Reference no: EM133791063

Question

62 year old with depression. Admitted to the hospital for major depressive episode. First episode at age 30 and has had periodic episodes since then lasting a few months over the fall and winter months. Hospitalized psychiatrically at age 37, 43 and 47. He had not been medicated prior to hospitalization at age 47 when he presented with depressed mood, psychomotor slowing, cognitive issues, low motivation, sleep issues, delusions of guilt and suicidal ideation. He does not smoke, use alcohol or illicit substances. He is not married and has one adult child who lives out of state. No medical or psychiatric family history. During his hospitalization, he was treated with mirtazapine, risperidone and valproic acid with only minimal improvement in depressed mood but no impact on cognitive issues, motivation issues, psychomotor slowing or suicidal ideation. Risperdal caused EPS so was switched to quetiapine with no benefit in target symptoms. Mirtazapine was switched to an SSRI with improved mood symptoms but no improvement in cognitive issues or psychomotor slowing. He then underwent ECT while only continuing with the SSRI (fluoxetine). ECT proved very effective and he was discharged to outpatient care only on fluoxetine. He presents to you with the same.