Anxiety and depression

A 70-year-old woman has scheduled an initial evaluation. Her medical diagnoses include hypertension, hyperglycemia, mild obesity, and hyperlipidemia. Her psychiatric diagnoses include anxiety and depression.  Her current medications are atorvastatin 20 mg daily for seven years, Ozempic 1 mg injection weekly for three years, lisinopril 10 mg daily for 10 years, and Abilify 5 mg daily for six years. Labs: Fasting Blood Glucose – 115, HbgA1C – 6.9, Total Cholesterol – 200, LDL – 100, HDL – 37. Her height is 5’2″ and her weight is 176 pounds.

Her blood pressure was 146/83 upon arrival at the office. During your interview, she explains she became depressed following the death of her husband seven years ago. She became anxious about performing everyday tasks without him present.  After starting Abilify, she gained 25 pounds and required an increased dose of atorvastatin and Ozempic.

She has been unable to lose the weight she gained and tries to closely monitor her dietary intake due to her persistently elevated glucose but reports still craving carbohydrates.  Her depression has improved slightly but she is still anxious to go out alone, so she no longer goes for daily walks to exercise.

Questions:

What advice or modifications to his treatment regimen would you recommend for your new patient? (Discuss a minimum of two). Please support your answer with research-based evidence.

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