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Major Depressive Disorder in the Older Adult Associated With Globus Pharyngeus and Weight Loss – An Indication for Electroconvulsive Therapy

Published:October 25, 2021DOI:https://doi.org/10.1016/j.jagp.2021.10.010

      Highlights

      • What is the primary question addressed by this study? What are is the presentation and course of major depression complicated by globus pharyngeus and weight loss in the older adult?
      • What is the main finding of this study? The complication of major depression occurring with globus pharyngeus in the older adult may be accompanied by life threatening weight loss and aspiration of oral secretions. The depression, globus pharyngeus and weight loss can be simultaneously reversed with the timely offering of electroconvulsive therapy.
      • What is the meaning of the finding? Most cases of globus pharyngeus are self-limited. However, when globus pharyngeus occurs in the setting of major depression in the older adult, then weight loss may be progressive and severe, and accompanied by life-threatening aspiration. The appearance of aspiration or marked weight loss should lead to early consideration of electroconvulsive therapy.

      Abstract

      Aspiration pneumonia and extreme weight loss are risks whenever globus pharyngeus (GP) complicates major depressive disorder (MDD) in the older adult. The timely administration of electroconvulsive therapy (ECT) may reverse GP in this context. We review cases of GP in depressed older adults and describe both successful outcomes, as well as a fatal outcome associated with delays in offering ECT. MDD in the older adult complicated by GP and marked weight loss, or repeated aspiration, should be considered an urgent indication for ECT.

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