I wish to comment on “When Depression Treatment Goes Nowhere” by Drs. Ahsan Khan and Katherine Grimsley (Current Psychiatry, August 2005).
I’m surprised the authors did not mention Mr. D’s untreated (presumably obstructive) sleep apnea after reporting that he could not use nasal positive airway pressure because of his work schedule.
Untreated apnea symptoms overlap many of the symptoms and concepts addressed in the article. Mr. D’s eventual weight loss could have helped resolve those symptoms, at least partially.
Did the treating physicians get Mr. D involved with effective apnea treatment but just not mention it in the article? Could his brother’s motor vehicle accident have been caused by apnea-related sleepiness as well?
Kenneth N. Wiesert, MD
Indianapolis, IN
The authors respond
We appreciate Dr. Wiesert’s thoughtful comments on the role sleep apnea may have played in Mr. D’s symptoms.
Mr. D’s excessive fatigue, decreased energy and concentration, and mood symptoms could have been attributed to sleep apnea alone. Because his medical workup uncovered strikingly elevated blood glucose and poorly treated hypertension, we chose to highlight these findings.
Although we did not mention it in our article, Mr. D was urged early in treatment to maintain his continuous positive airway pressure (CPAP) regimen, and was educated on the importance of proper adherence to decrease his daytime sleepiness and other problems.
We addressed Mr. D’s noncompliance with CPAP during his care, but he recovered significantly after he began managing his diabetes and hypertension and abstaining from drug use. Further, even if Mr. D had been using his CPAP as recommended, his symptoms would have improved minimally or not at all because of his uncontrolled diabetes and hypertension.
Ahsan Y. Khan, MD
Katherine Grimsley, MD
Department of psychiatry and behavioral health
University of Kansas School of Medicine, Wichita