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Original Question

Joann is a 30yr Caucasian female who presents to your clinic for chief complaint of “I don’t feel like doing anything.” She reports that about 6 months ago she began to feel sad without a trigger. She denies history of mental health issues prior to this. Symptoms escalated to occurring nearly every day. When she is feeling sad, she will spend most of her day in bed with little desire to leave the room. She will have times of excessive sleeping but other times she will lay in bed with minimal energy. She showers 4-5 days per week and is averaging 1 meal per day when having episodes of sadness. She states, “I just can’t get anything done.” She will have times where she feels alone and if no one can help her. She has thoughts that she may be better off not alive but denies a desire to die. She reports of having times of sadness throughout her life but states “It was normal sadness when something bad happened.” When she is not having depressive episode, believes she was doing well until the episodes of sadness began. She has missed numerous days of work and is falling behind in her sales calls and other tasks. She previously enjoyed exercising, walking her dog, and going to dinner with friends. However, over the past 3 months she has not been active with this. She denies use of substances and would drink alcohol socially averaging 1 night per week. She lives alone in a studio apartment in the city and believes she has friends who are supportive, however she has not spoken to them about how she feels. She has no history of mania or hypomania symptoms. PHYSICAL: Recent weight loss of 5 pounds over the past month. She appears tired, downcast, and sad. She denies chronic issues or medications. She has no history of pregnancy. What are the core symptoms you are treating with medication? Depressed mood, anhedonia, changes in sleep, changes in appetite and weight, low energy, feelings of worthlessness or guilt Identify three possible medication interventions including all three medication names and rationale. Prozac Select a medication you would prescribe for this client; include prescription, mechanism of action, and titration plan (ex. Fluoxetine 10mg QAM – Take one capsule in the morning. Increase to 20mg in two weeks if no effect) Explain rationale for selecting medication from question 3. Include reasons for ruling out other medications identified in question 2. What patient education is needed for the identified medication? Include common side effects, monitoring, lab work, etc. she reports of feeling “good.” She will maintain work, sleep, and daily life. She currently works in sales and believes she was doing

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