Dr. William Frederick Cox, MD

The short answer is that your mother's condition has undoubtedly affected your wife. I also want to convey my sympathies for your very trying situation. The caretaker role for anyone as debilitated as your mother is tremendously burdensome, but this scenario adds another dimension -- a "love triangle" of a different sort where the individual relationships between the three of you all stand to be challenged. Whether this is having a "bad" effect on your wife thus depends on each household member's point of view. In any event, all caregivers need respite, and I would encourage your wife to seek information and support through an agency (e.g., one dedicated to your mother's primary health problems, your city or county department of aging, or hospice, if your mother has been admitted to the same) or a formal individual mental health assessment with a psychiatrist or therapist.

I am sorry to learn of your mother's poor health, and empathize with the role of primary caregiver (especially an only caregiver). I highly recommend that you see a licensed mental health professional at your earliest convenience. You did not mention any of your mother's specific illnesses or how gravely ill she is, but most common (and many less common) diseases and conditions have foundations or similar organizations that offer in-person and/or on-line support groups and a wealth of information. If your mother has been admitted to hospice, their professionals are also usually very helpful, as I have learned from several of my patients as well as my own personal experience.

It sounds as if you have the "can't-shut-my-brain-off" symptoms which I see frequently in practice. You said that this delay in sleep onset is "normal" which points in the general direction of anxiety or depressive disorders though that is not by any means an exhaustive list. As with many of these other inquiries, I recommend a mental health consultation with a licensed professional. In the meantime, I can share the recommendations of sleep experts which include not laying in bed for more than about 45 minutes without falling asleep. Get out of the bedroom and move to a different location, and try to engage in a quiet but productive activity that is unlikely to provoke more anxiety (for example, clipping coupons or finishing that belated birthday card you've been promising yourself you would send). When you begin to feel ready for sleep again, return to the bedroom and try to sleep. Repeat as necessary.

I am frequently asked this question, not just about Zoloft, but with many other psychiatric medications. My standard response is designed to help my patients make an informed decision: alcohol is likewise a drug, and it acts by stimulating the brain's main inhibitory mechanisms, thus slowing down brain activity generally. When paired up with Zoloft, which functions by increasing brain activity along certain channels (serotonin, if you've done your research), the result is likely to be neutralization of antidepressant activity while the alcohol is in your system. Thus, I do not encourage drinking while taking antidepressants. I am aware, however, that many people enjoy alcohol in moderation and that a number of patients (mine and others) have consumed alcohol while taking prescription drugs with no apparent untoward effects. The ultimate decision to drink, then, rests with you--the patient.

Contact a mental health professional for an evaluation. Should you experience difficulty in finding one, your primary care provider may be able to help.

Anxiety or panic attacks are very common in people who present to urgent care centers or emergency rooms. In my experience, no actual heart problems are found in the vast majority of cases. However, if your recurrent anxiety symptoms have changed in quality or severity, especially over a short period of time, then the obvious choice is to be evaluated by your primary care provider (or cardiologist, if you have one) as soon as possible.

I suggest a mental health consultation.

I'm sorry to hear about his diagnosis. Privacy and confidentiality should be approached the same way, however, as with any other patient. Just because he's been diagnosed with AD does not automatically render him incapable of informed decision-making, and he retains privilege with respect to his medical records and information. An adult of statutory age is presumed to be competent unless ruled otherwise by a judge. You can still participate in the treatment process, however, with his permission, and you can always communicate any concerns to his treating provider(s). I have found that most patients in this type of situation are comfortable and even prefer their caregiver's presence while being evaluated or treated.