{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T02:13:21Z","timestamp":1778811201073,"version":"3.51.4"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,3,17]],"date-time":"2022-03-17T00:00:00Z","timestamp":1647475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Polypharmacy of psychotropic medications predisposes older adults to adverse drug events (ADEs). One contributing factor is inhibition of metabolic pathways between substrates (competitive inhibition) or between substrates and inhibitors of the same cytochrome P450 (CYP450) isoforms. The purpose of this case report is to demonstrate observed sedation and difficulty concentrating from augmentation therapy for resistant major depressive disorder (MDD) and to highlight the value of clinical tools to identify opportunities for treatment optimization to reduce ADEs. The pharmacist identified significant medication burden and competitive inhibition of drug metabolism in the CYP450 system during a telehealth medication therapy management consultation with a 69-year-old male. The pharmacist recommended clinical monitoring and communicated concerns about medication-induced sedation, difficulty concentrating, and other medication-related problems (MRP) to providers. Several recommendations were implemented which helped improved patient\u2019s outcomes. Individualizing MDD pharmacotherapy based on pharmacokinetic and pharmacodynamic drug interactions and geriatric dosage considerations may lead to better outcomes and tolerability among older adults.<\/jats:p>","DOI":"10.3390\/medicina58030438","type":"journal-article","created":{"date-parts":[[2022,3,20]],"date-time":"2022-03-20T21:34:27Z","timestamp":1647812067000},"page":"438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Mitigating the Risk of Adverse Effects Related to Augmentation Therapy for Resistant Major Depressive Disorder: A Case Report"],"prefix":"10.3390","volume":"58","author":[{"given":"Collin J.","family":"Amundson","sequence":"first","affiliation":[{"name":"Ken R. Coit College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Knight","sequence":"additional","affiliation":[{"name":"Tabula Rasa HealthCare, MedWiseRx, 100 N Stone Ave Suite 109-222, Tucson, AZ 85701, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgina M.","family":"Ybarra","sequence":"additional","affiliation":[{"name":"Tabula Rasa HealthCare, MedWiseRx, 100 N Stone Ave Suite 109-222, Tucson, AZ 85701, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7978-9280","authenticated-orcid":false,"given":"Jacques","family":"Turgeon","sequence":"additional","affiliation":[{"name":"Tabula Rasa HealthCare, Precision Pharmacotherapy Research & Development Institute, 13485 Veterans Way, Orlando, FL 32827, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4892-7879","authenticated-orcid":false,"given":"Jennifer M.","family":"Bingham","sequence":"additional","affiliation":[{"name":"Ken R. Coit College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA"},{"name":"Tabula Rasa HealthCare, Office of Translational Research & Residency Programs, 228 Strawbridge Dr, Moorestown, NJ 08057, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1111\/bcp.13590","article-title":"The relationship between frailty and polypharmacy in older people: A systematic review","volume":"84","author":"Izquierdo","year":"2018","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kirsch, I., Deacon, B.J., Huedo-Medina, T.B., Scoboria, A., Moore, T.J., and Johnson, B.T. (2008). Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. 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