A 91 yr old woman moved to an assisted living ctr about a year ago. Staff states she is very anxious most times, often manipulative and demanding. She is presently on 20mg paroxitine 1tab q/d in am and 10mg of amitriptyline at hs. As a modest, caring retired RN I question the diagnosis of moderate to severe depression with situational anxiety r/t mid stage dementia. I propose transplantation shock as prima: - reacting to a new environment of people, smells, sounds, diet, routines not of your choosing after 40-50 yrs of independence. I have been out of medicine several years [RN & pharma rep] but both conversation and observation, coupled by a thorough family provided H&P , patient displays an intense need for interaction and acceptance by other patients. A perceived slight by another triggers days of discord, needy self pity, insomnia, etc. Would not a low dose phenothiazine [eg 10-20mg thioridazine q8rs] be a better/equally viable choice.