Case Review Of A Man With Severe Depression Essay

Case Review Of A Man With Severe Depression Essay

Peter a 40 season old man, possessed become depressed pursuing some cash pressures which had put his livelihood and home under risk.

He have been to see his GP who had asked Peter to complete the self reporting Patient Health Questionnaire (PHQ9) to assist identification and determine the level of depression. Peter obtained 16 on this tool, which is indicative of any reasonably severe depressive episode.

The GP recommended Peter must have a couple of weeks off work, make an appointment to see me for a few emotional support and also prescribed the antidepressant medicine Fluoxetine.

Peter didn’t attend the visit directed at him to attend my clinic, did not take anytime off work and didn’t use the prescription for medication. Peter later described he had been rather stunned by his GP’s analysis as he sensed that depression was a sign of weakness and hadn’t considered himself to be a fragile man. Therefore he made a decision he would make an effort to sort himself out without the other intervention.Case Review Of A Man With Severe Depression Essay

Unfortunately Peter was unable to package with things himself and his depression worsened. When he went to the GP practice some 2 calendar months later at the insistence of his wife, he was severely depressed and possessed a PHQ9 rating of 25.


The GP immediately booked him into a space in my medical center and again urged Peter to begin taking the Fluoxetine.

I found Peter the next day and again assessed him to have a severe depression. I wanted to start a cognitive behavioural therapy approach to control the depression and again advised the antidepressant may be beneficial to lift his disposition. I explored his doubt around taking the medication and described the potential area effects which might occur. Peter needed the medication and after weekly found that his symptoms were needs to lift up. He experienced some gastro intestinal aspect effects, specifically, nausea which lasted for about 6 weeks but was manageable. I noticed Peter on 4 further situations when we worked on some behavioural activation work, which may be effective for depression, (NICE, 2009) and his ambiance began to lift further. His PHQ9 score dropped from 25 to 9, which is indicative of slight depression.

At the 6tth time, some 12 weeks later, Peter enlightened me he had quit taking the Fluoxetine as it was triggering some intimate dysfunction that was affecting his capacity to achieve orgasm. Peter found this very hard to discuss but explained that he and his wife fond this very frustrating therefore therefore had made a decision to stop the medication. Case Review Of A Man With Severe Depression Essay

I attempted to explore this with Peter and suggested that another antidepressant could be prescribed which might not exactly have this particular side effect. I also explained that his choice to avoid the antidepressant could also increase his likelihood of relapse. Peter was reluctant to explore these issues further and although he made another visit to see me, he didn’t attend that visit and failed to respond to any further communication.


On reflection, any difficulty. Peter had several issues relating to his diagnosis of depression. Peter plainly had negative views about depression and what it meant for him as a person, however this is actually the case for many people as there’s a great deal of stigma associated with depression.

He did not have enough information about taking the medication from his GP and although I felt I had formed covered the medial side effect profile in detail, it was clear that Peter experienced difficulty talking about sexual dysfunction part effects with me at night. He found this area specifically embarrassing to reveal.

I also feel that I did not wholly follow the 7 ideas of prescribing extensively enough as I did not make Peter aware of the necessity to continue taking the medication for at least 6 months following remission to be able to avoid relapse. I did not discuss this in the beginning with Peter as I was conscious this may be information overload for him at the start of treatment when our main concerns were symptom decrease. I was likely to discuss this aspect within my release planning time but Peter opted out of treatment prior to this happening. With hindsight it may have been good for introduce this concept earlier. Case Review Of A Man With Severe Depression Essay

These 3 things affected Peter’s potential to adhere to his medication regime therefore therefore I will explore the problem of adherence within the assignment mounted on this case study.


This project will consider the problem of medication concordance associated with depression and the utilization of antidepressant medication as this is clearly an issue which became obvious within the research study. The task will explore what is supposed by concordance in relation to the case study, factors influencing it and strategies which might be used to encourage concordance for the treatment of depression.

Depression is recognized among the major causes of sick health worldwide and in Britain it is the most frequent reason stated on incapacity advantage promises (World Health Group (WHO) 2001). Despite this statistic, depression along with other mental health issues continues to have a lot of stigma attached to it. Gray et al, (2008) facilitates this view and argues depression has been stigmatised anticipated to popular ignorance about the sources of the illness which has led it to be often perceived as an indicator of personal weakness. Consequently, people experiencing depression often fail to seek help as they feel ashamed or ashamed to disclose their symptoms or do not realize there are treatments available which might help.

The Country wide Institute for Clinical Excellence, (NICE, 2004) recommended approaches to raise the profile of mental health by suggesting ways of bettering the identification and treatment of common mental health problems, such as depression through self applied help, Cognitive behavioural remedy and antidepressant medication. Case Review Of A Man With Severe Depression Essay

The role of the mental health nurse prescriber also offers the actual to improve the treatment of average to severe depression in major care by merging the utilization of mental health treatments with medication management, (Badger, 2006). The amount of depression can be dependant on use of the individual Health Questionnaire, (PHQ9) which suggests that a report above ten signifies a possible moderate to severe depressive episode, if the reporter has already established these symptoms for longer than a two week period, (Anderson et al, 2008).

Several research articles have highlighted that only a percentage of antidepressants are considered as recommended and discontinuation after one month is common. The results because of this vary between 30 to 68% depending on the article. Fox, (1999), Warrington et al, (2000) and Olfson et al, (2006) verified that 42% of individuals prescribed antidepressants stop taking them at one month.

Prior to 2005, what compliance and adherence had been used to spell it out patients taking medication relative to instructions but because the NICE guidance. . . . . . . . the word concordance has been used as therefore a negotiated contract between the prescriber and the individual about the taking of medication. Despite this information, Hunot et al, (2007) argues concordance might not be any longer than compliance, unless the patient believes they may have an equal relationship with the prescriber. Case Review Of A Man With Severe Depression Essay



Between one third and a half of medicines1 that are prescribed for long-term conditions are not used as

recommended. This represents a health damage for patients and an economic loss for contemporary society.

Non-adherence shouldn’t be considered the patient’s problem. Rather, it usually results from a failure

to fully agree the prescription with the individual in the first place and support the patient once the

medicine has been dispensed.

Non-adherence falls into two overlapping categories: intentional (the individual decides never to follow the

treatment suggestions) and unintentional (the individual wants to follow the treatment

recommendations but has practical problems).

To understand non-adherence we need to consider perceptual factors (beliefs and personal preferences) that

influence motivation to start and continue treatment as well as sensible factors. Case Review Of A Man With Severe Depression Essay

This requires:

_ an open, no-blame strategy that stimulates patients to discuss any questions or concerns about


_ a patient-centred way that encourages up to date adherence

_ identification of perceptual and useful barriers to adherence during prescribing and

during regular review. Case Review Of A Man With Severe Depression Essay.