Case #29: The depressed man who thought he was out of options
The Case: The depressed man who thought he was out of options
The Question: Are some episodes of depression untreatable?
The Dilemma: What do you do when even ECT and MAOIs do not work?
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The Case: 55-year-old with depression not responsive to serotonergic treatment
The Question: (Pharmacogenetics, Part 2): How might psychopharmacology be delivered in the future?
The Dilemma: Can genotyping help predict successful treatment selection
· Provide the case number in the subject line of the Discussion thread.
· 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
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