Father has psychotic depression

[illegalop691]

Hello, my father recently lost his job which he had been at for over 30 years. He is in his mid sixties. Immediately after he went into a depression over what happened and his sudden change in routines. He was taken to see a psychiatrist who put him on Zoloft. His condition over the last 2 weeks worsened and has turned into a psychotic depression. Initially he was having paranoid delusions about his former coworkers trying to frame him for things he might have done wrong in his career. All his statements were very irrational. His psychiatrist put him on a higher dose of zoloft and started him on the antipsychotic zyprexa. Though it has only been several days, his condition is only worsening, with the paranoid delusions becoming more prevalent. He is losing his sane perspective on them and starting to believe them more. I am his son and I am currently at college but I am very worried for him.

This is not the first time this has happened. It happened once over 20 years ago (before I was born) in response to a traumatic event in his life. His psychiatrist then put him on the medication Nortriptyline which helped him tremendously and he recovered in less than 2 weeks when that happened. I am starting to think Zoloft is not helping him. He requested Nortriptyline from his current psychiatrist who refused to give it to him stating some side effects in elderly individuals and also told him it usually takes 4-6 weeks for an antidepressant to take effect. I personally dont agree with this and think he should change psychiatrists because it seems illogical to not place him on a medication he was previously seen to be very responsive to. Also, I cannot find any information showing a correlation between age and severe side effects from Nortriptyline.

Anyway, I was hoping someone could give me some insight. Not only toward what to do in terms of medication and psychiatrists but also in terms of what I should be doing personally. I am not used to dealing with someone who is suffering from paranoid delusions. I don't know how I should act and what i should say. Should I try to talk with him about what he is thinking? Should I try to point out that what he is thinking is irrational? I am uncertain. Any help would greatly be appreciated, thank you!

[illegalop691]

Thanks for all these replies guys. I definitely appreciate the feedback. We changed his psychiatrist because the guy was a total ******. My sister called and spoke on behalf of my dad (he signed a form permitting her to do that) and the pscyhiatrist completely kirked out on her when she suggested Nortryptiline. He even told her she didn't know anything and he was the one with the M.d. After that my dad saw him one more time and he had the audacity to tell my dad "your daughter was very rude and completely undermined my authority" which my sister told me was not true at all...she didn't even yell at him. After that my dad started getting paranoid that the psychiatrist will tell the FBI everything that my dad had told him because he was mad at my sister.

Needless to say we dropped that guy and are seeing the psychiatrist that saw my dad 20 years ago (apparently he is still working). We are paying out of our pocket because he does not take our insurance. He has my dad back on nortryptiline. My dad had a faster heart beat than normal lately plus some chest pains when stressed out (while he was on the zoloft too) so his new psychiatrist had him spend a few nights in the hospital to get all the necessary tests which all turned out negative. So he is continuing the nortryptiline at a higher dose at home and I talked to him today and while not 100% he seemed a bit less psychotic...and hes not afraid to leave the house as much so I take that as a good sign. I can't believe how inconsiderate some psychiatrists out there can be.. Any additional insight is greatly appreciated! Thanks again to everyone who responded.

[Elizaveta]

I also say it can't hurt to have a second opinion. The bad side effects the psychiatrist is talking about are suppossed to be exceedinly rare.

[gracelyn]

i would get your dad back on the nortripyline, for most of my life i could only take the nortrypline or amtriplmine ( or elavil) don't know the other name for nortrip.

The newer ssri's do not work for me, my mom was given elavil when she was 65 she got ok and got off the drug.

the side effects they worry about are irregular heartbeat and things like that, tho this does not happen to everyone, look at all the side effects of what he is taking now, and no doubt it is making him worse, he's your dad and you do what you think  is best, you know when your dad is normal

[slattery]

I speak as someone who has had chronic depression all his adult life and one who currently takes the anti-depressant Effexor (150 mg). I'm now 60. I've not had anything as severe as what your dad is experiencing. My advice is to get him to a different psychitrist. Your point of view seems very valid to me and I believe you're correct in asserting yourself in the matter. From experience I DO know that psychologists can be VERY different from one another, not just in approach but in their apparent capabilities. Getting another opinion is always a sound approach. Since apparently, the psychiatrist has not explained in detail his reluctance to prescribe the earlier medication, he loses a bit of credibility for me. I don't know, but I'm surprised the Dr. would prescribe a simple anti-depressant for such substantial symptoms.  Good luck!

[kiry]

Two summers ago, I lived through a very similar experience with my father who is in his mid sixties.  He had a depressive episode, brought on my a heavy work load, with psychosis.  It was very frightening.  He also became suicidal.  We kept him at home and he was treated aggressively with a wide range of antidepressants.  He was on Nortrip...along with many other meds to include lithium and lexapro....not sure what else.  It did take at least 6 weeks for the psychosis to clear up.  

It was very frightening.  At one point; I showed him his diagnosis on a piece of paper...it did not seem to help.  We tried everything....the only thing that we really could do was to wait for the meds to kick in and to make sure that he was safe and that we took him to his appointments with the psychiatrist.  

He is doing great now...he is still on most of the medications, just at a lower dose and the dr. is planning on keeping him on the meds indefinitely.  


Hang in there!  My dad's recovery at an older age took much longer than it did compared to his previous episode 20 years prior.  Also, you might want to read the book Against Depression by Peter Kramer.  I found it helpful ....