In a Clinical Crossroads article published in March 2002, Kurt Kroenke,
MD, discussed the prevalence, natural history, differential diagnosis, evaluation,
and treatment of depression in older adults.1 The
patient, Mr S, had been having difficulties with depression for about 2½
years following coronary artery bypass graft surgery and subsequent complications.
About 2 years earlier, Mr S started taking venlafaxine XR (75 mg/d) with initial
improvement of his symptoms. However, even with an increase in the dose, his
depression worsened. He acknowledged a lack of energy, lack of interest in
his usual activities, social withdrawal, loss of appetite, and hypersomnia.
His symptoms improved after seeing a social worker and a further increase
in his dose of venlafaxine XR to 150 mg/d. Mr S wondered whether he could
discontinue his antidepressant medication.