November 27, 1991

The patient was seen for 30 minutes for medication review and follow-up. He felt he was at least holding his own, if not somewhat improved, and the suicidal thoughts had lessened slightly. Nonetheless, his affect is still markedly depressed, his verbal output minimal and marked psychomotor slowing seems to be present for a person his age. He continued his nortriptyline on a dosage of 125 mg HS, despite my understanding that he would drop to 100 mg HS because of the over-sedation. I also added 25 mg of Desiparamine two weeks ago which he has been taking. This may account for the gradual uplifting of depression but I think that a larger does of Desipramine may still be helpful and recommended he raise the morning does to 50 mg, while keeping on 125 mg of nortriptyline at night. I will see him again in two weeks.

The Cheese Man, M.D.