Go BACK to the dr or find another one. Doctors are not mind readers, and they kind of have a 'list' they run through. Many elderly patients are notorious for not being very forthcoming with their issues and the poor doc is left guessing and playing guinea pig, b/c a patient won't be truthful, or expect the doc to just 'know'. And believe me, they DON'T. 2 of my kids are Drs and they are awesome in their own fields, but have them look at a sore throat--I can dx strep better than they can. I'm definitely better at psych things than they are.
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Bronish Apr 2021
Hi Midkid!
I suggest you get rid of the Zoloft, however it's spelled.
For RLS (restless legs syndrome)....just add Nutritional Yeast to his food....he's depleted in his B vitamins.
I have RLS, and learned from Dr Eric Berg on YT, that I was low on the B's....hence, I developed RLS.
Since I've added the Nutritional Yeast to my food, I'm no longer suffering and losing sleep due to the constant need to move and shuffle my legs around to stop the incessant tickling, itching sensation, and the crawlies that keep one on the move all night, every night!
I also recommend for those elders interested in improving their overall health to give up all sugar, and bread, unless the bread is made from nut flours.
Start watching Dr Eric Berg...he's literally saving lives by teaching good nutrition, rather than just eating what tastes good....Stop the sugar and bread, and start feeling great! Add good oils like Extra-Virgin Olive Oil and Organic, Unrefined, Virgin Coconut Oil to the hot food....Good health is essential to a happier and healthier life!
And all people need to Repent of our sins, and Trust our Eternal souls to our Maker and Creator, Jesus Christ. We will live in eternity forever, but, will it be Heaven or Hell? Choose Christ for Heaven forever, and to not choose or reject Jesus guarantees Hell, Forever.
It's up to each one of us to decide our Eternal destiny.
God's love to all, and Shalom! 💜🕊💜
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SSRI for pain? I would look for a second opinion. Follow your instincts.
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You should go directly to the prescribing doctor. I am uncertain why you are unwilling to "try" something that may help your Mom. Often low dose anti-depressants help with pain and anxiety. If it isn't working, then you can ask it be withdrawn, and again, speak to the doctor. A psychologist cannot order drugs in most areas. Only a psychiatrist or MD can. Speak to the person ordering this. Let the facility where Mom lives know what she is taking and that it is new and ask them to be on the lookout for any increase in anxiety, and drowsiness or difference in gait, any falls. Tell them you are worried about a mind altering drug in an elder this old.
Wishing you good luck. If your Mom is in distress something should be done. See if you can make an appointment with her psychologist, taking your POA papers with you, and tell her you are very worried, and why.
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Yes
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Not knowing why your mother has pain and anxiety, a possible solution is palliative care. The following is from the site listed. You would contact your local Hospice for an evaluation. These are a multidiscipline team who are experts in symptom control. Good luck.

What Are Palliative Care and Hospice Care? | National Institute on Aging (nih.gov)
Who can benefit from palliative care?
Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson's disease, and many others. Palliative care can be helpful at any stage of illness and is best provided from the point of diagnosis.
In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life. Palliative care can be provided along with curative treatment and does not depend on prognosis.

A palliative care consultation team is a multidisciplinary team that works with the patient, family, and the patient's other doctors to provide medical, social, emotional, and practical support. The team is made of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains.
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Have you or your mom in your presence voiced your concern to the doctor prescribing this medication? Before simply refusing it I would recommend making sure you have a clear picture about why that particular drug is being prescribed and what he or she hopes your mother will gain from it. There are several antidepressants that are used for their side affects because they block pain receptors. That said I think it’s a valid concern that at her age trial and error with these meds seems more difficult and time consuming. It also seems like the wrong specialist if the goal is her pain relief so if indeed that is the goal along with her anxiety (which could be very interconnected) I would ask that a specialist in geriatric care/pain be consulted as well. Maybe together with the psychologist (who probably works with a psychiatrist that actually prescribes) they can come up with a plan and explain it to you and Mom so it makes sense to you. It’s also of course possible that is happening behind the scenes given the medical care is being done through her AL facility and a good discussion with her medical team, including this prescriber, will shed some light on why this drug now for you.

You and mom if she’s capable have every right to understand and agree with treatment but don’t go in with an advasrial approach, skeptical sure but start by just making it clear you want to understand the thinking, the choices and why this is the plan rather than refusing the plan right off the bat. Hopefully this will also establish a relationship that will put you in the loop from now on. Good luck!
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As POA talk to her doctor about her medical care and drug treatment. You are the one who has to help her with medication decisions now. At age 91 you would want to have pain management, but there a lot of choices for the anxiety. Sometimes assisted living facilities take the path of least resistence, but you don't have to go along with this. You can ask the pharmacy not to fill the prescription while you are discussing options with her doctor.
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If your Mom and you do not want her to take an antidepressant for anxiety and pain, fine. I get it. Thing is, SSRI drugs are the first thing docs throw to see what sticks. At 91, that could be a long guessing game to find one that might help her anxiety. But the odds are, she will still have pain while navigating side effects of (Guess)SRI meds. Then repeat until one is found that helps her anxiety. You just want peace for her, and now. Is that too much to ask?

Is it possible that she could be consuming food or drink to make anxiety worse? Coffee or wheat? Does her anxiety start a few hours after her no or low protein breakfast? The first place effected by low BS\glucose is in the brain. Some ppl get mad, some angry, foggy, tired or some anxious. I have seen a pattern in my seniors with all 3 and have seen improvements by eliminating, substituting and keeping glucose levels even as possible. Enter small protein snack ever 2 hrs or before.
And last, if the doc is not hearing either of you on this, Hospice is always an option if she qualifies. Hospice does not mean she is actively dying, but at 91 there is failure to thrive. It is never too early for HOV if someone cannot be helped by docs with their pain and anxiety. I am a huge advocate for peaceful quality of time left rather than quantity of time, months or years left. That is just what they do. And I know my suggestion of HOV is biased, I have endured anxiety & panic attacks my entire life and there is nothing more exhausting. Not to mention the years of countless ?SRI meds docs said would work for my anxiety and did not. I could have enjoyed my 20s and 30’s had I just been given an anti anxiety med. There is no reason why she should not be given the smallest dose on a PRN basis & that goes for her pain too... best wishes for your dear Mom💕
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I didn't think psychologists could write prescriptions, I thought that was only psychiatrists and M.D.s. Correct me if I'm wrong, but SSRIs are for anxiety, but maybe she would have less anxiety if her pain is relieved. You don't mention if she takes anything for the pain.
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Wow! So you ask for something for pain and then you want to refuse it? I would suggest you discuss it with a pharmacist if not the psychologist first! Some of the antidepressants have been shown to be a good pain reliever, not addictive and have the benefit of helping improve the mood of someone depressed (you might become depressed if you were in chronic pain). So I suggest that unless you have been educated on the drug by someone knowledgeable, that you don't have a negative reaction...
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