What is your primary concern with this gentleman?

A 74 year old gentleman presents to your office with a 20 year history of depression. He is accompanied by his wife of 50 years. His family is concerned because he has begun to exclude himself from routine family activities. He is a retired police office but has remained part of the community despite his multiple medical complications. Most specifically is a femoral popliteal graph with a “rubber” vein that has led to chronic venous insufficiency and more importantly chronic intractable pain. Over the years he has tried all of the SSRI’s and is currently taking Wellbutrin XL 300mg and Gabapentin 900 mg tid. He also takes a BID dose of Oxycodone but is still unable to sleep for more than 2-3 hours at a time due to his pain. He has also tried Elavil in the past without relief.

What is your primary concern with this gentleman?

Please include the following using APA format:

• Any differential diagnoses

• Your diagnosis and reasoning

• Any additional questions you would have asked

• Medication recommendations along with your rationale. Note possible side effects or issues to address if attempting to obtain consent.

• Any labs and why they may be indicated

• Screener scales or diagnostic tools that may be beneficial

• Additional resources to give (Therapy modalities, support groups, activities, etc.)