BREXPIPRAZOLE AUGMENTATION ON MIRTAZAPINE FOR TREATMENT-RESISTANT DEPRESSION IN AN ELDERLY PATIENT

Treatment-resistant depression (TRD) poses a significant clinical challenge, particularly in elderly patients, due to age-related physiological changes, comorbidities, and reduced medication tolerability. TRD is generally defined as a major depressive disorder (MDD) that fails to respond to at least two adequate antidepressant trials. In this case, a 64-year-old male with no prior psychiatric history presented with a two-month history of depressive symptoms including insomnia, weight loss, paranoid delusions, and social withdrawal. Mirtazapine was initiated with partial improvement. Following the addition of brexpiprazole, the patient demonstrated marked clinical improvement in mood, motivation, and daily functioning.This case underscores the complexity of treating TRD in elderly patients and highlights the potential synergistic effect of combining mirtazapine with brexpiprazole, The pharmacological complementarity of these agents may enhance antidepressant efficacy while minimizing adverse effects in geriatric populations.