Case 041: Depression

PATIENT PRESENTATION

Chief Complaint

“This medication is affecting my relationship with my girlfriend.”

History of Present Illness

32-year-old male, taking sertraline 50 mg for approximately 2-weeks, is complaining of continued symptoms of major depressive disorder. His PHQ-9 today is 17.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs and symptoms of depression is the patient experiencing?

   Hint: See Table 39-1 in PPP

2. What real or potential drug therapy problems has this patient experienced?

   Hint: See Tables 39-4 and 39-5 in PPP

3. What questions do you have about his current treatment? How would you treat his depression now?

   Hint: See Figure 39-1 in PPP

4. What is the time course of response for antidepressant therapy and what is the response rate with antidepressants?

   Hint: See Treatment in PPP

5. How do you treat partial response to an antidepressant?

   Hint: See Treatment in PPP

FOLLOW-UP

If the patient continues to complain of sexual side effects with sertraline, how would you treat him?

Hint: See Treatment in PPP

CASE SUMMARY

Global Perspective

Major depressive disorder (MDD) is characterized by a minimum of 5-weeks of sadness or lack of ability to experience pleasure, in addition to at least 4 other symptoms. Those symptoms can include increased or decreased sleep, increased or decreased appetite, feelings of guilt or poor self-esteem, poor concentration, agitation or feeling slowed down, lack of interest in things usually enjoyed, or lack of energy/fatigue. The lifetime prevalence of depression is 20.6%.¹ In 2017, MDD ranked third in terms of years lived with disability (just below headache and back pain). The economic burden of depression has risen approximately 60% since 2005.¹ Although pharmacotherapy and psychotherapy can treat depression, it is often untreated, with less than 30% of individuals with depression ever receiving treatment.¹ Those less likely to receive care include males, the uninsured, African or Hispanic Americans and young adults under age 34. Only 50% of African Americans and 75% of Hispanic Americans receive treatment compared to White Americans.¹ Addressing treatment disparities including poverty, insurance status, race, ethnicity, and factors like stigma need improvement for individuals to receive the treatment they need and deserve.

Key References