Treatment of depression

Question 1

Initial assessment

Answer 1

-history, mse, physical examination
-ensure investigation for hypothyroidism, MS
-ongoing psychosocial stressors, co morbid
psychiatric conditions such as anxiety, grief reaction, PTSD, Psychosis, drug & alcohol
abuse, possibly could be due to her prescribed medications, (Cardiac drugs or
corticosteroids), lack of social support, premorbid personality.

Question 2

1. titrate antidepressant

Answer 2

• titrate to recognised therapeutic dose
• assess efficacy over 4-6 weeks
• increase dose after 2 weeks

Question 3

2. try an antidepressant from a different class

Answer 3

-titrate and review

Question 4

3. If no effect, augment

Answer 4

Augmentation of
antidepressants with Lithium, Tri-iodothyronine, high dose venlafaxine, LTryptophan, Combination of SSRI with mirtazapine

Question 5

4. ensure therapy in place

Answer 5

Also try psychosocial interventions like CBT, family therapy, individual /
group psychotherapy

Question 6

5. If no response, Obtain a second opinion.

Answer 6

seek second opinion from colleague

Question 7

6. ECT treatment

Answer 7

8-10 sessions with consent or with MHA powers