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https://openstax.org/books/psychology/pages/15-7-m…
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https://www.insider.com/ssris-mark-horowitz-antide…
PSY 250 Affective Disorders Case Studies
Below are two patient cases, which are based in part on actual medical cases reported in the literature. Please complete both by answering the questions that follow each case write-up.
Case 1 – Carmen
Carmen is a 21 year old junior at a large, state college. She has always been a high achiever, and is proud of her 4.0 GPA. She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled with strong feelings of guilt and worthlessness due to her inability to perform as well as she always has in the past.
For the past month, Carmen has felt especially worn out and found it increasingly difficult to concentrate on her class work. Her classmates have noticed that she seems more irritable and withdrawn than in the past, and has lost weight. She has even started missing classes, staying in bed all day, watching TV or sleeping. She also has problems falling asleep at night, often tossing and turning for hours before eventually falling asleep.
What do you diagnose Carmen with?
What are Carmen’s treatment options? Which medication(s) would be appropriate? Which neurotransmitter(s) do they work on?
Case 2 – Riley
Riley is a 24 year old man who recently moved back home with his parents to look for a job after graduating from college. Apparently, while in college, he had struggled with repeated bouts of depression. Over the past few weeks his family and friends have noticed increasingly odd behaviors, including an incident where he was found singing loudly in the back yard, dressed only in his underwear. When asked what he was doing, Riley said he was conversing with God about saving the world. His speech was rapid and difficult to follow (jumping from topic to topic), and he also broke into song or laughter mid-sentence. Later, he told neighbors that he was in fact God and was on an important mission to save the world.
What do you diagnose Riley with?
Which symptoms lead you to this diagnosis?Which neurotransmitter system(s) and brain regions might be involved?
Dr. Diaz-Asper
• A new comprehensive review disputes the serotonin theory of depression,
reporting there remains no clear evidence that serotonin levels or serotonin
activity is responsible for depression.
• As many as 85-90% of the public believes that depression is caused by low
serotonin or a chemical imbalance
• “The main areas of serotonin research provide no consistent evidence of there
being an association between serotonin and depression, and no support for the
hypothesis that depression is caused by lowered serotonin activity or
concentrations. Some evidence was consistent with the possibility that longterm antidepressant use reduces serotonin concentration.”
Tricyclics: block proteins that reabsorb serotonin,
dopamine, & norepinephrine into the presynaptic
neuron after release
Example: imipramine (Tofranil)
Also block histamine receptors, acetylcholine
receptors, & certain sodium channels
Creates side-effects (drowsiness, dry mouth,
difficulty urinating, heart irregularities)
Selective serotonin reuptake inhibitors (SSRIs):
block reuptake of serotonin
Examples: fluoxetine (Prozac), sertraline (Zoloft),
fluvoxamine (Luvox), citalopram (Celexa) and paroxetine
(Paxil)
Work similarly to tricyclics but are specific to
serotonin
Milder side effects but same effectiveness
Serotonin norepinephrine reuptake inhibitors
(SNRIs): block reuptake of serotonin &
norepinephrine
Examples: duloxetine (Cymbalta) and venlafaxine
(Effexor)
Monoamine oxidase inhibitors (MAOIs): blocks the
enzyme monoamine oxidase that metabolizes
catecholamines & serotonin into inactive forms
Blockage of the enzyme results in more of the
transmitters in the presynaptic terminal available
for release
Usually prescribed if SSRIs & tricyclics are not
effective
High blood pressure results with some food
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