Often, when we are presented with a case it can be difficult to find a way forward. To aid clinical decisions, it is sometimes necessary to break down the decision making process into stages. The problem based learning task below does just that. Here I was given a case study and we methodically worked through the problem to get to a solution.
Identify, read and reflect upon the information supplied
Archie’s mother’s illness triggered his depression and anxiety and although she is recovered, his symptoms remain. He has been prescribed Citalopram 20mg but has some concerns about addiction but does not feel able to ask his GP about this and has not started taking them.
Identify what you already know to work toward resolving the problem
- Diagnosed with moderate Depression (DSM-5, 2013)
- Moderate Depression recommended treatment is low- intensity CBT based guided self help and / or antidepressant medication (NICE, 2009)
- CBT has been shown to be as effective as antidepressant medication
- Some antidepressants in the past have been known to be addictive but SSRIs such as Citalopram are not addictive
- 20mg is a relatively low dose of Citalopram
- Not everyone experiences side effects to antidepressants
- Side effects to antidepressants often reduce within a few weeks of taking them
- There is a lot of medication advice literature available from NHS and IAPT
- Archie is motivated to get better
- Archie seems to have a good relationship with his mother’s GP
Identify what you need to know in order to work towards resolving the problems.
- Common side effects of Citalopram and likelihood of these
- Whether Archie feels able to speak to his mother’s GP
How and where you can access new information to lead towards the resolution of problems
- Information about SSRIs from NHS here
- Incidences of Citalopram side effects from drugs.com here
- Discussion with Archie about willingness to consult second GP
Treatment plan
- Empathising and normalisation of concerns about mother and medication
- Psycho-education about right to ask for different GP, or to change GP practice
- Psycho-education about medication management, both in literature form and in discussion
- Psycho-education about evidence base showing that CBT based treatment can be as effective as antidepressant medication
- Psycho-education about depression and anxiety, and occurrence of NATs
- CCBT, group or telephone Guided Self Help for depression in line with Healthy Minds service recommendations
- Focus on Thought Challenging may be considered
Signposting
- Signposting to reliable drug information websites (see above) may be appropriate
- If mother’s health was deteriorating then signposting to care options, but at this stage it is not felt to be necessary
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