My 91 year old mother went into a rest home in january. She was upset re the move from her home. The rest home put her on 1/4 of 30 mil mirtazapine. The family noticed she was excessively tired and even lower mood. We asked if it was the medication we were told no and mum was increased to 1/2 a 30 mil tablet. She became worse and more tired and depressed and mood swings. We asked for the medication to be reviewed and we were told its not the medication and they increased it to 3/4 tablet. Now mum is crying for no reason and totally wiped out. What do you think and what can we do please?

Dr. Saranya DevanathanPsychiatrist48yrs exp

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Depression at this late years of life, is more common. Moreover, the change of environment and new faces around challenges her. What are her medical conditions? How long was she counselled to go to a rest home. Depression at this age can be treated with mirtazapine, if there are no contraindications. The dose of mirtazapine need to be increased depending on her drowsiness and other side effects, may be upto 90 mg/day. Like all antidepressants, mirtazapine also takes 2-3 weeks to start its antidepressant action. All the symptoms you have described are due to her depression and new unknown environment. Can you shift her back to her familiar home with family around - probably with a hired caretaker?  

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