Depression Case Study-38-Year-Old Woman

Depression Case Study-38-Year-Old Woman

The case study is of a 38-year-old woman presenting with low mood. The target symptoms that are evident in this case border around sleep, mood, cognition, and behavior. The patient notes that she has been having trouble falling asleep, wakes up early, and feels exhausted. Early awakenings, difficulty falling asleep, and restless sleep are depressive symptoms evident in the case. Symptoms bordering mood evident in the case include loss of interest in things, hopelessness, and sadness. The patient also notes behavioral manifestations as evident in excessive crying. Cognitive symptoms include slowness in activities that the patient could routinely execute and lack of concentration. The patient has also lost appetite and lost some weight.

Subjective and objective information is vital in diagnosing depression. Additional subjective data that may be valuable in this case is family history. Family history may reveal the patient’s likelihood of developing depression. Alshaya (2022) reports that individuals with a family history of depression are more likely to develop depression. Objective information that may be necessary in this regard is general appearance. Of significance to note are psychomotor retardation, tearfulness, and inattentiveness to physical appearance.

The psychiatric symptoms to be prioritized, in this case, are suicidal ideation and attempts. The patient’s past medical history revealed that she had taken 12 paracetamol tablets with wine in what appears to be an attempted suicide. Addressing suicidal attempts and ideation may minimize the patient’s chances of self-harm.

Medication Choice

The medication of choice for this patient is Fluoxetine. The patient can be started on Fluoxetine 20 mg every 24 hours. Fluoxetine is a selective serotonin reuptake inhibitor. It maintains effectiveness in alleviating depressive symptoms (Reyad et al., 2020). It was selected because it is effective in managing depression and its fairly tolerable toxicological profile. Fluoxetine acts by binding to the presynaptic serotonin receptors in the dorsal raphe nucleus. It blocks the reuptake of serotonin into the presynaptic neurons by blocking serotonin reuptake transporters (SERT) (Reyad et al., 2020). This results in sustained levels of the neurotransmitter in the brain and subsequent alleviation of depressive symptoms.

Despite its tolerable toxicological profile, monitoring may be necessary for some patient groups. ECG assessment may be necessitated in patients with a high risk for ventricular arrhythmia and QT prolongation. Glucose monitoring and liver function tests may also be necessitated in diabetics and the elderly groups. Fluoxetine is contraindicated in known hypersensitivity to Fluoxetine. Its use is also contraindicated within two weeks of discontinuing monoamine oxidase inhibitors due to the risk of serotonergic syndrome (Reyad et al., 2020). Fluoxetine should not also be used in a patient taking linezolid to avoid a serotonin crisis.

Safety Risk Assessment

Symptomatic manifestations in the patient are suggestive of depression. The patient, having a past medical history of suicidal ideation and attempts, is at risk for having suicidal ideation and tendencies. The patient should therefore be monitored closely to detect any recurrence of suicidal ideation and tendencies. Depression is a serious mental health illness with high morbidity and mortality. If left untreated, the patient may experience symptomatic exacerbation and deterioration in her quality of life (Park & Zarate, 2019). It is, therefore, important that the patient be put on therapy. Pharmacotherapy using antidepressant medications, along with other non-pharmacological interventions, may help alleviate depressive symptoms and improve the quality of life of the individual. Frequent monitoring of the patient is necessary to determine the prognosis of her disease. Bi-weekly clinical visits after the patient begins therapy may help clinicians in determining the depression prognosis of the patient.

References

Alshaya, D. S. (2022). Genetic and epigenetic factors associated with depression: An updated overview. Saudi Journal of Biological Sciences, 29(8), 103311. https://doi.org/10.1016/j.sjbs.2022.103311

Park, L. T., & Zarate, C. A. (2019). Depression in the primary care setting. New England Journal of Medicine, 380(6), 559–568. https://doi.org/10.1056/nejmcp1712493

Reyad, A. A., Plaha, K., Girgis, E., & Mishriky, R. (2020). Fluoxetine in the management of the major depressive disorder in children and adolescents: A meta-analysis of randomized controlled trials. Hospital Pharmacy, 56(5), 525–531. https://doi.org/10.1177/0018578720925384

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Review the case study in the video Psychiatric Interventions for Teaching: Depression.

Based on the case study, answer the following questions.

Identify the target symptoms/problems.

What additional subjective and objective information would you gather?

Which psychiatric symptoms are a treatment priority for this case?

Medication Choice:

List one medication that would be appropriate for this case. Include the name and starting dose.

What is your rationale for choosing this medication? What is the mechanism of action for your medication choice?

What laboratory testing/monitoring is needed for safely prescribing this medication?

Are there any contraindications or safety issues associated with this medication?

Safety Risk Assessment:

What are the safety concerns, if any, associated with this case? How will you address safety?

When would you follow up with this patient?

References:

List at least two references.