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Case Study: A 49-year-old married patient, A.L., comes in to see their medical provider complaining of severe sleep difficulty involving initial insomnia, poor appetite, a severe decrease in energy level (anergia) to the extent that some weeks they call out of work 2 or more days, and lack of enjoyment in their usual hobbies and interests (anhedonia). A.L. describes their mood as “depressed.” You observe the patient to have a sad, blunted affect; slowed speech; and psychomotor retardation. In exploring the patient’s life stressors, you learn that A.L. has a 19-year-old child who is away at college and that 4 months ago, their 17-year-old child was killed in a car accident. The patient admits to maladaptive grieving and an irrational fear that something “bad” will happen to the child at college. The patient also admits that they are depressed and have some vague suicidal ideation but no specific plan. A.L. feels compelled to watch over their 19-year-old child, as they feel a degree of guilt that they were not a good parent and that this failing contributed to the death of the 17-year-old. A.L. tells you that they have been taking St. John’s wort for the past 2 months but does not think that it has helped with the depression. The primary provider gives the patient a prescription for citalopram. 

 

1. Are there potential complications that can result from the interaction of St. John’s wort and citalopram? What symptoms would be indicative of this interaction?

 

2. What should be included when assessing the patient’s risk for suicide?

 

3. Please share something you have learned in this course, one thing, pertaining to whatever topic you choose. It is always good to provide different perspectives, so perhaps your knowledge can contribute to this course? 

SCIENCE
HEALTH SCIENCE
NURSING