A 36-Year-Old Woman with a History of Recurrent Major Depressive

question 587

Multiple Choice

A 36-year-old woman with a history of recurrent major depressive episodes comes to the office due to a 1-month history of severely depressed mood, social isolation, decreased libido, low energy, sleeping 14 hours a day, and weight gain.  The patient works as a real estate agent but recently took a leave of absence as she has no motivation and is unable to concentrate.  She has had 4 prior episodes of severe depression, starting in her mid-20s after the birth of her first child.  The patient's first episode responded to sertraline within several days.  She also responded well to venlafaxine, but her husband recalls that she was instructed to stop the medication after 2 weeks due to severe insomnia.  The patient has no significant medical history.  She has a family history of opioid use disorder.  She drinks 1 or 2 glasses of wine a day and does not use illicit drugs.
Temperature is 36 C (96.8 F) , blood pressure is 118/75 mm Hg, and pulse is 68/min.  Physical examination is normal.
Which of the following would be most important to obtain prior to initiating antidepressant treatment?

• A)Complete blood count
• B)History of alcohol-related complications
• C)History of anxiety symptoms
• D)History of elevated mood
• E)Urine drug screen

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Definitions:

Chemical Factors

Elements and compounds that influence reactions and processes in biological and environmental systems.

Ecosphere

A term often used synonymously with the biosphere, referring to all the ecosystems on Earth where living organisms interact with each other and their physical environment.

Synonymous

Having the same or nearly the same meaning as another word or phrase in the same language.

Biosphere

The biosphere encompasses all ecosystems and living organisms on Earth, along with the physical environments they inhabit.