According to the case, a 42-year-old man turned to a psychiatrist with symptoms of depression, which he had already encountered earlier – 20 and 15 years ago. The patient is confident in the symptoms, denies taking illicit drugs and a recent traumatic event. His past treatment of the major depressive disorder (MDD) with imipramine helped after 4-6 weeks. However, the man wants to avoid taking this medicine, as he was disturbed by side effects – dry eyes, dry mouth, and constellation.
To create an effective treatment plan, the psychiatrist must ensure that the diagnosis is correct. According to Fulghum Bruce (2020), the symptoms that determine MDR are:
- energy loss and permanent fatigue;
- concentration disorders;
- sleep disorders – insomnia or hypersomnia;
- guilt or worthlessness;
- drastic changes in weight;
- suicidal thoughts.
Upon confirmation of the diagnosis, the specialist may prescribe drugs to improve the patient’s condition. Cipriani et al. (2018) conducted a broad study of antidepressants and their effects on adults. The study assesses the efficacy and acceptability of 21 antidepressants, which may help choose the best drug instead of imipramine. According to the results, medicines such as agomelatine, escitalopram, and vortioxetine had the best performance for both efficacy and acceptability (Cipriani et al., 2018). A psychiatrist may consider these options for prescribing to the patient.
It is crucial to evaluate rationales to prescribe antidepressants to a patient. The significance is justified by the fact that recently their appointment has become excessive (Kendrick, 2021). According to Kendrick (2021), significant rationales are:
- the inefficiency of non-pharmacological treatment as cognitive behavioral therapy;
- risk of developing more severe symptoms;
- case of recurrent depression, and the patient asks to prescribe the same medicine, which helped earlier.
Since the man asks for another medicine, the psychiatrist should focus on assessing the severity of the symptoms.
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. Focus, 16(4), 420-429. Web.
Fulghum Bruce, D. (2020). Major depression (clinical depression). WebMD. Web.
Kendrick, T. (2021). Strategies to reduce use of antidepressants. British Journal of Clinical Pharmacology, 87(1), 23-33. Web.