A 74-Year-Old Man Is Hospitalized Due to Severe Depression and a 9-Kg

A 74-year-old man is hospitalized due to severe depression and a 9-kg (19.8-lb) weight loss over the last month.  The patient has become progressively withdrawn from friends and family, stopped attending his weekly bridge game, and refuses to leave the house to visit his children and grandchildren.  He sleeps poorly and ruminates at night about his financial situation and past events such as fighting with his brother when they were adolescents.  The patient has a history of depression and responded to treatment with a tricyclic antidepressant 30 years ago.  A recent trial of a selective serotonin reuptake inhibitor was ineffective and was discontinued.  The patient has a history of controlled hypertension and a myocardial infarction 10 years ago from which he recovered completely.  In the hospital, efforts to get him to eat and drink are unsuccessful.  On mental status examination, the patient's eyes are downcast and he gives brief, barely audible responses.  He reluctantly discloses that he has been hearing the voice of his brother, who died 15 years ago, accusing him of committing multiple crimes.  Which of the following is the most appropriate treatment for this patient?

A) Antipsychotic medication
B) Cognitive-behavioral psychotherapy
C) Electroconvulsive therapy
D) Monoamine oxidase inhibitor
E) Serotonin norepinephrine reuptake inhibitor
F) Tricyclic antidepressant

Correct Answer:

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