This case study focuses on a 70-year-old Hispanic male named Pt who presents with symptoms of depression. Pt shares a history of being teased as a child and the loss of his mother. He describes feeling withdrawn and uninterested in activities, along with experiencing weight gain, poor concentration, and insomnia. Additional physical symptoms of back pain and stiffness in the shoulders are also present. The depression assessment reveals a severe level of depression, with a score of 51.
Given Pt’s age, it is crucial to consider the safety and potential interactions of any medication prescribed. The author mentions that sertraline is considered a safe choice for the elderly due to its low potential for drug-drug interactions based on cytochrome P-450 interaction. Sertraline belongs to a class of medications known as selective serotonin reuptake inhibitors (SSRIs). These medications work by increasing the availability of serotonin in the brain, which can help improve mood.
However, an unfortunate side effect of sertraline is erectile dysfunction, which Pt experiences. In an attempt to manage this side effect, the author decreased the dosage of sertraline, resulting in a reduction of erectile dysfunction symptoms. However, this reduction in dosage led to a worsening of Pt’s depression. Therefore, the decision to switch Pt’s medication to Paxil, also an SSRI, is made.
It is important to note that Paxil, like sertraline, can also cause sexual dysfunction. This potential side effect may not make it an ideal long-term option for Pt. However, Paxil has an additional benefit in that it has a mild to moderate nonadrenergic effect by inhibiting the reuptake of norepinephrine. This effect can help address Pt’s insomnia, a symptom he reports experiencing.
Follow-up and close monitoring of Pt’s signs and symptoms are vital for successful treatment. Therapy is also recommended as a beneficial intervention to assist Pt in generating ideas to become more active. Therapy can support Pt in exploring ways to engage in activities that may reduce symptoms of depression and improve overall well-being.
In conclusion, this case study highlights the challenges of treating geriatric depression. It emphasizes the importance of considering the safety and potential interactions of medications when prescribing for elderly patients. The choice to switch Pt’s medication from sertraline to Paxil is made based on potential benefits and side effects of each medication. Close monitoring, follow-up, and therapy are recommended to support Pt’s treatment and overall well-being.
