Discussion Part One
Barbara is a married 39-year-old woman with no children, smokes 1 pack/day, and weighs 180 pounds who has scheduled an appointment with you to discuss feelings of anhedonia that she has been experiencing for the past few months. She has a history of depression as a teenager, but has not needed or received therapy for ~20 years. At the appointment, she relays that she has been experiencing chronic fatigue/loss of energy, feelings of worthlessness, appetite disturbances, weight gain, inability to concentrate, psychomotor disturbances, and insomnia.
Please provide a list of differential diagnoses, as well as an indication of your primary diagnosis.
Once this has been completed, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.
Discussion Part Two (graded)
Monitoring for efficacy and toxicity of the current drug regimen you prescribed in Part One
Subsequent steps if this patient did not have an adequate response?
Assume you had her on a common, selective serotonin reuptake inhibitor for several months without great response. Explain why the SSRI should be slowly discontinued prior to starting bupropion in Part Three.
Discussion Part Three
You decide to begin the patient on bupropion.
At what dose should she be started on bupropion, and how does bupropion differ from other commonly prescribed antidepressants, such as fluoxetine, venlafaxine, and nortriptyline?
Why would this be the best option for this patient given her symptoms and lifestyle? In your answer, be sure to compare and contrast bupropion with each medication mentioned above (fluoxetine, venlafaxine, and nortriptyline).