A 41-year-old man presents to his PCP with feelings of hopelessness, sadness, and helplessness. He says that he cries for no reason, and has difficulty sleeping. He noticed that the problems began about 6 weeks before, and he did not feel able to shrug them off. He has been drinking more alcohol than usual and has stopped going to work. When on his own, he admitted that he had thought of driving his car into the nearest canal.
Summarize the clinical case.
What is the DSM 5-TR diagnosis based on the information provided in the case?
Which pharmacological treatment would you prescribe including the name, dose, route and frequency of the drug in accordance with the clinical guidelines? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5.
our initial post should be at least 500 words, formatted and cited in the current APA style with support from at least 2 academic sources.
### Clinical Case Summary
A 41-year-old man presents to his primary care physician (PCP) with symptoms of hopelessness, sadness, and helplessness. He reports crying without an apparent reason, difficulty sleeping, increased alcohol consumption, and absenteeism from work. He has experienced these problems for about six weeks and feels unable to overcome them. The patient also admitted to having suicidal thoughts, specifically contemplating driving his car into a canal.
### DSM-5-TR Diagnosis
Based on the information provided, the patient meets the criteria for Major Depressive Disorder (MDD). According to the DSM-5-TR, MDD is diagnosed when a person experiences at least five of the following symptoms for a minimum of two weeks, which cause significant distress or impairment: depressed mood, diminished interest or pleasure in activities, weight changes, sleep disturbances, psychomotor agitation or retardation, fatigue, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicide. This patient exhibits several of these symptoms, including a depressed mood, insomnia, feelings of hopelessness, increased alcohol use, and suicidal ideation.
### Pharmacological Treatment
**Medication:** Sertraline
**Dose:** Initial dose of 50 mg per day, which can be adjusted based on response and tolerance.
**Route:** Oral
**Frequency:** Once daily
**Rationale:** Sertraline, a selective serotonin reuptake inhibitor (SSRI), is commonly prescribed for MDD due to its efficacy, safety profile, and tolerability. SSRIs increase the level of serotonin in the brain, which can help improve mood and emotional state. Sertraline is particularly suitable for patients with severe depression and suicidal thoughts due to its lower risk of overdose compared to other antidepressants.
### Non-Pharmacological Treatment
**Treatment:** Exercise program
**Rationale:** Regular physical activity has been shown to have antidepressant effects and improve mental health. Exercise can increase endorphin levels, reduce stress, improve sleep, and enhance overall well-being. An exercise regimen can serve as an adjunct to pharmacological treatment, providing holistic benefits without the side effects associated with medications.
### Treatment Assessment
**Appropriateness:** Sertraline is appropriate given the patient’s severe depressive symptoms and suicidal ideation. It is well-tolerated and effective for MDD, making it a suitable first-line treatment.
**Cost:** The cost of sertraline can vary, but generic versions are available and generally more affordable. Based on a local pharmacy search, a 30-day supply of generic sertraline (50 mg) costs approximately $10-$20. Insurance coverage and patient assistance programs can further reduce out-of-pocket expenses.
**Effectiveness:** SSRIs, including sertraline, are highly effective in treating MDD. Clinical trials have demonstrated significant improvements in depressive symptoms with sertraline treatment. It typically takes 4-6 weeks for patients to notice the full therapeutic effects, so ongoing monitoring is essential.
**Safety:** Sertraline has a favorable safety profile with common side effects such as nausea, headache, and sexual dysfunction. Serious side effects are rare but include serotonin syndrome, especially when combined with other serotonergic agents. Regular follow-up with the PCP can help manage any adverse effects.
**Patient Adherence:** Adherence to medication can be challenging but is crucial for treatment success. Factors influencing adherence include the severity of side effects, the complexity of the medication regimen, and the patient’s understanding of the treatment plan. Providing clear instructions, discussing potential side effects, and ensuring the patient feels supported can enhance adherence. The once-daily dosing of sertraline simplifies the regimen, making it easier for the patient to comply.
### Conclusion
For this patient, a comprehensive treatment plan involving both pharmacological (sertraline) and non-pharmacological (exercise) interventions is recommended. Sertraline is effective, safe, and cost-effective, with a dosing regimen that supports adherence. Incorporating an exercise program provides additional mental health benefits, contributing to the overall improvement of the patient’s condition. Regular follow-ups and supportive care are essential to monitor progress and make any necessary adjustments to the treatment plan.
### References
– American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
– Kennedy, S. H., Lam, R. W., McIntyre, R. S., Tourjman, S. V., Bhat, V., Blier, P., … & Parikh, S. V. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder. Canadian Journal of Psychiatry, 61(9), 540-560.
– Mayo Clinic. (2021). Depression (major depressive disorder) treatments. Retrieved from [Mayo Clinic](https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013).
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