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46 y old woman has decreased energy, apathy and difficulty sleeping since been fired from her jop 3 wks ago. She awakes at 4 am daily and not able to fall back asleep. She has crying spells each morning. During the past 6 month she had 3.2 kg weight loss. She has no history of serious illness and takes no medications. her father committed suicide at the age of 52. The patient is 170 cm tall and weighs 69 kg, BMI 24. Physical examination shows no abnormalities. On mental status examination, she is sad and tearful. Her speech is soft and goal directed. She has not thought about suicide and doesnot want to die. Laboratory findings including CBC, electrolytes and TSH are within reference range. What is the appropriate therapy?
a) psychodynamic psychotherapy
b) Citalopram therapy
c) Lithium carbonate therapy
d) Zolpidem therapy
e) Electroconvulsive therapy
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Citalopram ?? she had weight loss in last 6 months, means loss of job precipitated her depression.
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d/d is major depression and adjustment disorder
for major dep she has
dec energy
difficulty sleeping+early morning wakening(isomnia)
mood sad
wt loss that shows dec appetite but that is from 6 mths before being fired from job
being fired from job might be due to lack of conc (as wt loss is 6 mths back)
that fulfills five criteria needed (among all) for dep+ pt has f/h/o suicide ,ill go with ssri
she also fits for adjustment disorder,but the only point is presence of wt loss from 6 mths before she got fired.
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Junaid her weight loss is not important 3 kg in 6 months. around 500 mg per month...this does not mean depression.
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A
pt has symptoms for only 3 wks, therefore doesn't have major depression (at least 6 months)
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dream thats what i said it can be an adjustment disorder (not a grief)as symptoms need to be started within 3 mths of stressor ,but if she is not suicidal doesnt mean we can exclude depression.
lets c what others say
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sa123,A might be the ans but dep symptoms doesnt require "6 mths",
DSMIV criteria required five or more of the symptoms for "at least two weeks",one of them should be depressed mood or lost of interset.
why not A. psychodynamic therapy ( it looks like a grief) with no suicidal ideas...precipitating events clearly identified...