Depression geri patientCOLLAPSE
Pt is a 70yr old Hispanic male who c/o depression. Pt has a hx of being teased as a kid and his mom died. Pt said he keeps to himself and has lost interest in doing anything. Pt also said that he gained 15lbs in the past 2 months and c/o poor concentration at work and insomnia. Pt has poor eye contact and constricted affect. After doing a depression assessment he scored a 51 which showed him to be severely depressed. Pt c/o back pain and stiffness in shoulders from possibly working in the warehouse but can also be a symptom of depression in geriatric patients. (Krans 2018)
Sertraline is considered a safe choice for the elderly because of its “lowest potential for drug-drug interactions based on their cytochrome P-450 interaction.” (Wiese 2011) Common side effects include erectile dysfunction which was manifested by this patient. At first I had decreased the dosage hoping that it would reduce the ED, which it did, but his depression worsened so changing his medication to Paxil seemed appropriate since it’s in the same class. Paxil also can cause sexual dysfunction so it may not be a good option long-term. Since it is a serotonin reuptake inhibitor, it also has a mild to moderate nonaderenergic effect through inhibting reuptake of norepinephrine which would help the patients issue with insomnia. (Nevels, R., Gontkovsky, S., & Williams, B. n.d.)
Follow-up and reporting signs and symptoms are helpful for successive treatment. Therapy can also be beneficial to get ideas to ideas on becoming more active.
Krans, B. (2018, September 02). Geriatric Depression (Depression in Older Adults). https;//www.healthline.com/health/depression/elderly
Wiese, B (2011, September). Geriatric depression: The use of antidepressants in the elderly. BCMJ, (53) 47, 341-347. https://bcmj.org/articles/geriatric-depression-use-antidepressants-elderly
Nevels, R.M., Gontkovsky, S.T., and Williams, B.E. (n.d.). Paroxetine-The Antidepressant from Hell? Probably Not, But Caution Required. https://pubmed.ncbi.nlm.gov/2778376/