Reference no: EM133701334

Question

Mr. Jones, a 74-year-old man, was referred to a psychiatrist by his primary care provider (PCP) for evaluation of depressive symptoms that had not responded to medication trials. His wife reported that her husband had begun to change at age 71, about a year after his retirement. He had gradually stopped playing golf and poker with his friends, activities he had enjoyed "for decades." He told her that he no longer enjoyed seeing his friends and he generally refused to socialize. Instead, he sat on the couch all day, worrying about their future and finances. He denied being sad. He denied any suicidal or homicidal ideation. His wife said he was slept an average of 12 hours a day instead of his normal seven hours. He had also gained 12 pounds in the past year. His wife had become worried that retirement had left him depressed, and she had discussed her concerns with their PCP. Their PCP agreed and prescribed Mr. Jones sertraline which was titrated up to 100 mg/day for eight months. Then, extended-release venlafaxine titrated up to 150 mg/day and maintained at that level for over one year. Mr. Jones' symptoms gradually worsened during these medication trials. Thus,