Discussion
This case illustrates the difficulties faced by clinicians with stereotyping older patients with a recognizable neurological disease. The patient’s major depressive disorder was misdiagnosed with dementia due to inadequate trial of sertraline, followed by side effects induced by paliperidone and donepezil. Unfortunately, his symptoms then appeared to be more consistent with Parkinson’s disease due to adverse side effects of his medications. Treatment with L-dopa, amantadine, memantine produced no benefit. Discontinuation of all the medications followed by the judicious use of high-dose selegiline with a precaution of tyramine free diet produced significant resolution of all his symptoms and an ability to return to “normal functioning” and enjoyment of daily life.