DEAR DR. GOTT:
My 82-year-old mother has been diagnosed with panic disorder and anxiety. She is currently taking 100 mg of Ativan and 100 mg of Zoloft. When she takes these in the morning she is wiped out and cannot seem to function until around 6:00 at night. Could these medications be too high a dose for her? She has always been sensitive with medications, so I am wondering if by the time 6:00 comes around are the medications out of her system? Perhaps this is why she feels better later in the day. She doesn’t have a problem sleeping. She is physically healthy otherwise and does not want to nap all day. It is frustrating for the both of us.

DEAR READER:
Ativan is used to treat anxiety disorders. It is also unavailable in 100 mg tablets. At that dosage she would have to be taking 50 of the highest dosage pills (2 mg) every day. I highly doubt this is the situation. Perhaps she is taking 1 mg daily. This is something that you need to clarify in case of an emergency. Knowing proper prescription names, dosages, etc. is vital. The same holds true for her Zoloft.

Zoloft is prescribed for panic disorders and as an anti-depressant. It is available in 25, 50, and 100 mg tablets. A general initial dose would be 25 mg per day for the first week, with graduation to 50 mg following that. Periodic evaluation by a physician would determine a necessity for an increase in dosage. Therefore, your mother could certainly be (and in my opinion, most likely is) overmedicated.

Side effects from the two medications are similar. These include confusion, agitation, drowsiness, dizziness, balance/coordination problems, weakness, nausea, and changes in appetite. Ativan carries the very serious side effect of seizures and Zoloft may (usually during initial treatment) worsen depression and increase thoughts of suicide or bodily harm. Also of interest is that Zoloft can adversely interact with Ativan.

I believe now is the time to sit down with your mother’s physician and psychiatrist to explain what is going on and express your concerns that she is being over medicated. If they are unwilling to listen, perhaps it is also time to find a new psychiatrist who will re-evaluate her and hopefully reduce her medications.

To give you related information, I am sending you copies of my Health Reports “Medical Specialists” and “Mental and Emotional Illness”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).