Mood disorders: characteristics, causes, and treatment approaches

Mood Disorders

CONSIDER THE CORE DRUG KNOWLEDGE FOR Fluoxetine (Prozac®)

Why is Rita taking fluoxetine?

Rita is currently taking Fluoxetine in response to a psychological evaluation that demonstrates Major Depressive disorder and there is also some evidence of PMDD (Premenstrual Dysphoric Disorder). Major depressive disorder as described by the multi-axial system includes the presence of a single episode of the mood disorder, Major Depressive Disorder on the Axis I table as the patient has not reported having such severe episodes prior to this time and the episode is not better explained by any other psychotic disorder nor does she exhibit signs of having mixed episodes including mania or any other psychiatric disorder. It is also clear that Rita's Major Depressive Disorder episode is linked with the melancholic features as a modifier. The criteria for this modifier, experienced by Rita include loss of pleasure in all or most activities coupled with several of the secondary qualifiers, including distinct quality of depressed mood, as this is a novel reported experience for Rita, insomnia, marked psychomotor retardation (reported sluggishness and inability to move rapidly), significant weight loss. The likely diagnosis for Rita would be Major Depressive Disorder Multiple Episode with Melancholic Features. Axis II does not apply to Rita as she does not report any marked personality disorder. Axis III is also non-applicable as she does not seem to be experiencing any underlying medical or neurological condition that could affect her outward presentation of diagnosis. Axis IV is appropriate to explore as Rita is and has experienced several life changing psychological stressors over her lifetime and is presently experiencing excessive life stressors associated with juggling work and a demanding school schedule. First she still has demonstrative feelings of loss with regard to her mother's death and the resulting placement in foster care. Her only sister is also being treated for MDD. On an Axis V code Rita would likely code between 41-50 as she is experiencing serious impairment in social and occupational functioning that has gotten worse over the last year, where she is now only attending work spottily and her school performance is seriously impaired. (APA, DSM-IV-TR, 2000, pp. 348-350)

How does fluoxetine work to address Rita's underlying pathologic condition?

Fluoxetine is a Selective Serotonin Reuptake Inhibitor, which is thought to increase the Serotonin serum available in her blood stream. Serotonin is a neurotransmitter that can be decreased in patients with MDD that effects mood and positive thought functioning.

What other antidepressant drugs could be used to treat Rita's major depressive disorder?

In this case a trial of a non-traditional antidepressant such as Wellbutrin (Bupropion), Cymbalta (Duloxetine) or Effexor (Venlafaxine) may be warranted.

Are any of these drugs contraindicated for her?

Trying almost any of the other SSRIs would be contraindicated given the persistence of insomnia and its disruptive effects on Rita's functionality.