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nbme24/Block 2/Question#38

A 65-year-old man comes to the physician because of ...


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submitted by neonem(262),

This patient has major depressive disorder: loss of interest/anhedonia (need to have this or depressed mood),sleep problems, weight changes, decreased energy, thoughts of death. Meets criteria because > 2 weeks timeframe. SSRIs are first-line; paroxetine is in this category. SSRIs also help with weight gain - might be an added benefit if the patient is underweight.

The cardiac stuff might have just been a distractor, except that you probably wouldn't want to give tricyclics (i.e. amitriptyline) since they have pro-arrhythmic side effects. Patient probably has prolonged PR interval due to beta blockers.

adisdiadochokinetic  Another reason not to use TCAs (or alprazolam or haloperidol for that matter) is that the Beers criteria state to avoid the use of all of those drugs in patients over the age of 65. +