What can be expected as to behavior when meds are stopped?

Usually when meds are stopped, there is a good reason. The two main reasons: are side effects, for example diarrhea, stomach upset, agitation or insomnia.  If the medication was causing these side effects, typically within a few days these side effects will get better. The second main reason medications are stopped is because they are not helping or doing anything.  This can be harder to tell in Alzheimer’s particularly with behavior. In other words their can be agitation or insomnia with Alzheimer’s. Is the medicine helping those symptoms or making it worse? Sometimes it is impossible to tell. If there are not side effects, the medicine can actually be helping those symptoms, however the current medicines have limitations. They can not stop or reverse, the Alzheimer’s process, but they can slow it down. However it is really impossible to tell exactly how well the meds are working sometimes, since the disease will progress anyway, the progression varies a bit from person to person with or without meds on a day to day basis. Unfortunately over time it will always progress.

Generally speaking if at all possible, it is better to start or stop one medicine at a time. If two or more medicines are stopped at the same time, and the person improves or gets worse, it may be impossible to tell which med is doing what.

Generally speaking, one must look at trends and patterns, over a month or two after the meds are stopped, is the general sense that the behavior is better or worse. Is the person having more “bad days” as a general trend? The trends can be subtle or pronounced and sometimes it is a judgment call on the doctor and families behalf. If you can have some specific markers or target symptoms to monitor that is better. For example, shouting out, or striking out at others, or wandering at night. Did these episodes increase or decrease over the month. Are the more frequent or prolonged or more intense?

Tracking symptoms may be easy or difficult depending on ones situation.

Again this must be taken in the context of the fact that meds or no meds the disease will progress.

If someone has been on meds for awhile (like months), like Namenda or Exelon, and they are not having terrible side effects, it may be better to taper or withdraw them over a few days or a week or two, they are not addicting, however it is a little easier and smoother on the person’s system to take them away a bit more slowly. If they are withdrawn abruptly, there may be some changes in behavior for a few days or a week or two, it should not be life threatening, sometimes the person may even seem better almost immediately, or worse, this must be given a few days to a couple weeks to start tracking and gauging the general big picture.

So you should make sure you understand from your doctor, exactly why a med is to be started or stopped. Ask what they expect in the first few days and week. Remember when a med is added or increased or decreased or taken away, there are only three outcomes: better, worse or no change. With AD, given where the clinical world currently is in 2009, those outcomes can sometimes be extremely difficult to assess. Watch for trends. Understand the specific target symptoms. Good Luck and God Bless.