A 41-year-old woman presents to an outpatient mental health clinic on referral by her family physician. She has complaints, signs, and symptoms indicative of a major depressive episode with melancholic features. She has undergone treatment for alcoholism within the last year. She is experiencing severe family stressors, namely, her children have moved out of the home. She is already receiving antidepressant therapy, mirtazapine, prescribed by her family physician, without improvement, and complains of weight gain as a side effect. Nondrug therapies such as psychotherapy and a support group should be initiated concurrently with alternate pharmacotherapy. Feasible drug treatment options for this patient include selective serotonin reuptake inhibitors (SSRIs), agents with mixed reuptake inhibition pharmacology, and tricyclic antidepressants (TCAs). Efficacy is determined by evaluating target signs and symptoms; standardized rating scales may also be used. It is important to question the patient about adverse effects at each visit and to encourage adherence to the prescribed therapy
Questions to be answered
Symptoms; List two pertinent signs and symptoms,
Recommended Drugs: Provide list of recommended drugs as indicated for this diagnosis,
Drug Categories and Subcategories: Identify the category of each recommended drug
Rationale: Provide rationale, clinical guidelines, or evidence for the selected drug of choice
Contraindications and/ or Risks, as appropriate: Identify contraindications and risks as appropriate
What Patients Must Understand: Identify at least three appropriate teaching points for the patient and/or family