What depression therapy for the elderly can help my father?

Question

Hello doctor,

My father is 80 years old. He is a diabetic and hypertensive, both under control. He has mitral valve regurgitation and is on heart, diabetes, and blood pressure medicines. A couple of years ago, his brother passed away, and since then, his mental and physical health has been deteriorating, and he lost around 44 pounds.

One year ago, he was very depressed, and I convinced him to take the tablet Cipralex after consulting our family doctor. Still, it worsened the case, and he was admitted to the hospital with a very low heart rate due to loss of appetite. This was a turning point back then, and he got better after he left the hospital and started to eat again, and the depression almost reduced.

Unfortunately, recently, we faced some unfavorable circumstances, and he got depressed again. He sleeps all day and barely eats (around 500 to 600 calories a day). I would appreciate your help, considering he will not agree to take antidepressants.

Kindly advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

At 80, any significant life event or loss can cause depression in many individuals. As he has diabetes, hypertension, and MR, the tablet Escitalopram must be avoided due to its risk of cardiac side effects.

Tablet Sertraline would be the drug of choice for depression, considering his clinical condition. If he is ready to take the medicines, Sertraline must be the first choice. As you mentioned, he has stopped eating properly, which can worsen his electrolyte levels and cause psychosis. Try to convince him that if he does not start eating properly, he must be admitted to a hospital.

We can also consider giving him a tablet Olanzapine as his diabetes is under control. This drug is safe except for its metabolic side effects at higher doses. This drug should help him come out of his symptoms. It will relax him and reduce his depressive symptoms, too. A 5 mg dose would be enough for him. It can also be given by mixing it in food if he does not agree to take it. You can talk to his psychiatrist regarding this drug.

I hope this helps.

Thank you.