Question

The man whose antidepressants stopped working.

• List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
• List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
• Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations

Answer 1

There can be various questions needed to be asked when we get to know that antidepressants have stopped working for someone. Among them, three important questions which I feel is very important and will not make the patient uncomfortable while answering are :

• For how long are you sleeping at present for a week and has there been any change in it recently?
• Has there been any change in your appetite in the past one week and how do you perceive this change?
• Do you feel some change in energy in this past one week?

These questions basically assesses the biological markers of depression and thus help in knowing the state of the patient at present.

The people who are close to the patient and are observing him daily and closely are the ones needed as informants. These people can be work colleagues, parents, spouse or children depending on the life status of the patient.

These people will be mainly asked to give a brief about what changes they observed after antidepressants started being used for the first time and do they feel that some of those changes are fading out and early symptoms of depression are coming back in the patient. Through these questions, a brief case history can be gathered and it will be easy to understand that for how long antidepressants are not working and how it is affecting the patient.

Two tests will b mostly important in this case. A physical test to check the activity of serotonin, dopamine and cortisol levels in blood is necessary as they are highly involved in the etiology of depression. A psychological test of "Beck Depression Inventory-II" can be used to assess the level of depression of the patient at present. This will help in understanding the present state of the patient correctly and will also help in planning interventions.

NOTE: We are supposed to answer only four subpart incase of multiple subpart and thus, answering the first four subpart of the lot. Incase you need answers to all subpart please do post them individually.