A 28-year-old woman presents to her primary care physician reporting a 6-week history of pervasive sadness, loss of interest in her usual hobbies, significant fatigue, and difficulty concentrating at work. She has no past medical history and takes no medications. Physical examination and initial laboratory studies, including a thyroid-stimulating hormone level, are unremarkable. The physician determines she meets the criteria for a major depressive episode and considers initiating a selective serotonin reuptake inhibitor. Which of the following is the most critical historical information to obtain before prescribing this medication?
- History of unusually elevated mood and decreased need for sleepAnswer
- BFamily history of major depressive disorder and medication response
- CRecent stressful life events or significant personal losses
- DHistory of sudden, unexpected episodes of intense fear or panic
- EPresence of concurrent over-the-counter dietary supplements
Answer
History of unusually elevated mood and decreased need for sleep
A major depressive episode is not exclusive to major depressive disorder; it also occurs in bipolar I and bipolar II disorders. Initiating an antidepressant, such as a selective serotonin reuptake inhibitor, without a concurrent mood stabilizer in a patient with bipolar disorder can precipitate a dangerous manic or hypomanic episode (a 'manic switch'). Therefore, inquiring about past periods of elevated mood, impulsivity, and a decreased need for sleep is the most critical safety screening step before prescribing any antidepressant.
Step-by-Step Solution
Key Concept
Before initiating antidepressant monotherapy for a major depressive episode, physicians must screen for a history of manic or hypomanic episodes to prevent iatrogenic precipitation of mania.