Primary Care Clinical Case
Clinical Case Summary
A 41-year-old man presents to his primary care physician (PCP) with feelings of hopelessness, sadness, and helplessness. He reports crying without reason, difficulty sleeping, increased alcohol consumption, and absenteeism from work. These symptoms began about six weeks ago and have progressively worsened. Additionally, he admitted to having suicidal thoughts, specifically considering driving his car into a canal.
DSM-5-TR Diagnosis
Based on the symptoms and their duration, the man likely meets the criteria for Major Depressive Disorder (MDD) according to the DSM-5-TR. The key symptoms include:
– Depressed mood most of the day, nearly every day.
– Markedly diminished interest or pleasure in almost all activities.
– Insomnia or hypersomnia.
– Feelings of worthlessness or excessive guilt.
– Recurrent thoughts of death or suicidal ideation.
Primary Care Clinical Case
Pharmacological Treatment
Medication: Sertraline (Zoloft)
Dose: Initial dose of 50 mg
Route: Oral
Frequency: Once daily
Rationale: Sertraline is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for MDD. It is chosen due to its efficacy in alleviating depressive symptoms and relatively favorable side effect profile. Starting with 50 mg allows the patient to adjust to the medication, with the potential to increase the dose if necessary based on the patient’s response and tolerance.
Non-Pharmacological Treatment
Treatment: Lifestyle Modifications
Rationale: Non-pharmacological interventions like regular exercise, a balanced diet, and proper sleep hygiene are crucial in managing depression. Exercise, in particular, has been shown to improve mood by increasing endorphins and enhancing overall physical health. Encouraging the patient to establish a routine can help in mitigating some symptoms of depression.
Primary Care Clinical Case
Assessment of the Treatment’s Appropriateness
Appropriateness: Sertraline is appropriate given the patient’s symptoms and the first-line treatment status of SSRIs for MDD. It addresses the chemical imbalances in the brain that contribute to depression.
Cost: A generic version of Sertraline can be very cost-effective. At a local pharmacy, a 30-day supply of 50 mg tablets costs approximately $4 to $10.
Effectiveness: SSRIs like Sertraline are effective in treating MDD, with many patients experiencing improvement within 4 to 6 weeks. Regular follow-up is necessary to monitor the effectiveness and adjust the dose as needed.
Safety: Sertraline has a well-documented safety profile. Common side effects include nausea, headache, and insomnia, which often diminish over time. It has a lower risk of overdose compared to tricyclic antidepressants and is generally safe for long-term use.
Patient Adherence: Adherence is likely given the once-daily dosing and the relatively mild side effects. Educating the patient on the importance of taking the medication as prescribed and discussing potential side effects can enhance adherence.
Cost-Effectiveness
Sertraline, particularly the generic form, is cost-effective. Many insurance plans cover it, and it’s available at a low cost in most pharmacies. For a patient without insurance, the cost remains manageable. According to GoodRx, a 30-day supply of generic Sertraline 50 mg tablets costs between $4 to $10 at major pharmacies.
Primary Care Clinical Case
Local Pharmacy Cost Research
A local pharmacy reports that a 30-day supply of Sertraline (50 mg) costs around $10 without insurance. The price may vary slightly depending on the pharmacy and available discounts.
Conclusion
The 41-year-old patient is diagnosed with Major Depressive Disorder based on his symptoms and their duration. Sertraline is recommended as the pharmacological treatment due to its efficacy, safety, and cost-effectiveness. Non-pharmacological treatments, including lifestyle modifications, support the overall treatment plan by addressing physical and mental health. The proposed treatment plan considers the appropriateness, cost, effectiveness, safety, and potential for patient adherence, ensuring comprehensive care for the patient. APA.
References
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Gelenberg, A. J., Freeman, M. P., Markowitz, J. C., Rosenbaum, J. F., Thase, M. E., Trivedi, M. H., … & Reus, V. I. (2019). Practice guideline for the treatment of patients with major depressive disorder. American Psychiatric Association.
- Thase, M. E., Mahableshwarkar, A. R., Dragheim, M., Loft, H., & Vieta, E. (2020). A meta-analysis of randomized controlled trials of vortioxetine for the treatment of major depressive disorder in adults. European Neuropsychopharmacology, 31, 150-161.
- Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., van Straten, A., & Ebert, D. D. (2019). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. Journal of Affective Disorders, 240, 138-148.
- GoodRx. (2023). Sertraline Prices, Coupons & Savings Tips. Retrieved from https://www.goodrx.com/sertraline
