A 38-year-old man comes to the physician because of depressed mood for 2 months. He works as a store manager and cannot concentrate at work anymore. He experiences daytime sleepiness and fatigue because he repeatedly wakes up at night and has difficulties falling asleep again after 4 AM. He reports no longer taking pleasure in activities he used to enjoy, such as going fishing with his son. He has decreased appetite and has had a weight loss of 5 kg (11 lb) over the past 3 months. The patient had a previous depressive episode in his 20s that responded rapidly to sertraline. Physical examination is normal. Which of the following would be most important to assess prior to initiating pharmacologic treatment for this patient?

Question

A 38-year-old man comes to the physician because of depressed mood for 2 months. He works as a store manager and cannot concentrate at work anymore. He experiences daytime sleepiness and fatigue because he repeatedly wakes up at night and has difficulties falling asleep again after 4 AM. He reports no longer taking pleasure in activities he used to enjoy, such as going fishing with his son. He has decreased appetite and has had a weight loss of 5 kg (11 lb) over the past 3 months. The patient had a previous depressive episode in his 20s that responded rapidly to sertraline.    Physical examination is normal.  Which of the following would be most important to assess prior to initiating pharmacologic treatment for this patient?

Quizplus · Accepted Answer

Eductional Objective: Patients experiencing a major depressive episode should be carefully screened for past manic episodes to rule out bipolar disorder.  Antidepressant monotherapy should be avoided in patients with bipolar disorder due to the risk of precipitating mania.

A 38-Year-Old Man Comes to the Physician Because of Depressed