What could be causing the sudden onset of my father's anxiety and depression?

Kinderbrech asked...

We are at our wits end. My dad went from being a normal, healthy, functioning adult to an anxious, delusional, and depressed mess, within - and I'm not kidding - about three week's time. This was in May 2008. He has been put on Paxil, Ativan, Prozac, Wellbutrin, Risperdal, Effexor and Remeron with no relief of symptoms. In fact, he had to come off these medications to rule out Parkinson's, because he began to have those symptoms in February of 2009. He is a mess, and his primary care physician says that medically he's fine (except for the weight loss - he hardly eats).His psychiatrist said she doesn't know what else she can do for him and recommended he get an MRI. He he got an MRI and his neurologist said that his cognitive issues were due to his anxiety and depression and that he needed to visit with his PCP and psychiatrist to treat these conditions. However, he's already been that route and had to come OFF of the medications that they were trying to relieve the anxiety and depression symptoms because, as the neurologist believes, his Parkinson's symptoms were medication induced. In the meantime, my dad isn't sleeping and isn't functioning, which means it's a strain on my mom. He can't make decisions and he often refuses his medication. He was hospitalized last December in the psychiatric ward only to come out just as anxious as when he went in. What in the world do we do? From the reading I've done, it really seems like he has true Parkinson's but we are being dismissed. To top it off, he has an HMO so he is very limited where he can go. Please...anyone have any ideas? Where in the Colorado region could we take him for a second opinion that won't break the bank? His brain clearly is not working -- oh, yes, and his MRI, CT, and chest x-ray all came back clear. HELP!!!!!!!

Expert Answer

Kenneth Robbins, M.D., is a senior medical editor of Caring.com. He is board certified in psychiatry and internal medicine, has a master's in public health from the University of Michigan, and is a clinical professor of psychiatry at the University of Wisconsin-Madison. His current clinical practice focuses primarily on geriatrics. He has written and contributed to many articles and is frequently invited to speak on psychiatric topics, such as psychiatry and the law, depression, anxiety, dementia, and suicide risk and prevention.

This sounds incredibly frustrating. Your dad must be extremely uncomfortable and no one seems to know how to help him. The symptoms you describe, can be caused by a number of medical illnesses, but I am presuming with all the care he has had, the workups did not find any such illnesses. His symptoms include decreased energy, cognitive problems, insomnia, decreased appetite, difficulty making decisions, sadness, anxiety and delusions. He sounds like he is feeling hopeless and is often refusing his medications. He has been tried on at least 5 antidepressants, Paxil, Prozac, Wellbutrin, Effexor and Remeron; at least one antipsychotic medication, Risperdal; and at least one antianxiety medication, Ativan. He has been hospitalized without success and has developed symptoms of Parkinson's Disease which may be a side effect of medications. The brain scans and neurologist suggest this is not dementia, but rather all a result of a severe depression.

Unfortunately, about 20% of people with severe depressions are refractory to medications, they just don't seem to help. Sometimes the depression will go away with time, but sometimes the symptoms hang on, as seems to have happened in your dad's case. The fact the symptoms came on so suddenly, also supports a diagnosis of depression rather than dementia, because usually dementia begins gradually and the symptoms increase over time.

Given that he has failed on 5 antidepressants and he has very severe symptoms, I would suggest you and your family speak with someone about the possibility of ECT, better known as shock treatments. It sounds like a brutal thing to do, but in this day and age it is painless and incredibly effective. In fact, it is the most effective treatment we have for depression. What heppens with ECT is that an anesthesiologist puts the person to sleep, then injects a medication to paralyze the muscles. A stimulus is administered that triggers a seizure, but the person is asleep and paralyzed, so there is no pain. They wake up shortly thereafter and magically after several of these sessions the depression usually gets dramatically better. It is not without risks, but leaving him as he is sounds miserable for him and your family. I am afraid I do not know enough about Colorado to give you a specific person to see, but any psychiatrist in your area should know who could possibly provide this for your dad. You might also want to call the Colorado chapter of the Alliance for the Mentally Ill, and speak to someone there about possible recommendations. This is an organization of people who have family members with mental illnesses and they are very helpful and knowledegable. The alternative is to continue to try antidepressants, perhaps with a second medication to improve the effectiveness, but given the 5 failures, new medications trials are not likely to be the answer.