Interactive Case Study /Depression


After reviewing the case study: Antidepressant therapy/Psychotherapy Treatment Prescribed:

Pt returns to the clinic in 2 weeks. He says that he is still feeling   sad, still has decreased motivation, and feels that things are getting worse.
 1. What additional questions do you have now? 

2. Has the diagnosis of depression changed?

 3. What medications would you recommend and why? 

Identify one research or evidence-based practice article to support responses and include in citation/reference. Include a link if possible.
 
(1)
The psychiatrist needs to know early psychiatric treatments and diagnoses, encompassing illness onset and development, psychiatric hospitalization, and also curing for substance use disorders.   Moreover, the psychiatrist should ask for the patient’s family history of mental disorder, as well as how they responded to psychiatric medications, and current psychiatric medication.
(2)
The diagnosis for depression has not changed. However, it seems that the previous prescription for psychiatric medication was not effective for the patient. The effectiveness of antidepressants is not the same. For that reason, the patient needs alternative psychiatric medication. Normally, the initial prescription for depression consists of antidepressant use and psychotherapy. Studies indicate that the combination of antidepressant use and psychotherapy is effective than using either psychotherapy or antidepressant alone (Patrick et al., 2009). Scholars argue that the ideal treatment for depression is one with a low side-effect profile and a high degree of effectiveness (Patrick et al., 2009). There are limited studies that provide the effectiveness of one antidepressant over the other. Early meta-analyses failed to provide important differences in either acceptability and efficacy among several antidepressants. Therefore, psychiatrists make decisions on initial monotherapy treatment according to the cost and side-effects of antidepressants. Contrary to early meta-analyses, the meta-analysis of Patrick, Combs, and Gavagan provide different evidence (2009). They assessed six psychiatric drugs such as sertraline, paroxetine, fluoxetine, duloxetine, and escitalopram. They found out that escitalopram and sertraline were most acceptable and effective in the meta-analysis of Cipriani. Escitalopram and sertraline accounted for 14.5% and 11.8%, respectively (Patrick et al., 2009).  
(3)
Based on the patient’s symptoms, previous psychiatric medication and literature, the use of escitalopram and sertraline antidepressants will be most effective for the treatment of a patient’s condition. Studies reveal that these two antidepressant drugs are effective for an initial psychiatric prescription (Patrick et al., 2009).

References
Patrick, G., Combs, G., & Gavagan, T. (2009). Initiating antidepressant therapy? Try these 2 drugs first. 367_JFPO709, Vol. 58, no. 7, 365-369. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183928/.



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