A 67-year-old man experie...

A 67-year-old man experiencing chronic affective symptoms for years was sent to a geriatric psychiatry outpatient clinic. He had a sad mood, anhedonia, loss of initiative, increased appetite, worrying, catastrophizing, feelings of anxiety with heavy perspiration, trouble falling asleep, nightmares, increased need for sleep, loss of energy, and exhaustion from that point on. A worn-out man with bags under his eyes and a dulled look underwent psychiatric assessment. Higher-order cognitive processes were unaltered. He was despondent and had a flat demeanor, although he denied having suicidal thoughts. An analysis of his sleep habits showed that he fell asleep quickly. Still, it was noteworthy that he never felt fully rested when he woke up, frequently dozed off during the day, and was frequently in danger of dozing off while operating a motor vehicle. On the 30-item Inventory of Depressive Symptomatology (IDS), the patient had a score of 38, which indicates severe depression. The results of the Cambridge Examination for Mental Disorders of the Elderly/Cambridge Cognition test (CAMDEX/CAMCOG) and the Mini-Mental State Examination (MMSE) did not point to any cognitive issues (MMSE: 30/30, CAMDEX/CAMCOG: 90/120). The Epworth Sleepiness Scale result was 16/24, which indicates that the person is excessively sleepy during the day. A polysomnographic analysis of 6 hours revealed 356 apnoea and an Apnoea-Hypopnoea Index (AHI) of 57. The arterial oxygen saturation ranged from 76% to 95%. Over eight weeks, citalopram, a medication approved for depression and anxiety disorders, marginally improved his gloomy mood and decreased his anxiety symptoms. The patient agreed to cognitive behavioral therapy (CBT) to cope better with his job and boost his self-esteem.