A 30 year old Marsha Lansing presented reporting of daily headaches, irritability, and sadness, difficulty concentrating and getting out of bed some days, as well as having stressful home life with constant worries about family, finances, work, home and pets. A physical exam, blood work, and PHQ-9 patient depression Questionnaire was provided. Ms. Lansing physical and blood work WNL was performed to rule out other medical conditions. Ms. Lansing completed the PHQ-9 Depression and screening there were 5 in the shaded area indicating Major Depression. I provided to her a diagnosis of Major Depressive Disorder, as outlined by the DSM5 (2013). There are so many different type of treatment for depression, so it is possible you may see different physicians for different treatments. I as your Primary Care Practitioner I will prescribe you antidepressants. These medications are designed to elevate your mood and ease your sadness. It is important for you to know that it takes time for the antidepressant to have its full affect about a month. The antidepressants work with three chemicals in your brain norepinephrine, serotonin and dopamine, often with depression you might have difficulty with theses chemicals, a brain that has depression does not uptake these chemical properly. The medication helps the chemicals work properly and can improve your mood. There are several different types of antidepressants, the most common and the one that I will be prescribing is called selective serotonin reuptake inhibitors or SSRI’s. I have chosen Escitalopram (Lexapro ) 10 mg daily, to be taken at the same time each day. While we wait for a blood level of your medication, which can take a month, there are other treatments available to help you with your depression. Talking with a professional about what is happening in your life through psychotherapy. This type of therapy means you will meet with a psychiatrist, psychologist, and social worker or other trained mental health professional. They will assist you and teach you new ways to address challenges and change the way of thinking about certain situation that depression affects. Exercise has also proven as a extremely beneficial treatment along with medicine and psychotherapy. Another treatment that can ease your depression is your diet. A diet that is high in nutrients, antioxidants, and vitamins. I would also provide patient education regarding Lexapro and potential side effects according PubMed Health, U.S. national Library of Medicine (Depression 2010): severe side effects to Lexapro include allergic reactions such as skin irritation or generalized hives, swelling of the face, mouth, and extremities, a feeling of a thickened tongue, difficulty swallowing or speaking, chest tightness, difficulty breathing, a feeling of doom and gloom, restlessness, increased sweating, fever, nausea, vomiting, diarrhea, seeing or hearing things that are not there, muscle spasms, confusion or fuzzy thoughts, muscle weakness and twitching, eye pain, seeing aura around objects, increased heart rate , palpitation, or feeling a skip beat, racing thoughts, insomnia, seizure, thoughts of hurting self or others, unexplainable bleeding or bruising. These side effects must be reported to me right away and be seen at the clinic. I also would encourage Ms. Lansing to speak to me if she is experiencing less serious side effects such as dizziness, drowsiness, dry mouth, headaches, nausea , constipation, diarrhea, or sexual problems. I would further educate Ms. Lansing that Lexapro should not taken with any other MAOIs as this interaction could lead to an increased bleeding risk as well as Serotonin Syndrome that could be life-threatening. I educated Ms. Lansing the need to take Lexapro and that I would continue to monitor for side effects , and for her to plan to return to the clinic in 4 weeks to discuss the progress of the medication and treatment plan.
References
American Psychiatric Association. (2013). Diagnosis and statistical manual of mental disorders DSM-5. Washington, D. C: American Psychiatric Association.
Depression: The treatment and Management of Depression in Adults. NICE Clinical Guidelines, No. 90. National Collaborating Centre for Mental Health (UK). Leicester (UK) : British Psychological Society; 2010.
Lowe B. Kroenke K. Herzog W, Grafe K. Measuring depression outcome with a short self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affective Disorders. 2009: 78: 131-140.
Medscape (2017). Retrieved February 9, 2018. Retrieved from: http://reference.medscape.com/
