Case 3: Introduction
Christoph U. Correll, MD, professor of psychiatry at The Zucker School of Medicine at Hofstra/Northwell and professor and chair of the department of child and adolescent psychiatry at Charité University Medicine in Berlin, Germany, introduces the third case.
Editor’s note: The following is an automatically generated transcript of the above video.
"Here is now case three. This is Mary, a 59-year-old African-American female with a history of migraines since her 20's. Those are under control with treatment by a neurologist, and a history of depression, age 40, when her mother died of cancer, who she took care of for several years. Back then, the depression resolved within six months with treatment of fluoxetine (Prozac, Eli Lilly) and psychotherapy. After the death of her husband a year ago though, Mary became very depressed again, a second loss, a second hit. Psychotherapy and three months of fluoxetine, now up to 40 milligrams, were only moderately helpful.
Ongoing relevant depressed mood, anhedonia, initial and middle insomnia, feeling guilty about things she hadn't really done wrongly, but was ruminating over it, also interfering with her falling asleep. She had fatigue, and passive to intermittently active suicidal thinking, to be with Richard again, with her husband, but she didn't have a plan or intent. She even was so depressed that she was unable to leave the house more than once a week, and only with prodding by her daughter who lives nearby, had free and few interactions with others, including her two pre-adolescent grandchildren who she very much enjoyed spending time with in the past, and even that joy was lost to anhedonia.
Due to the partial improvement and clinically relevant residual depressive symptomatology, as well as subjective distress and functional impact, augmentation with aripiprazole, 7.5 milligrams was initiated nine months ago. As you know, second generation antipsychotics, certain of them have approval as augmentation treatments for insufficient responding antidepressant treated depression. This combination of fluoxetine and aripiprazole improved Mary's depression significantly, and two months ago, she began feeling almost being back to normal again."