- Joined
- Jan 11, 2012
- Messages
- 50
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Q. 63 y o WM, recently reired after working a s plumber for over 30 years with sxs of "feeling down", decreased appetite and loss of interest in previously interesting activities. Smokes, but drinks no alcohol. PMH of hypertension for which he is being treated by his primary care doctor. PE is unchanged. Which of the following is the next step in management?
A. Discuss activities that will help him enjoy his retirement
B. Order a TSH level
C. Order ECT
D. Prescribe an antidepressant.
E. Review the patient's medication history.
The correct answer is said to be E.
Explanation: Medication which control HTN such as Propranolol, an in the past Reserpine are known to occasionally lead to depressive sxs.
BUT:
This is what Uptodate has to say:
Although studies have linked other medications to depression (eg, opioid analgesics and varenicline) [79,80], much of the literature is problematic. Drug induced symptoms (eg, anorexia, fatigue, insomnia, or sedation) may have been misinterpreted as a depressive syndrome, preexisting depression misattributed to the drug, and depressive symptoms may have been the result of the disease for which the drug was prescribed [70,78].
As an example, depression has commonly been cited as a side effect of beta blockers. However, a meta-analysis of 13 randomized trials (n >15,000 patients with heart failure) compared beta blockers with placebo and found that depression occurred less often in patients who received beta blockers [81]. Additional information about depression as a spurious side effect of beta blocker therapy is discussed separately.
Personally I thought the best answer was B.
Could someone please tell me whether to take the "the antihypertensives did it" theory into account?? Or is that just plain rubbish?
A. Discuss activities that will help him enjoy his retirement
B. Order a TSH level
C. Order ECT
D. Prescribe an antidepressant.
E. Review the patient's medication history.
The correct answer is said to be E.
Explanation: Medication which control HTN such as Propranolol, an in the past Reserpine are known to occasionally lead to depressive sxs.
BUT:
This is what Uptodate has to say:
Although studies have linked other medications to depression (eg, opioid analgesics and varenicline) [79,80], much of the literature is problematic. Drug induced symptoms (eg, anorexia, fatigue, insomnia, or sedation) may have been misinterpreted as a depressive syndrome, preexisting depression misattributed to the drug, and depressive symptoms may have been the result of the disease for which the drug was prescribed [70,78].
As an example, depression has commonly been cited as a side effect of beta blockers. However, a meta-analysis of 13 randomized trials (n >15,000 patients with heart failure) compared beta blockers with placebo and found that depression occurred less often in patients who received beta blockers [81]. Additional information about depression as a spurious side effect of beta blocker therapy is discussed separately.
Personally I thought the best answer was B.
Could someone please tell me whether to take the "the antihypertensives did it" theory into account?? Or is that just plain rubbish?
