What is the best course of action for managing a 61-year-old female patient's depression and anxiety on Adderall (amphetamine and dextroamphetamine) with elevated PHQ and GAD 7 scores prior to her appointment with a new psychiatrist?

Management of Adderall Refill for 61-Year-Old Female with Elevated PHQ and GAD-7 Scores

The most appropriate course of action is to provide a limited refill of Adderall to bridge the patient until her upcoming psychiatry appointment, while monitoring her anxiety and depression symptoms.

Assessment of Current Situation

Medication Considerations

• Adderall (amphetamine and dextroamphetamine) is a stimulant medication that requires careful monitoring, especially in older adults
• According to guidelines, amphetamines can potentially worsen anxiety symptoms and require special consideration in patients with elevated anxiety scores 1
• The patient reports being stable on her current medication regimen despite slightly elevated PHQ and GAD-7 scores

Risk Assessment

• At 61 years old, this patient falls into a higher risk category for stimulant side effects
• Guidelines indicate that patients aged ≥65 years (and by extension, those approaching this age) require additional caution with medications that can affect mental health symptoms 1
• Amphetamines are listed as medications that may potentially cause elevated blood pressure and require careful monitoring 1

Management Plan

Short-term Medication Management

1. Provide a limited refill of Adderall sufficient to last until the upcoming psychiatry appointment
2. Document that the patient reports stability on current medication
3. Avoid making any dose adjustments at this time, as the patient reports being stable

Monitoring Requirements

• Reassess vital signs, particularly blood pressure, as stimulants can elevate BP 1
• Document the elevated PHQ and GAD-7 scores but note patient's self-reported stability
• Consider using standardized assessment tools at follow-up visits to track symptom trends 1

Communication with New Psychiatrist

• Ensure documentation of current medication regimen, dosage, and duration of treatment
• Note the slightly elevated anxiety and depression scores for the new psychiatrist to address
• Document any side effects or concerns the patient has reported

Follow-up Plan

After Psychiatry Appointment

• Schedule a follow-up appointment after the patient sees the new psychiatrist
• Request records from the psychiatry visit to ensure continuity of care
• Be prepared to adjust management based on psychiatrist recommendations

Monitoring Parameters

• Continue to monitor PHQ and GAD-7 scores at subsequent visits
• Monitor for potential side effects of Adderall, including:
  • Cardiovascular effects (hypertension, tachycardia)
  • Worsening anxiety or mood symptoms
  • Sleep disturbances
  • Appetite changes

Important Considerations

Potential Pitfalls

• Abruptly discontinuing Adderall could lead to withdrawal symptoms and worsening of underlying conditions
• Making medication changes without psychiatric input could disrupt the patient's current stability
• Ignoring elevated PHQ and GAD-7 scores completely would be inappropriate, even though the patient reports stability

Documentation Requirements

• Document the rationale for continuing the medication until psychiatric evaluation
• Note that the patient reports stability despite slightly elevated screening scores
• Record that the plan was discussed with the patient, including the importance of keeping the upcoming psychiatry appointment

By providing a limited refill to bridge care until the psychiatric appointment while acknowledging the elevated screening scores, you maintain continuity of care while ensuring appropriate specialist follow-up for this patient's mental health needs.