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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Identify the symptoms and clinical features of major depressive disorder

  • Outline the goals of therapy for depression

  • Develop an appropriate treatment plan for a patient with depression on the basis of individual patient characteristics

  • Educate patients and caregivers on the proper use of antidepressants

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PATIENT PRESENTATION

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Chief Complaint

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"I can't keep living like this."

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History of Present Illness

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Melvin Collie is a 36-year-old male who presents to the primary care clinic for the management of his depression. He was diagnosed with major depressive disorder (MDD) by his primary care physician and is presenting for initiation of medication treatment. During the past month, he experienced a depressed mood, anhedonia, poor sleep and appetite, isolative behavior, and crying spells. In addition, he reports having a passive death wish. There have been no precipitating events and he states "I felt like this two years ago." He states that he initially took an over-the-counter medication for depression, but it did not work. He states that at that point he went to see his physician; he diagnosed him with depression and he has been taking sertraline 50 mg faithfully since then. He states that initially he felt better, but then the medication seemed to stop working and his original symptoms returned. He also states that his friend said that she gained weight on her antidepressant and that he does not want to take any medications that will make him gain weight.

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Past Medical History

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Depression diagnosed 2 years ago

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Tonsillectomy age 14 years

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Right-knee arthroscopy in 2002

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Family History

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Mother suffers from depression, and alcohol and cocaine dependence. Father died from suicide at age 57 years.

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Social History

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Thirty-six-year-old male who is divorced. Has one son in high school. Works in sales at a local business.

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Tobacco/Alcohol/Substance Abuse

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Smokes 1½ packs of cigarettes per week; recently increased alcohol intake (6–8 beers daily); no current illicit drug use, smoked marijuana in high school

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Allergies/Intolerances/Adverse Drug Events

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Penicillin (pruritus, last exposure at age 4)

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Medications (Current)

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Tramadol ER 100 mg daily for low back pain

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Centrum multivitamin one tablet PO daily

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Sertraline 50 mg PO daily

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Ibuprofen 200 mg two tablets PO as needed for pain

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Prior Medication Use

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St. John's wort 300 mg PO tid for 3 months, with no effect

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Review of Systems

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Chronic low back pain, currently using ibuprofen 200 mg two tablets as needed for pain, and tramadol ER 100 mg daily for ...

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