Mark is a 38-year-old man working as an IT Manager. He presents with depressed mood, feelings of worthlessness, irritability, and fatigue, loss of interest in daily activities, and difficulty concentrating, and has a Patient Health Questionnaire (PHQ)-9 score of 13. He expresses frustration over continued symptoms have caused him to reduce hours at work despite being on an antidepressant medication.
Mark’s current depressive episode was diagnosed 3 months ago; at that time, his PHQ-9 score was 19. He was initiated on a selective serotonin reuptake inhibitor (SSRI) with an on-label dose for 6 weeks, but he was then switched to an serotonin-norepinephrine reuptake inhibitor (SNRI) due to continued depressive symptoms after 8 weeks.
Probing revealed a long history with depression, starting in college. Mark remembers responding well to an SNRI the first time he was treated for depression. Mark noted that he responded quickly and stopped the medication after 9 months. He also believes the medications he was given did not really work and that his “depression just got better on its own,” which is why he did not seek treatment for his second episode.
Mark also reported that his subsequent depressive episodes have varied in length, but each bout of depression seemed to be worse than the last and that financial difficulties have contributed to his symptoms as well. He mentioned drinking “a lot” of alcohol in college, but now only has “only a few beers” on weekends.
Further conversation on Mark’s medical and family history revealed that this current depressive episode is likely his third lifetime episode. He did not report mood swings or increased confidence, feeling overly energetic, and needing less sleep. Mark noted feeling self-conscious with transient feelings of worthlessness and irritability. He has not exhibited risky behavior, and noted that his financial stress was due to working fewer hours. Additional questions revealed that Mark has had difficulty concentrating and experienced “fogginess” due to his symptoms. Mark also believes that his mother had depression.
In reviewing medication history, Mark noted starting on an SNRI for his first depressive episode. He responded well to treatment and stopping taking his medication after 9 months; he did not take any medication during his second episode.
Based on the information provided in this case study, test your knowledge about screening Mark for bipolar disorder and other mental health conditions by taking the quiz below:
New on NP Psych Navigator
Digesting DSM-5 Criteria and Patient Probes for Bipolar Disorder: Depressive Episodes
In Part 1 of this video, Alan 'Tony' Amberg, MSN, APRN, PMHNP-BC discusses making the DSM-5 criteria for depressive episodes in bipolar disorder more digestible for providers utilizing clinical patient probes.