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Patient Case 4


Date of Presentation: 12/15/2018

82M   CAUCASIAN   Retired


DST Recommendations: Aifred Health

Treatment Names Chance of Remission
Escitalopram 81%
Sertraline 76%
Bupropion 69%
Venlafaxine 79%

Patient Information

Basic Information
MH No major medical issues PH No clear previous PH

Please hover on numbers to see detailed explanations about patient variables:

EDUCAT 18.0educat : Number of years in formal education dm01 value of 18.0 graduate EMPL 20.0empl : Current employment status dm01 value of 20.0 retired SOC_PHOB 0soc_phob : Axis I: Social phobia psist01 value of 0
SFHS 4.0sfhs12 : 10. How often interfered sf36v201 value of 4.0 interfered with social activity some of the time SLMCH 0hsuic : HRS Suicide hrsd01 value of 0 SLDIF 0sldif : Sleep: Difficulty sleeping prise01 value of 0
IANX 2.0ianx : Mood (anxious) idsc01 value of 2.0 anxious ALCOH 0alcoh : Alcohol Lifetime Prevalence scid01 value of 0 GNSEA 0gnsea : GI: Nausea/vomiting prise01 value of 0
ATMTSUIC 0atmtsuic : Attempted suicide ccv01 value of 0 IPANC 1ipanc : Panic/phobic symptoms idsc01 value of 1 Has mild panic episodes or phobias that do not usually alter behavior or incapacitate SXERC 0sxerc : Sexual: Trouble with erections prise01 value of 0
GCNST 0gcnst : GI: Constipation value of 0 GDIAR 0gdiar : GI: Diarrhea prise01 value of 0 SXLS 0sxls : Sexual: Loss of sexual desire prise01 value of 0
HEMIN 1hemin : HRS Late insomnia hrsd01 value of 1 Waking in early hours of the morning but goes back to sleep HHYPC 0hhypc : HRS Hypochondriasis hrsd01 value of 0 URDIF 0urdif : Gen/Urin: Difficulty urinating prise01 value of 0
HINSG 0hinsg : HRS Loss of insight hrsd01 value of 0 HINTR 0hintr : HRS Work and interests hrsd01 value of 0 URFRQ 0urfrq : Gen/Urin: Frequent urination prise01 value of 0
HMDSD 2hmdsd : HRS Depressed mood hrsd01 value of 2 – SPONTANEOUSLY REPORTS SADNESS HMNIN 0hmnin : HRS Middle insomnia hrsd01 value of 0 VMDSD 0vmdsd : QIDS Mood (sad) qids01 value of 1 1=Feels sad less than half the time
HSEX 0hsex : HRS Libido hrsd01 value of 0 HSLOW 0hslow : HRS Retardation. Psychomotor (Slowness of thought and speech; impaired ability to concentrate; decreased motor activity). hrsd01 value of 2 HSOIN 2hsoin : HRS Initial insomnia hrsd01 value of 2
HSUIC 0hsuic : HRS Suicide hrsd01 value of 0 HTDZY 1htdzy : Heart: Dizziness on standing prise01 value of 1- YES HAGIT 0hagit : HRS Agitation hrsd01 value of 0
HTPLP 0htplp : Heart: Palpitations prise01 value of 0 HVWSF 2hvwsf : HRS Guilt feelings and delusions hrsd01 value of 2 | Ideas of guilt or rumination over past errors or sinful deeds. INTERVIEW_AGE 82interview_age : Age at the time of the interview/test/sampling/imaging. hrsd01 value of 82
HWL 0hwl : HRS Weight loss hrsd01 value of 0 OFTGE 1oftge : Other Symptom: Fatigue prise01 value of 1- YES IAGIT 1iagit : Psychomotor agitation idsc01 value of 1 Fidgets and wrings hands and shifts positions often
ICNTR 1tion often wanders icntr : Concentration/decision making idsc01 value of 1 Occasionally feels indecisive or notes that attnetion often wanders IPANC 1ipanc : Panic/phobic symptoms idsc01 value of 1 Has mild panic episodes or phobias that do not usually alter behavior or incapacitate NVTRM 0nvtrm : CNS: Tremors prise01 value of 1- YES
SKICH 2skich : Skin: Itching prise01 value of 1- YES Respiratory 0respiratory : Respiratory Problems medhistory01 value of 0 SLMCH 0hsuic : HRS Suicide hrsd01 value of 0

Current Medications

Other Information
9 Symptoms of Depression:

•Sadness: Yes, sadness but not constant
•Loss of pleasure/interest: Yes, less interest in social activities
•Concentration: Occasionally feels indecisive, attention wanders
•Slowing or agitation: Some slowing, noticed by others
•Suicidality: None
•Guilt: Guilt, preoccupation about past separation and past mistakes
•Fatigue: Increased fatigue
•Altered sleep: Difficulty falling asleep, early morning awakening
•Altered appetite: Normal appetite

Examination Result
No Examination Result.

Literature Evidence

Please click literature names for PICO summary, or enter PICO keywords to filter out literature you interested.

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Below table displays the matchable literatures from PubMed and Google Scholar filtered by patient's SX.

Literature Names Year

388 patients with unipolar depression, 74 men and 314 women.

The survey was carried out using the clinical psychopathological method and psychometric scales for depression.

There are gender differences for several parameters, with women being older and more often having comorbid somatic and organic disorders, and men having personality disorders and chronic depression.


Adult Participants (mean age, 43.4 years; 72.4% female) with confirmed MDD who reported a major depressive episode within the past 2 years, for which they had received pharmacologic treatment for ≥6 weeks.

This qualitative study uses facilitated focus-group sessions to collect data on the bothersome symptoms, quality of life, and treatment participants received for their most recent MDE.

The most commonly prescribed antidepressants were bupropion, escitalopram, and sertraline. The most frequently reported bothersome MDD symptoms were fatigue, lack of motivation/loss of interest, anxiety/panic, sadness, and lack of concentration/brain fog.


Late-life depression patients are people after the age of 65 years present dysphoria and anhedonia.

Antidepressants currently available can be divided into four pharmacological groups, which clinicians choose from based on the patient's symptoms, drug side effects profile, and concurrent medical illness.

The medications are effective ~75 % of the time with patients usually responding in 6-1 2 weeks. The medication regime commonly remains in force for 6-12 months after recovery because of the propensity for relapse.


The study included 84 subjects suffering from unipolar depression without psychotic features.

The control(CDS<70) and associated depersonalization group (CDS<70) are formed based on CDS score. The groups were compared with the intensity of depressive symptomatology, depressive symptoms frequency and the depressive symptoms duration.

Depression is more severe when it is unipolar. It has a bigger number of manifest symptoms which have a tendency to continuous duration. A special focus is on the negative impact on the occurrence and lasting presence of suicidal thoughts.


4,856 individuals (53% female) who experienced depressive symptoms in the previous year were assessed in up to four waves over a maximum of 12 years.

Patients were assessed for up to 12 years and reported the severity of 12 symptoms disaggregated from the nine DSM-III-R criteria for major depression and the self-identified cause of these symptoms, which were classified into nine categories of adverse life events.

The patterns of depressive symptoms associated with the 9 categories of adverse life events differed significantly, with the most notable differences being between deaths of loved ones and romantic breakups on one hand, and chronic stress and failures on the other.


2925 individuals with DSM-IV bipolar disorder recruited into the UK Bipolar Disorder Research Network

The prevalence of agitation in the most severe depressive episode was estimated in patients based on semi-structured interview and medical case-notes.

The study found that agitation was significantly associated with insomnia, poor concentration, decreased libido, suicidal ideation, slowed activity, and poor appetite, and that co-morbid panic disorder, suicide attempt, and dysphoric mania were significantly associated with AD over the lifetime illness course.


Patients with major depressive disorder (MDD) while taking antidepressants

The eligible studies focus on the use of at least one of 15 antidepressants and report data on treatment-emergent gastrointestinal SEs within 12 weeks of treatment.

All considered antidepressants showed higher rates of gastrointestinal SEs than placebo. The least tolerated antidepressants on the gastrointestinal tract are escitalopram and sertraline, while mirtazapine is the antidepressant with fewer side effects on the gut.


Multiple groups of patients with depression.

Clinical studies rom placebo-controlled and/or head-to-head comparisons of the ASRI escitalopram versus the SSRIs sertraline and paroxetine.

All three antidepressants are efficacious compared with placebo, but there is evidence that escitalopram is more effective than a range of other antidepressants.


Fatigue and depression patients

Fatigue and depression symptom profiles and classifications were generated using SOFA, general health questionnaire, etc; The study found that people with fatigue and depression are associated with differences in the preponderance of symptoms.

Individuals with either fatigue or depression have an approximately two-fold increased risk for comorbid presentation of both traits, compared to the general population. Depressed individuals were more likely to report all SOFA fatigue symptoms.


Fifty-eight women (29 with DD, 29 with SSD) reported subjective recent fatigue and chronic stress levels, as well as levels of depression and somatic complaints

Patients with DD, SSD, fatigue, stress, and depression completed an ambulatory assessment period measuring fatigue, stress, and salivary cortisol five times a day for 14 consecutive days.

Women with DD reported higher levels of general and mental fatigue than did women with SSD, which was explained by their higher level of depression.


765 participants with bipolar disorder.

Investigated the relationship between the deviation from the median WBC count and multinomial regression analysis between different WBC levels; Analysis were performed gender-specific, age, body mass index, smoking, race, and somatic diseases.

The overall MADRS score increased significantly for each 1.0×109/l deviation from the median WBC among 322 men (coefficient=1.10; 95% CI=0.32-1.89; p=0.006), but not among 443 women (coefficient=0.56; 95% CI=-0.19-1.31; p=0.14).


Patients under treatment with substances licensed for major depression.

A systematic review on seizures under treatment with substances licensed for major depression, where a total of 2291 articles were screened.

There is a moderate risk for clomipramine, quetiapine, amitriptyline, venlafaxine, citalopram, sertraline, trazodone, mirtazapine, paroxetine, bupropion, and escitalopram, and a negligible risk for fluoxetine and duloxetine.