Bonus Episode: Brief, High-Yield Psych Case. A Board Question You Can’t Miss.
Pearls and Prep · Apr 19, 2026 · 12:59
Pearls and Prep · Apr 19, 2026 · 12:59
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There are two kinds of clinicians—the ones who follow algorithms, and the ones who understand the “why.”
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This podcast episode delves into the complex case of a 68-year-old woman presenting with atrial fibrillation and new onset depression, following the recent loss of her husband. We examine the intricacies of her treatment options, particularly focusing on the selection of an appropriate antidepressant amidst her anticoagulant regimen. The discussion emphasizes the heightened risk of bleeding associated with certain selective serotonin reuptake inhibitors (SSRIs) in patients taking anticoagulants. Instead, we advocate for the use of Wellbutrin, a non-serotonergic option that not only mitigates bleeding risks but also aligns well with the patient’s specific symptoms of low energy and increased appetite. This episode serves as a critical reminder of the necessity to consider medication interactions and patient safety in clinical practice.
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Bonus Episode: Brief, High-Yield Psych Case. A Board Question You Can’t Miss.
Pearls and Prep
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A poignant exploration of the complexities surrounding the treatment of depression in an elderly patient, this episode delves into a case study involving a (mock patient) 68-year-old woman with atrial fibrillation who presents with new onset depression following the loss of her husband. The discussion begins by highlighting her current medication of Apixaban, an anticoagulant, which complicates the selection of an appropriate antidepressant due to the potential for increased bleeding risks associated with SSRIs. Through a thorough analysis, we dissect the implications of her PHQ9 score of 18, her low energy levels, and her increased appetite manifesting in binge eating. The episode meticulously examines various pharmacological options, ultimately arriving at the conclusion that Wellbutrin represents a preferable choice. This is attributed to its non-serotonergic nature, which mitigates the bleeding risk while also addressing her depressive symptoms effectively. We emphasize the necessity of considering the patient's comprehensive medical history, the pharmacodynamics of the medications involved, and the critical importance of a thoughtful approach in clinical decision-making. This case not only serves as an educational resource but also highlights the delicate interplay between mental health and chronic medical conditions in the geriatric population.
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