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.