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could my wife be over medicated?

"Hello, I am actually writing for my wife. We are 70 years old and have been married for over 50 years. My wife has struggled with depression on and off for over 20 years. She has previously been on Prozac and Effexor for depression and anxiety. In 2009 our oldest son (40) passed away. Since then her depression has gotten much worse. We move from SoCal to be nearer to our other son and grandkids 6 years ago. I had hoped that being nearer to our son and grandkids would be a source of joy for her. The grandkids help but the weather here is well known to cause depression. Our primary care physician referred her to a psychiatrist. My wife asked if she could be taken off some of her medications. At that point, the psychiatrist weened her off of Effexor but added Abilify. The Abilify didn't help as much as hoped so she added Mirtazapine. A few weeks into the Mirtazepine she got really bad anxiety and depression. Frankly, it nearly killed her. As the doctor weaned her off both Mirtazapine and Abilify. For about 4 or 5 weeks I did not leave her side as she was in so much pain from depression that she no longer wanted to live. Her doctor then suggested ECT which my wife agreed to. It took about 5 sessions before we saw any improvement. She had a total of 17 sessions of ECT. Thank god it pulled her out of not wanting to live but she is still depressed. Due to insurance requirements, we were referred to a new psychiatric nurse. We have tried a couple new medications and she is now on the highest dose allowable of Cymbalta, 60mg 2X daily. It seems to be helping lift her mood but she seems almost intoxicated. Her equilibrium is very bad but that may be a whole different issue. My concern now wondering if she is over medicated. She takes Prozac 20mg 2x daily, Buspirone 10mg 3x daily, Cymbalta 60mg 2x daily, Lorazepam .5mg 4x daily, Promethazine 25mg 3x daily, Nortriptyline 25mg 2x daily, and Gabapentin 300mg 2x daily. That's a lot of medication. Most of those are psychotropic medications which have the side effects of the same depression she is fighting. I can't help but wonder if she is just over medicated.
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Avatar universal
That depends on the person, but probably, yes.  The other problem is, some of this stuff might have been caused by the weaning off the meds -- it might have been done too quickly for her.  Everyone as a different speed that works for them, and every drug is different.  Effexor and Paxil are the hardest of them all to stop taking.  Insufficient tapering off can leave a person with protracted withdrawals, which make everything worse.  She's also at high risk of serotonin syndrome, as she's on several drugs that target it.  The snri class of meds such as Cymbalta and Effexor are very stimulating as they target not just serotonin but also norepinephrine, which is a part of adrenaline, so it's probably creating some problems for her anxiety.  But she's on a stew of uppers and downers and the array of side effects, withdrawal effects, and cross effects might very well be making this worse.  Here's how it's supposed to work:  you take a drug.  One drug.  If it works, great.  If it doesn't, you taper off it and try another, you don't add to it.  If it works but not completely, that's when you augment it with another medication.  It sounds like your wife had drugs added to that weren't working, which makes no sense when you think about it -- another drug doesn't activate the first one.  You can read about augmentation studies on the NIH website.  Your wife needs a psychopharmacologist, not a nurse of any kind, and not a general doc.  She's in a mess and only the best specialist might be able to help her clear it up some.  But know that nobody can tell you for certain whether her problems are caused by medication or the stoppage of medication or made worse by medication or the result of an intractable case of depression that meds just aren't helping so far.  This is trial and error stuff, but it does sound like a lot of errors were committed here in adding meds instead of trying other meds at some points in her treatment.  And some people can tolerate an insane amounts of meds that would kill most of us.  
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