Family Medicine

67 year old male presenting with memory loss

Cassandra Betts on Jan 16, 2014

His other results are pending, but you explain to MB and his daughter that the onset of depression in the elderly can be accompanied by cognitive impairment that is reversible and you wonder if this may be contributing in his recent decline. You note that this may not constitute a complete explanation, but that it is worth exploring and treating with the hope that he will improve. They would like to discuss treatment options.

What would you recommend in terms of his treatment?

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Psychotherapy
Great idea. If you believe that his depression is precipitated by a specific stressor (having lost his job, in this case), this may be a reasonable option by itself. A number of psychotherapies are reasonable, including cognitive behavioral therapy, interpersonal therapy, and supportive psychotherapy. The effect size of this option relative to medication therapy alone is similar in this age group. Overall, it’s recommended to give this a shot in conjunction with medication therapy.


An SSRI like fluoxetine
A good option. The data for the response in the elderly to antidepressants is equivocal Note though that antidepressants have been associated with an increased risk for falls in older adults.


A tricyclic antidepressant like amitriptyline
Not as good an idea, even though metanalyses have found these to be equally tolerated in older adults, they can have more worrying side effects, like arrhythmias and anticholinergic effects.


ECT
Sloooow down. ECT is worth considering, but only after our patient has failed to respond to antidepressant treatment or his condition has worsened.


His other results are pending, but you explain to MB and his daughter that the onset of depression in the elderly can be accompanied by cognitive impairment that is reversible and you wonder if this may be contributing in his recent decline. You note that this may not constitute a complete explanation, but that it is worth exploring and treating with the hope that he will improve. They would like to discuss treatment options.

What would you recommend in terms of his treatment?

Select all that apply
Expand all answers
Psychotherapy
Great idea. If you believe that his depression is precipitated by a specific stressor (having lost his job, in this case), this may be a reasonable option by itself. A number of psychotherapies are reasonable, including cognitive behavioral therapy, interpersonal therapy, and supportive psychotherapy. The effect size of this option relative to medication therapy alone is similar in this age group. Overall, it’s recommended to give this a shot in conjunction with medication therapy.


An SSRI like fluoxetine
A good option. The data for the response in the elderly to antidepressants is equivocal Note though that antidepressants have been associated with an increased risk for falls in older adults.


A tricyclic antidepressant like amitriptyline
Not as good an idea, even though metanalyses have found these to be equally tolerated in older adults, they can have more worrying side effects, like arrhythmias and anticholinergic effects.


ECT
Sloooow down. ECT is worth considering, but only after our patient has failed to respond to antidepressant treatment or his condition has worsened.


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