Case 14-2008

A 78-year-old man was admitted to the inpatient psychiatry service because of anergia and anhedonia of 33 months' duration. His symptoms began shortly after he was told he needed repair of an abdominal aortic aneurysm, persisted despite multiple trials of antidepressant medications, and worsened after repair of the aneurysm. An episode of major depression had occurred at the age of 58 years after coronary-artery bypass surgery and had responded to electroconvulsive therapy. A management decision was made.