What medication is best for anxiety that happens mostly in evenings, maybe sundowning?

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What medication is best for anxiety that happens mostly in evenings, maybe sundowning?

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My mother gets anxious around dinner or thereafter. It seems that as evening is approaching or upon, us she becomes anxiety ridden, argumentative and hard to deal with period. I took her to a general practice doctor today for a follow up visit after hospitalization for Arrhythmia and told them I needed medication for her bloating after eating and anxiety in the evenings and asked if they were familiar with 'Sundowning" and they said they were.

They prescribed Prilosec for the bloating and when my sister brought home the medications the one they prescribed for anxiety was Ativan. I have personally taken Ativan before and half of one pill knocks me out cold in about 15 minutes so I cannot see that this medication could ever be the correct one for her anxiety. I do not want her groggy or chance her falling when she gets up at night to use the bathroom.

Can you all share with me the types or names of medications you have found to be helpful for anxiety/sundowning and with the fewest side effects please.

Medications Sundowner's Syndrome

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Bethmarie, I realize your post was a year ago and you may have come up with whatever you needed to help your husband. I hope so. My mother has dementia and has the same trouble with her sundowners setting in around noon and again around dinner/supper time. I noticed hers more often then not starts right after she eats. She also complains of being in pain. During my research the idea of bloating came up multiple times and I am going to ask the doctor about that possibility. I do know that pain can trigger an episode of anxiety and possibly sundowners. I also have learned that dementia patients pain can seem excessive compared to someone who does not have dementia. It's like bloating would be uncomfortable to me and I might whine about it a little but, to a dementia patient that uncomfortable feeling is like have a knife stuck in their gut. So, I have a call into the doctor to ask about this correlation and to see if there is anything we can do prior to eating to possibly prevent bloating. Beano does not work for me and I doubt that the doc will suggest that but, just thought I'd toss it in here just the same. If I can remember to come back to this page I will update with the doctors response.

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My father takes Ativan 1mg. Twice a day and it doesn’t knock him out at all but definitely makes him more calm. I think everyone is different. When he was in rehab after surgery, they gave him higher dosage in the nursing home and that did knock him out. We used trazadone as a sleep aid for a long time and realized that he became very aggressive within minutes after taking it so we tapered off from 50mg to 25mg for a few days and then stopped it. The mood swings have mostly stopped, except for some sundowners which the Ativan seems very helpful for.

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Trazodone has worked wonders for my mom. Yes, trazodone is usually used as a sleeping aid but with people with Alzheimer’s and dementia it works differently .

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My mother was given the same drug, Ativan, as well so must be common to prescribe to elders to keep them calm. I take it for sleeplessness but do not use it regularly. If your mother gets out of bed inside the 4 hour effective period, she may be groggy. I usually stay lying down when I wake up for a minute or two and collect myself first. Another option would be to research herbal remedies as I know there are some out there that other folks have used for calming without groggy side effects.

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I don't understand why my husband is having what appears to be sundowning everyday at 11:30 am and 5:30 pm. I am beside myself. He has parkimgsom with dimentia. Dr. Said maybe meds were wearing off? Carbilevdopa. However, we adjusts the dosage times and that did nothing. My husband also says when he is going through this sundowning that he is in pain. I just don't know what to do and I don't think the meds the doctor keeps throwing at us helps at all. It just create more confusion and hallucinations.

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To all of you who have mentioned Ativan: My mother, who is 91, has some dementia and multiple medical issues, was put on Ativan. She had a very bad reaction to it. Instead of it being calming, she became almost combative. She got herself out of bed and fell on the floor. She seemed to hallucinate all kinds of things. I insisted that it be stopped. The nurse at the nursing home contacted our MD, and my mother was put back on Seriquel which does seem to calm her. I would also like to thank everyone who has mentioned that Sundowning changes with the seasons. My mother has been doing very well on Seriquel but yesterday was very upset at around 6PM. She believed that my father had just died and that there was a funeral. She was crying as if she had just lost him all over again. Shortly after receiving the medication, she fell asleep. When she woke up, she ate her dinner and did not remember anything about her grief. So, once again, I agree with many others who say that all of these medications affect individuals differently. Good luck to all of the families who are watching over their elders both at home and in nursing homes. It is hard on everyone involved.

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I experienced instant sympotoms of Altzheimers from being given Lunesta or Ambien to try to kick me into a better sleep cycle. Did not work. Next day severe short term memory loss lasting 12 hours. My illness, kidney disease.
In my optinion, a rubber malet is safer.

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No,no,no to Xanax, everclear or Antivan. Note: Antivert helps prevent dizziness. I suggest asking about Clonazapam...pam NOT Klonopine. I used to work 60 hour weeks on this Rx

You can put it under the tounge for quick release if needed. You can cut it to reduce dose. Also love Melatonine, or dissolve honey in an once of hot water and add Orange Juice. Natural tranquilizer. Especially useful for former (or current drinkers) and if swings in blood sugar are complicating factors.
Antivan and Halidol are uzed in ERs because they act quickly, but they compound effects of other meds, and dosing is often too high for seniors or those with Altzheimers or dimentia.

Bringing a person back to simple and safe rules and beliefs from childhood, live in their world is very helpful. Warm Ovaltine gived sedation and nutrients. Think what helps an over tired 3year old, but dont treat an adult like a child, just use lessons learned and adapt them. (Retired MA, MS in Counseling, LPC. NBCC)

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Clonazapan is what I am taking for panic attacks but seems to leave me very groggy

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I have been taking Sertraline for many years. Anxiety began several years ago.Anxiety meds seem to make it worse

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Hi , I have OCD and panic attacks and anxiety and take Paxil and clonazapan. I have tried all the other SSRI drugs and , unfortunately/fortunately paxil is the one that works the best for me. But the side effects ain't so great. As for the clonazapan, I do think with the elderly be careful. It does work for me but it does lose its effect after awhile. But that may not be an issue with the elderly -I think more of it working too well would be the worry.

Just a thought but does your Mom(it is Mom right?) have a favorite TV show that she really enjoys? Even an oldie? You could get a DVD of it and play it as the sun sets. I would close the curtains, turn up the lights and play a favorite show. And maybe give her a hand massage or foot massage at that time. Make it a routine -something to look forward to. Maybe?

Good luck

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I also used a low dose of Clonazepam for my insomnia and anxiety, it was very helpful.

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Raven, yes it is whats prescribed by neurology instead of the black label seraquel type medications. I know its for seizures, but my Mom didnt have a seizure issue, it was just to calm her brain from go go going all the time. I talked to the daycare a few years ago and its the most common drug their clients are also on. I had a student in school on double the amount my Mom was on because of severe behavior issues/adhd. It was a lifesaver and I have finally weaned her off of it just this week finally. She hardly sleeps now, haha, its ok, I'll take it because she is calm now without it and laughs a lot. She used to nap 2 hours and sleep 12 a night, now she doesnt nap hardly and sleeps about 8 hours a night, but shes happier for sure, more of herself.

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Raven1, Look up digestive enzymes (isotonix is wonderful) that can be taken before or with a meal. Helps to digest food more thoroughly and aides absorbtion of nutrients. However, your Mom may have a gluten or wheat intolerance if she bloats up immediately. If the digestive enzymes don't help after a while, then you may have to try modifying her diet.

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A low dose antidepressant may be helpful for anxiety, I would ask the dr., I also agree with light therapy. Her anxiety will probably be worse in the winter months. I use to have terrible panic attacks through the dark winter months, I taught myself cognitive behavioral therapy, it ended my panic attacks/anxiety. Good Luck!

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Reverseroles: I am surprised about the Depakote sprinkles working for this. I personally took Depakote and Depakane and it was horrible for me but mine was to control gran mal seizures. I actually took it twice and the first time it was manageable but the second time I had such horrible panic and anxiety attacks I had to stop taking it. This medication I was told never let you go into a deep sleep so I had horrible dreams of always running and trying to either get away from something or trying to find someone in a camp that resembled a military camp with tents etc. I remember it to this day because it was the same thing every night.

I know medications do not affect everyone the same way so if this has turned out to work well for your Mom that is all that matters, if it worked well for my Mom I would love it as well.

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totally anxious the minute my feet hit the floor in the am. am taking zanax and it seems to help but I want to sleep a lot

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I never gave the Ativan to Mom because I know how it affected me. I am at a loss as what to do because we have no Primary Care Doctor, the one she had for over 25 years retired and sold his practice to an HMO. She has no Neurologist because she hated the fact that USC doctors told her she had dementia and she raised the roof so many times with tantrums that we finally gave in and stopped going. Now we are here in a bad spot needing help and have no idea where to go and it feels like the sky is falling in on me. I now think Mom needs a Gastroenterologist because she has a gallbladder problem and is in discomfort with bloating every single time she puts a bite of food in her mouth. She is miserable, so it is hurry up and wait because you have to wait for appointments with everyone and every test and it is driving me nuts! Not to mention what it is doing to her.

Captain, what is everclear? I never heard of it.

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You might want to look into Clonazepam (Klonopin). The normal dosage is 0.5 mg. However, the pills can be cut in half for a 0.25 mg dosage. I've had 2 home care clients use this medication effectively for night-time anxiety with little side effects. One of my clients uses it during the day as well when she feels anxious.

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Debralee, about ativan:
Some people tell horror stories about it, and I believe them, but that doesn't happen to everyone. Just keep it in mind if she starts getting confused or falling.

I know it is a medication that you need to taper off, or you get weird symptoms. I don't find it at all addictive.

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What's everclear? Isn't that the one that got you arrested?

By the way, If you want references to your good character for that %@#$&@ judge, just ask us!

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With older folks it is VERY tricky... I think trying to use distraction finding something she is interested in... Birds and Blooms magazines have wonderful pictures...also County magazine. Medication can be just be hard, Buspar, Risperdol and Xanax are the common ones... Be very careful, take care, Jaleyn

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My mother has been prescribed .5 mg Ativan pill by her Pulmonologist to help her get to sleep at night due to her having COPD. He told her to also take one when she became anxious during the day. What a nightmare. Her whole personality changed and she almost killed us driving while under the influence of this medication, unbeknown to me. I researched the use of Ativan and warned her about the side effects and dangers of this medication. Now she only takes it at night prior to going to sleep. She seems fine with this regiment. Her care primary physician is also aware of her on this medication. Should I be concerned with the long term effects of this medication?

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We had some success with tiny amounts of Xanax for my 92 year old MIL in the last eighteen months of her life when she had a very hard time with sundowning and general anxiety. She had always been whats often referred to as "high strung", but she went off the charts with this after her husband died and her dementia deepened. She was a very petite woman and we had to calibrate whatever medication she was given very carefully. Also, just let her set most of her agenda and pace of life for the last year. We were there to accommodate her. She didn't take much medication, and we tried to keep it minimal, but when Namenda was added to the regimen, that seemed to help a lot with the behaviors, helped calm and settle her, and she seemed less confused. The addition of most of these medications needs to be titrated carefully, and takes about 30 days to reach full effect. I wish I had known then about the depakote sprinkles. I've read a lot about them since her passing and think those might have helped more than xanax. I have heard mostly bad things about ativan. It's important to remember, too, that what merely sedates younger people can severely suppress respiratory activity, or lead to further confusion and falls in the elderly. I cannot stress enough the importance of being very watchful and closely monitoring the use of pharmaceuticals in the elderly, especially the frail very old.

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zanax and everclear. your welcome..

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I can take one tiny edge of a 2 mg melatonin to help me sleep, but my Dad was taking 20 mg sometimes several at a time. Having horrible nightmares and bad days after, would not give it up because he had read it would work. Finally he's stopped, but unfortunately it's because he sleeps just about all the time now. Like most effective things, melatonin is bad if used improperly.

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PS those medications are all similar and the cons of them are they become unsteady on their feet and are groggy in the mornings when its hard to get them up. They slow dow the body so watch out for constipation.They are also very addictive so if you continue nightly, she will probably have to be weaned off very slowly.

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I also tried melatonin but the Neurologist said never give more than 6mg to an elderly person. We ended up on Depakote Sprinkles after a year of not slepeing, and it was a life saver to us. My Mom tried to get out the doors and windows, it was awful but after a year, it ended and she became mellow again, as she is now. Ask the Dr and see what he says. I have taken Ativan to go on 2 plane rides and it never made me sleep but it did my Mom so much her face fell into her plate, Try a 1/4, then 1/2, as long as the pharmacist says you can cut it. I only get pills you can crush, no extended release of time release meds. Good Luck and dont try and reason with her, agree with everything she says! She will forget it anyway.

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Ativan is very, very scary to me...I know we can all react in different ways to any medication, but I can tell you that Ativan was an absolute nightmare for my family in regards to my Mother...she had a 'resolved TIA' according to the ER doctor, but she had been given Ativan to ease her anxiety when she was refusing to have a catheter inserted (they hurt like crazy in the elderly)...unfortunately, the Ativan did a complete number on my Mom...she went into a semi-coma from which she never recovered and she died one week to the day later. The consensus is that Ativan should never be given to an elderly patient with dementia. This also happened to an aunt of mine, so this wasn't just a question of wondering if Ativan had a negative effect, it clearly did. It's entirely possible your Mom will tolerate it just fine, but I find it very scary and wouldn't feel right not to at least tell you what happened in my own family and possibly prevent the same thing from happening to you. You can check out other people's comments by googling 'Ativan and the elderly' to see what I'm talking about. Best of luck to you!

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We had very good experience with my AD 93 year old MIL by keeping bright lights on until bedtime and giving her 10mg of Melatonin (OTC) with no side effects. However, everyone is an individual and there may be other underlying problems that a normal GP visit can't cover. I'd suggest finding a good Endocrinologist and have a thorough chemical workup/evaluation.

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What medication is best for anxiety that happens mostly in evenings, maybe sundowning?

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