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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.

Student Work-Up

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Missing Information?

Evaluate:

Patient Database

Drug Therapy Problems

Care Plan (by Problem)

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

1. +
VA/DoD Clinical Practice Guideline. (2022). The Management of Major Depressive Disorder. Washington, DC: U.S. Government Printing Office.

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