The patient is a 59-year-old married woman with 5 grown children She is moderately overweight (BMI 30) and was diagnosed with non-insulin-dependent diabetes 10 years ago
The patient is a 59-year-old married woman with 5 grown children
She is moderately overweight (BMI 30) and was diagnosed with non-insulin-dependent diabetes 10 years ago; she is fairly well managed on an oral hypoglycemic medication (glipizide 10 mg twice per day)
Two years ago, the patient experienced 2 tremendous stressors: her oldest child developed leukemia (now in remission), and her mother and father both passed away
She suffered a significant and impairing major depressive episode that went untreated until recently
This was her fifth episode of depression; she experienced 2 major depressive episodes as a teenager, and she developed postpartum depression and anxiety following the births of 2 of her children
Four months ago, after she was too fatigued to get out of bed, she sought treatment for the first time in her life
After receiving education and support from her clinician, she reluctantly agreed to take Paxil 30 mg/day
The patient has experienced a near-complete resolution of her symptoms in the last 6 months; however, she has developed side effects and wants to discontinue the medication
Specifically, she has increased appetite and has correspondingly gained 7 pounds in the last 4 months, with an increase in HgA1c of 1 full percentage point
She also reports excess daytime sedation and anorgasmia (very unusual for her)
What options can you offer to manage these side effects? Be specific
What education should you give the patient about stopping this medication abruptly?
What is your treatment plan?
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