Week 2 psychiatry- prescribing tutorial case 1 Flashcards
A 25 year old woman presents with a 2 month history of low mood, loss of interest, lethargy. She is finding it increasingly difficult to cope with work, takes more than 2 hours to get to sleep and even then wakens repeatedly through the night. She denies any previous similar episodes. 4 months ago her husband left her and she has since been living alone; her parents and family are 200 miles away.
What is the likely diagnosis?
Depression
What are the three main groups of antidepressants? Name a specific example from each group. How do they differ in their mechanisms of action?
Tricyclic antidepressants
Monoamine oxidase inhibitors
SSRIs
Tricyclic antidepressants work by inhibiting the reuptake of monoamines at the presynaptic membrane
Monoamine oxidase inhibitors work by inhibiting monoamine oxidase, an enzyme which essentially recycles the neurotransmitters, causing an increased concentration of neurotransmitter in the synaptic cleft.
SSRI’s work by not allowing the reuptake of serotonin at the synaptic cleft.
How would you decide which group of antidepressants to prescribe from in this situation?
First line is SSRI’s. Also think about patients past medical history, drug history and age/gender.
What information would you give her about the medication?
Tell her the possible side effects, how long it takes to work and whether they are addictive.
She is prescribed fluoxetine, but re-attends one month later – she is no better.
The drug may not have had the time it needed to work by then. Also the dose may be too low. She may not be compliant.
What non-pharmacological treatments are there for depression?
CBT
Counselling
IPT- interpersonal therapy
Dynamic psychotherapy.
How would you consider what type of antidepressants to prescribe next?
If the other class still isn’t working, considering using a different class of drug.
When can anti-depressants be stopped?
6 months after recovery.
