Sarah is a 30-year-old woman working as a sales director. She has been diagnosed with MDD, and she is currently taking a serotonin-norepinephrine reuptake inhibitor (SNRI) at an on-label dose. Her Patient Health Questionnaire (PHQ)-9 score today is 13.
She complains that she is frustrated with continued depression despite switching to a second medication. Sarah presents with depressed mood, feelings of worthlessness, irritability, fatigue, loss of interest in daily activities, and difficulty concentrating. She also reports falling behind with work. Her current depressive episode was diagnosed 3 months ago. At that time, her PHQ-9 score was 19. At initial diagnosis, she was initiated on a selective serotonin reuptake inhibitor (SSRI) with an on-label dose for 6 weeks, but she was then switched to an SNRI due to continued depressive symptoms.
Sarah feels like she’s had depressive episodes “all of her life.” She remembers responding well to an SNRI in college, which was the first time she was treated for depression. She states that she responded quickly and felt like her old self, and sometimes even better in the months after. She reports that her subsequent depressive episodes did not last “too long” but feels “each depressive episode is worse than the last.”
Sarah reports a major financial stressor in the past year. She currently drinks nightly, at times to excess, to “keep from thinking about her problems.” Family members describe her father as being “unstable” and drinking “a lot” when she was growing up.