Case Formulation and Treatment Plan:
Pharmacological Intervention: the pharmacological treatment ia as follows: start with Cymbalta 30 mg PO after dinner for the first week, then increase to 60 mg. Cymbalta (duloxetine) is an SNRI that has proven effective in the treatment of patients with anxiety, MDD and chronic back pain. Duloxetine demonstrated efficacy in 80% of MDD cases (Rodrigues-Amorim et al., 2020). Besides, evidence-based research demonstrates that Cymbalta is safe and well-tolerated among geriatric patients with MDD and chronic pain. The patient should also take Gabapentin 300mg PO prn Q8h for anxiety. Gabapentin is not FDA approved medication for anxiety treatment; however, growing evidence suggests that it can be a potential treatment for anxiety (Ahmed et al., 2019). Gabapentin will address both the anxiety and chronic back pain. The client is also having sleeping difficulties; thus, Trazodone 50 mg 1-2 tabs at bedtime would be recommended. Current evidence shows that Trazodone can be used in the treatment of insomnia effectively (Yi et al., 2018). However, if the symptoms fail to improve, mood stabilizers should be considered.