Q: My mother is 76 years old and suffering from severe anxiety disorder. She is taking Mirtaz 35. How can we as family members tackle her anxiety, which starts right from the time I wake up? I am feeling trapped and her behaviour is also causing stress on my father who is 80 years old. Some days are so frustrating and I feel that I too will go into depression if I am with her all the time. I am neglecting my husband because I stay irritable nowadays. How does one cope in such situations?

A:I can fully understand the stress that you are passing through, also keeping in mind the increasing age and various responsibilities. There are two major issues here- one is the psychiatric disorder- its management, and second is the impact on others as well as you and its management. With respect to the psychiatric disorder - there are a lot of gaps in the provided information viz; what is the subjective report of your mother, what do we witness objectively, how long does it last, are there any crying spells, is there a disturbance in sleep, appetite, does she report of feeling scared / fearful that somebody would harm her or reporting any thing bizarre. What all medications / treatment she has been tried on, for how long, which have been the best medications until now, are there any medical problems. What does the consulting psychiatrist feel? Now, obviously the best advice can come after the gaps in information are filled. Overall, if there are no contraindications there is a possibility of increasing Mirtazapine further to 45 mg/ day. There is also possibility of changing the medications if an adequate trial of mirtazapine has been given with no gains. Also, we should acknowledge in intractable cases there is a role of combination of medications, which you should be able to discuss with your psychiatrist. If it is predominantly anxiety, there can be a role of relaxation therapy, and other behavioural methods. The second issue is about caregiver stress: It is widely understood that this is a common phenomenon, and should be tackled effectively for the effective care of the patient/ client. Some of the proposed techniques are: division of labour – that times / days are fixed for family members who would take care of the needs of your mother. There are periods of timeout / and following of the routine for other family members. Although difficult, but the need is to recognize that the world and life of others have to go on in spite of the problems in one- it does not imply that one disregards the needs and requirements of the person who is ill. But simply not to be involved the whole time that one ignores the personal life and them themselves fall ill leading to major disasters. Have proper times of engagement with social life which will help again in relieving distress and not feeling guilty in having periods of entertainment like watching a movie, listening to music. This will also help in changing the stressful atmosphere of the house and distracting the ill person and be a very effective strategy overall. Review! Reorganise! Release your worries! Responsibility sharing! Relax!