A 70-year-old man, recently widowed, reports insomnia and crying but no suicidal ideation. What is the best initial management approach?

A 70-year-old man, recently widowed, reports insomnia and crying but no suicidal ideation. What is the best initial management approach?

• A. Start an SSRI
• B. Admit to hospital
• C. Schedule follow-up appointments to monitor mood
• D. Electroconvulsive therapy

Answer: (C)

After a bereavement, it’s important to distinguish normal grief from a depressive disorder. In normal grief, mood and sleep can be affected, but there isn’t persistent impairment or thoughts of self-harm. The right first move is to provide support and closely monitor how the person’s mood evolves over time. In this scenario, the man is recently widowed and reports insomnia and crying but has no suicidal thoughts. He does not appear severely impaired or acutely unsafe, so the best initial plan is to schedule follow-up visits to monitor mood and functioning. This keeps the door open to intervene promptly if symptoms persist or worsen, indicating major depressive disorder or a complicated grief reaction. Starting an antidepressant now isn’t warranted without clear evidence of a persistent depressive disorder, and sleep disturbance often improves with time and supportive care in bereavement. Hospital admission or electroconvulsive therapy would be excessive unless there were suicidality, severe functional impairment, or treatment-resistant depression. If symptoms endure beyond a couple of months, or if there’s significant impairment or anhedonia, then more active treatment with psychotherapy and possibly antidepressants can be considered.

After a bereavement, it’s important to distinguish normal grief from a depressive disorder. In normal grief, mood and sleep can be affected, but there isn’t persistent impairment or thoughts of self-harm. The right first move is to provide support and closely monitor how the person’s mood evolves over time.

In this scenario, the man is recently widowed and reports insomnia and crying but has no suicidal thoughts. He does not appear severely impaired or acutely unsafe, so the best initial plan is to schedule follow-up visits to monitor mood and functioning. This keeps the door open to intervene promptly if symptoms persist or worsen, indicating major depressive disorder or a complicated grief reaction.

Starting an antidepressant now isn’t warranted without clear evidence of a persistent depressive disorder, and sleep disturbance often improves with time and supportive care in bereavement. Hospital admission or electroconvulsive therapy would be excessive unless there were suicidality, severe functional impairment, or treatment-resistant depression. If symptoms endure beyond a couple of months, or if there’s significant impairment or anhedonia, then more active treatment with psychotherapy and possibly antidepressants can be considered.