Treating Resistant Depression in Elders - Add or Switch Meds?

We're back!

Fun, quick episode this week.    https://pubmed.ncbi.nlm.nih.gov/33934725/   Non-fatal senior pickleball and tennis-related injuries treated in United States emergency departments, 2010-2019   Harold Weiss 1, Jacob Dougherty 2, Charles DiMaggio 3

Today's episode is a very complicated topic without clear cut benefits. Expert opinions and modeling data to address a dangerous and serious topic. Let's look at 2 sources: a new study from the Annals of Internal Medicine and an expert opinion from Uptodate.   https://www.uptodate.com/contents/selecting-adult-patients-with-lower-extremity-deep-venous-thrombosis-and-pulmonary-embolism-for-indefinite-anticoagulation?search=unprovoked%20dvt&sectionRank=1&usage_type=default&anchor=H648618&source=machineLearning&selectedTitle=1~150&display_rank=1#H648618   vs.   https://pubmed.ncbi.nlm.nih.gov/37364263/ Indefinite Anticoagulant Therapy for First Unprovoked Venous Thromboembolism : A Cost-Effectiveness Study Faizan Khan 1, Doug Coyle 2, Kednapa Thavorn 3, Sasha van Katwyk 4, Tobias Tritschler 5, Brian Hutton 6, Grégoire Le Gal 7, Marc A Rodger 8, Dean A Fergusson 9

Time restricted eating vs. caloric restriction. Is there a winner in this 1:1:1 12-month trial from Chicago?   https://pubmed.ncbi.nlm.nih.gov/37364268/ Time-Restricted Eating Without Calorie Counting for Weight Loss in a Racially Diverse Population : A Randomized Controlled Trial Shuhao Lin 1, Sofia Cienfuegos 1, Mark Ezpeleta 1, Kelsey Gabel 1, Vasiliki Pavlou 1, Andrea Mulas 1, Kaitie Chakos 1, Mara McStay 1, Jackie Wu 1, Lisa Tussing-Humphreys 2, Shaina J Alexandria 3, Julienne Sanchez 4, Terry Unterman 5, Krista A Varady 1

Talking about 2 studies released last month:   1. Giving it to 3rd trimester moms and seeing what happens in newborns: https://pubmed.ncbi.nlm.nih.gov/37018474/   2. Giving it to 60+ yo adults and seeing what happens: https://pubmed.ncbi.nlm.nih.gov/37018468/   What happens when I review these? Listen to find out!   Helpful table (Not sure if this will reproduce well or not):   NNT Vaccine Efficacy Severe LRI     first 90 d 142 81% In 6 mo 75 69% ADULTS 1428 85%       non-severe LRI     first 90 d 111 57 6mo 55 51% ADULTS 769 66%       Any URI     ADULTS 500 62%  

Hey everyone, on today's episode we are talking about a recent JAMA article on Heterogeneity in Blood Pressure Response to various blood pressure medicines and the idea of individualizing antihypertensive algorithms.   https://jamanetwork.com/journals/jama/article-abstract/2803518

Today's episode we look at a study of 60+ year olds who have poorly controlled depression.  Is it better to add on medications? Switch medications? Does it matter?    Study link: https://pubmed.ncbi.nlm.nih.gov/36867173/

Bempedoic Acid aka Nexletol has a new trial in NEJM that shows MACE reduction in very high risk patients (mostly secondary but some primary prevention).  NNT? NNH? Other trials on Bempedoic acid? Tune in and find out.    

Interesting study today that looks at High dose ICS inhalers possibly have worse outcomes in patients than medium dose ICS inhalers, leading to more exacerbations and need for antibiotics. Plausible? Let's discuss!

We take a Pre-operative study from the Annals of Surgery and talk about perioperative risk management for patients with low serum creatinine.