A 33-year-old lab technician presented to the emergency department to refill his anti-depressant citalopram prescription. He was very restless, pacing up and down the waiting room. He was mumbling to himself and intermittently started singing rather loudly. He was wearing bright clothes and lots of jewelry. His mother told the doctor that he used up 4 weeks’ worth of medication in 2 weeks.
When the staff nurse approached him to calm him, he started shouting and swearing loudly and became quite intimidating and threatening. He was first diagnosed with depression 5 years ago and responded well to citalopram 20 mg once a day, which was discontinued after a year. Six months ago, he became depressed once again and was started with citalopram 20 mg a day. On his last visit 2 weeks ago, he complained of poor sleep and was prescribed temazepam 10 mg nocte. He has been taking double the dose of…
