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Treatment-Resistant Depression in Older Adults.

Publication ,  Journal Article
Steffens, DC
Published in: N Engl J Med
February 15, 2024

A 67-year-old woman with a history of obesity, chronic low back pain, and recurrent episodes of major depression presents with mild depressive symptoms of more than 2 years’ duration, with worsening symptoms over the past 4 months. She was receiving sertraline at a stable dose of 100 mg per day until 3 months ago, when she initially presented for her worsening depressive symptoms. At that time, sertraline was tapered off, and treatment with extra-long extended-release bupropion (bupropion XL) was started at a dose of 150 mg daily and was increased to 300 mg daily 3 weeks later. Despite having taken the higher dose of bupropion XL for more than 2 months, the patient continues to have low mood, loss of interest in usual pleasurable activities, trouble falling asleep, wakefulness several times during the night, diminished energy, poor appetite, difficulty concentrating, and intrusive thoughts of being “better off dead,” but she does not have active suicidal thinking. Her nine-question Patient Health Questionnaire (PHQ-9) score is 17 (on a scale of 0 to 27, with higher scores indicating greater severity of depressive symptoms). How would you evaluate and treat this patient?

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Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

February 15, 2024

Volume

390

Issue

7

Start / End Page

630 / 639

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Humans
  • General & Internal Medicine
  • Depressive Disorder, Treatment-Resistant
  • Depression
  • Aged
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences
 

Citation

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ICMJE
MLA
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Steffens, D. C. (2024). Treatment-Resistant Depression in Older Adults. N Engl J Med, 390(7), 630–639. https://doi.org/10.1056/NEJMcp2305428
Steffens, David C. “Treatment-Resistant Depression in Older Adults.N Engl J Med 390, no. 7 (February 15, 2024): 630–39. https://doi.org/10.1056/NEJMcp2305428.
Steffens DC. Treatment-Resistant Depression in Older Adults. N Engl J Med. 2024 Feb 15;390(7):630–9.
Steffens, David C. “Treatment-Resistant Depression in Older Adults.N Engl J Med, vol. 390, no. 7, Feb. 2024, pp. 630–39. Pubmed, doi:10.1056/NEJMcp2305428.
Steffens DC. Treatment-Resistant Depression in Older Adults. N Engl J Med. 2024 Feb 15;390(7):630–639.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

February 15, 2024

Volume

390

Issue

7

Start / End Page

630 / 639

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Humans
  • General & Internal Medicine
  • Depressive Disorder, Treatment-Resistant
  • Depression
  • Aged
  • 42 Health sciences
  • 32 Biomedical and clinical sciences
  • 11 Medical and Health Sciences