Anne Morrison (she, her, hers), age 51, presents with complaints of depressed mood and low libido. She says she has become irritable and snaps easily at her four children and her wife. She has no interest in sex, no urge to masturbate, and has had no sexual intercourse for six months. She also complains of fatigue, dry hair and skin, warm flushes, and painful joints. She has no personal or family history of depression. She is not suicidal but she “really doesn’t want to live anymore if this is it.”
Anne says her wife is angry about the lack of sexual intercourse and she feels the stress in their marriage. She also is worrying about her oldest children leaving for college and about her mother’s ill health.
She scores 20 on the Beck Depression Inventory, which indicates that she has mild to moderate depression. Her menstrual periods remain regular, but her cycle has shortened from 29 to 24 days. She reports that some hot flashes wake her at night and that she hasn’t had a good night’s sleep in months.
Laboratory tests show follicle-stimulating hormone of 25 mIU/mL and inhibin B below 45 pg/mL. Her estradiol is 80 pg/mL—not yet in the menopausal range. Her thyroid-stimulating hormone is normal. Her shortened menstrual cycles suggest a diagnosis of perimenopause.
1.What referrals would you make?
Case Study: Bobby Andres, Erectile Dysfunction
Bobby Andres (he, him, his), a 48-year-old man, presents to your office with complaints of erectile dysfunction for about one year. He reports that sexual desire is present but that he has a lack of ability to achieve and maintain erection. Bobby notes that he has avoided physical affection with his wife to avoid the embarrassment of “not being able to perform.” He often falls asleep early so that he may avoid initiation of sexual contact. Bobby also states that he had a history of depression and anxiety, but his primary care doctor put him on sertraline and buspirone and that has taken care of those symptoms. He reports that he has been on those medications for two to three years.
2.Pick one medication that could be used to help Bobby. Include brand and generic names, starting dose, tapering (if applicable), contraindications, needed lab work, and patient education.
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