Match each clinical presentation of a patient with a depressive disorder to the most appropriate next step in clinical management.
- An 81-year-old male with severe depression who has refused all food and fluids for a week, resulting in hospitalization for acute renal failure and dehydration.Urgent electroconvulsive therapy (ECT)
- A 39-year-old female whose depressive symptoms remitted on fluoxetine, but who now requests a medication change due to persistent, distressing anorgasmia.Cross-taper to bupropion
- A 22-year-old university student prescribed citalopram for low mood three weeks ago, now brought to the emergency department for severe agitation, hyper-religiosity, and going without sleep for four days.Discontinue the antidepressant immediately
- A 48-year-old female who reports a 40 percent reduction in depressive symptoms after eight weeks of maximum-dose escitalopram, but continues to struggle with severe residual anhedonia.Augment with an atypical antipsychotic
Answer
The 81-year-old refusing food requires urgent electroconvulsive therapy. The 39-year-old with sexual dysfunction should cross-taper to bupropion. The 22-year-old with manic symptoms must have the antidepressant discontinued immediately. The 48-year-old with a partial response should be augmented with an atypical antipsychotic.
Each patient represents a critical decision point in the management of depressive disorders. Life-threatening physiological decline requires ECT, SSRI-induced sexual dysfunction is managed with bupropion, treatment-emergent mania requires stopping the antidepressant, and partial SSRI responders benefit from augmentation.
Step-by-Step Solution
Key Concept
Pharmacological and Somatic Management of Depressive Disorders and Complications