A 42-year-old man comes to his outpatient psychiatrist with complaints of a depressed mood, which he states is identical to depressions he has experience previously. He was diagnosed with major depression for the first time 20 years ago. At that time, he was treated with imipramine, up to 150 mg/d, with good results.
During a second episode, which occurred 15 years ago, he was treated with imipramine, and once again his symptoms remitted after 4 to 6 weeks. He denies illicit drug use or any recent traumatic events.
The man states although he is sure he is experiencing another major depression, he would like to avoid imipramine this time because it produced unacceptable side effects such as dry mouth, dry eyes, and constipation.
Questions
• What is the best therapy and why?
• What are the side effects of the proposed therapy?