Problem: Donna R. is a 27-year-old nurse who presents to her primary care NP, Nancy Walker, DNP, with an 18-lb weight loss over the previous 2 months. Donna tearfully explains that she is plagued by feelings of sadness and by a sense of helplessness and inadequacy at work. She feels so terrible that she has not had a good night of sleep in more than a month.
She denies suicidal/homicidal ideation. Her PHQ score is 13.
1. What signs and symptoms may indicate that Donna R. is depressed?
2. How would you discuss the diagnosis of depression with the patient?
3. How would you proceed? Please prescribe an antidepressant for this patient and the rationale. Please report mechanism of action, pharmacokinetics, side effects and prescribing principles.
4. 3 weeks later, the patient notes slight improvement, but PHQ remains at 13. How would you proceed?