What are the recommendations for a 62-year-old female with a history of depression, currently taking sertraline (Zoloft) 100mg daily, aripiprazole (Abilify) 5mg daily, and Auvelity (dextromethorphan-bupropion) 105-45mg twice a day, with well-managed depression (Patient Health Questionnaire-9 (PHQ-9) score of 3) and no anxiety (Generalized Anxiety Disorder 7-item scale (GAD-7) score of 0)?

Depression Management Assessment for 62-Year-Old Female

The patient's depression is well-controlled with her current medication regimen, as evidenced by a PHQ-9 score of 3 and GAD-7 score of 0. The current medication regimen should be maintained as it is effectively managing the patient's depression and anxiety symptoms, with continued monitoring for potential medication interactions and side effects. 1

Current Medication Assessment

Psychiatric Medications

• Sertraline 100mg daily: SSRI antidepressant with established efficacy 2
• Aripiprazole 5mg daily: Atypical antipsychotic used as adjunctive therapy for depression 3
• Auvelity (dextromethorphan-bupropion) 105-45mg twice daily: Newer combination medication for major depressive disorder 4

Medical Medications

• Benazepril: ACE inhibitor for hypertension
• Omeprazole: Proton pump inhibitor for acid reflux
• Spironolactone: Potassium-sparing diuretic
• Baby aspirin: Antiplatelet for cardiovascular protection
• Glipizide: Sulfonylurea for diabetes management

Efficacy Assessment

• PHQ-9 score of 3 indicates minimal depression symptoms 1
• GAD-7 score of 0 indicates absence of anxiety symptoms 1
• These scores suggest excellent symptom control, as scores <5 on both scales indicate minimal to no symptoms 1

Medication Interaction and Safety Considerations

Potential Concerns

• The combination of sertraline (SSRI) and Auvelity (contains bupropion) requires monitoring for serotonin syndrome, though the risk appears well-managed currently 2, 5
• Multiple serotonergic agents (sertraline and dextromethorphan component of Auvelity) increase theoretical risk of serotonin syndrome 2, 4
• Aripiprazole requires metabolic monitoring due to potential effects on glucose metabolism 6

Monitoring Recommendations

• Continue regular assessment of depression and anxiety symptoms using PHQ-9 and GAD-7 scales 1
• Monitor for signs of serotonin syndrome: mental status changes, autonomic instability, neuromuscular symptoms, or gastrointestinal symptoms 2
• Regular metabolic monitoring for patients on aripiprazole:
  • Fasting blood glucose within 1-2 months of starting aripiprazole and every 3-4 months thereafter 6
  • Consider HbA1c as alternative or supplement to fasting glucose 6
  • More vigilant monitoring for patients with diabetes (as this patient is on glipizide) 6

Follow-up Recommendations

• Continue current medication regimen as it is effectively managing symptoms 1
• Schedule follow-up visits every 3-4 months to reassess symptom control using standardized measures (PHQ-9 and GAD-7) 1
• Monitor for medication side effects at each visit, particularly:
  • Sexual dysfunction, dizziness, headache, insomnia with sertraline and Auvelity 2, 4
  • Metabolic effects with aripiprazole 6
• Annual comprehensive medication review to assess for continued need of all medications and potential for dose optimization 1

Potential Pitfalls and Considerations

• Avoid abrupt discontinuation of any psychiatric medications if changes are needed in the future, as this can lead to withdrawal symptoms 2
• Be vigilant for emergence of manic symptoms, as combination antidepressant therapy can potentially trigger mania in susceptible individuals 2
• The combination of multiple psychotropic medications increases risk of drug interactions, so any new medications should be carefully evaluated before adding to regimen 2, 5
• Consider diabetes management in medication decisions, as some psychiatric medications can affect glucose control 6