88 y/o with a history of depressive type symptoms was placed on an antidepressant to manage symptoms shortly after admission to a long term care facility.
This particular patient was trialed on Zoloft (sertraline) and then transitioned to Cymbalta (duloxetine), neither of which made a significant difference in symptoms. This patient continued to have ongoing symptoms of depression despite antidepressant therapy.
Hypothyorid symptoms can often overlap/mimic signs of depression and this is a scenario I’ve seen play out several times. What was of note, was that the patient was on chronic amiodarone for an arrhythmia. Amiodarone has many unique side effects one of which is it can affect thyroid function. It was requested that a TSH be checked to monitor for this unique side effect of amiodarone. TSH labwork was done and elevated at about 30 indicating hypothyroidism – normal range is approximately 0.5-6 depending upon the lab. Synthroid was initiated and the symptoms of “depression” started to improve allowing for discontinuation of the Cymbalta (duloxetine).
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