Case 1

summary
• 42 y o man complaints of a depressed mood
• History of diagnosed major depression 20 years ago and 15 years ago
• History of takes imipramine 150 mg/day
• He would like to avoid imipramine because side effect : dry mouth,
dry eyes, and constipation

Best therapy : SSRI (sertraline, fluoxetine, citalopram)

Side effect : GI tract symptom, sedation, sexual dysfunction
 Risk factor
• age
• gender
• Genetics (history of parent with depression)
 Most likely diagnosis
• Recurrent depression now major depression with no psychotic figure
Cause its already the third time he experiencing depressed mood, and already
diagnosed with major depression, but without suicidal thinking.
 DD
• Schizoaffective depression type - (congruent)
• GAB Disorder – (no history of mania)
• Because the patient is old (AD) >> MMSE, Geriatric Depression Scale
 Symptom
• Anhedonia
• Anenergya
• Affect depressed

SIGECAPS
• Sleep changes
• Interest
• Guilt
• Energy
• Concentration
• Appetite changes
• Psychomotor agitation or retardation
• Suicidal ideation
 Diagnosis criteria
• Major symptom : affect depressive, anhedonia, anergya
• Minor symptom :
• decreased concetration and attention
• Loss of confidence
• Waham nihilistic
• Thinking about bad or no future
• Sleep change
• Suicidal attempt
• Appetite changes
• For 2 weeks minimum
• 3 major criteria and min 4 minor criteria
 Treatment
Anti Depressant drugs start slow go slow
• Step 1 = SSRI (sertraline >zoloft 50-150mg/d or fluoxetine >prozac 10-40mg/d)
• Step 2 = TCA (amitryptiline 75-300mg/d), SNRI (venlaflaxine)
• Step 3 = atypical (trazodone), MAOI (moblobemide)

Psychotherapy :
• Supportive
• CBT
• Family Psychoeducation

+++ ECT (recurrent depressive/affective episodes)

 Follow up
• Clinical Symptoms (medicine adherence)
• Vital sign
• Drug Side Effects (SSRI = GI tract symptom, sedation, sexual
dysfunction)
 Prognosis
• Based on drug intake (dosage, kepatuhan)