DEAR DR. ROACH: My elderly sister (78) is going through a traumatic experience and is very depressed. She has been on Prozac for eight months, and it is not helping. She is moderately cognitively disabled, and her doctor says the medication will not be very effective for her because she lacks the rationality to work through this crisis. (She has always lacked the ability to be logical.) She has gone through some counseling, and that has not helped either. Do you think there are different medications that could help her? — H.K.
ANSWER: I also am skeptical of the doctor’s opinion. Most research in this subject shows that people with cognitive impairment (the phrase “mentally retarded” is no longer used clinically) respond as well as people with normal cognitive ability to antidepressant use, including medications like Prozac. However, any given medication will not work for everybody, so if the Prozac hasn’t worked, it’s appropriate to try something else. Normally, a related medication, such as sertraline (Zoloft) or citalopram (Celexa), would be the next to try.
Diagnosis of depression in someone with cognitive disability usually is harder than treatment. Nondrug treatment like psychological counseling can be effective, but probably is less so with more disabled individuals. Electroconvulsive therapy is seldom used, but it can be very effective when used judiciously.
DEAR DR. ROACH: I am a middle-age male in generally good health; I don’t take any prescription medications. I have had three episodes of vertigo in the past three years, lasting from three to 12 days, including one as I write this. It sometimes can be bad enough to make me motion-sick just from staggering across a room. My doctor prescribed meclizine, which doesn’t help. It seems to happen one to 14 days after I get my yearly flu shot.