Chief Complaint: “I think I want to stop taking my antidepressant.”History of Presenting Illness (HPI)The client is a 35 year old male who presents today to discuss discontinuing his antidepressant medication. The patient reported that he has been on this medication for the past 2 years for depression after a divorce and multiple losses. He currently is taking citalopram 20mg a day and feels that the medication has been helpful at managing his depression. The patient reports he is currently in a new relationship and is very concerned about the medication’s sexual side effects.
He is here today to discuss medication options.
The client reports sleep, appetite, and energy level are all within normal limits. He reports his mood good and denies any depression at this time. His weight is stable and he reports going to the gym at least 3 times a week.
Past Medical History:Torn left knee ligament (playing foot ball in high school)
Borderline elevated cholesterol
Family History (FH):
Father – HTN, HyperlipidemiaMother
– Healthy and well, no medical issues. Anxiety
Brother- Deceased 2017, MVA
Sister – Depression & Anxiety
Social History (SH):Married once, Divorced X 2 years, no children Works as sterile processor at local hospital
Non-smoker, Alcohol use rare, Denies drug use
Works out at gym at least 3 times a week.
Medications:citalopram 20mg daily fish oil omega 3 daily men’s multi-vite daily
Physical and Lab Findings: Temp 98, Pulse 70, Resp 16, BP 130/70Ht. 6”, Wt. 175 lbsNo recent lab findings available.
1. Is there any additional information you would like or need to know about this client?
2. After reviewing the case history what will your initial plan be?
3. Will you discontinue the client’s medication, change the medication, lower the dose, augment with another medication? (give rationale for your plan)
4. If you and the client decide to make medication changes, what medication/class will you prescribe for this client? (If you are augmenting a medication answer a-d for both medications the client will be taking) a. Initial dose:b. Titration Plan:c. Goal Dose Range:d. Max Dose:
5. Provide rationale for the medication/s you selected above other medication options.
6. What is your client education regarding the timing and onset of effect (how long with the client need to wait to see a positive effect from the medication)
7. What are the potential side effects from this medication/s? (name two common and one severe side effect)
8. Are there any contraindications between what you have prescribed for your client and the medication/s the client is already taking?
9. Are there any lab values that need to be ordered for a client taking this medication, and how frequently?
10. Will you order any additional therapies for this client? (what and why)