Depression in adults unresponsive to first drug
Introduction: Patients who don’t respond to the first proposal for antidepressant agents compose a separate group, and the clinical doctor must know their management, since remission rates to selective serotonin reuptake inhibitors are about 30% to 35%. In such cases treatment is a matter of discussion. Discussing and analyzing approaches and methods for improving recognition and management is useful in clinical practice, justifying the case report, which contribute to new studies. Objective: report a clinical case of depression in adult not responsive to the first drug approach. Case report: 25 years old woman, reported a year ago started with symptoms of anhedonia, unexplained sadness, frequent cries, headache, somnolence, inattention, irritability, memory loss and “empty head feeling”. After 3 months, the patient evolved with anhedonia worsening associated with suicidal ideation. Pharmacological treatment started in basic attention with fluoxetine (20 mg in the beginning, following 40 mg daily after 1 month) and amitriptyline (already suspended). Referenced, the patient shows low antidepressant response after 1 month and 3 weeks of treatment. The patient refers hypercholesterolemia as previous pathological history and denies use of alcohol and illicit drugs and traumatic events during the life. In the mental exam the patient was oriented, with depressed mood and preserved insight. In view of the current condition, fluoxetine was discontinued, with venlafaxine replacement 75 mg in the morning during 10 days and 150 mg after this period. Psychoeducation and orientation against the abrupt discontinuation of the drug was made. Discussion: Most patients with depression should be managed in the primary care service, and treatment should be diverted to secondary care only in the most serious and singular cases². The effectiveness of the treatment needs to be evaluated within 2 to 4 weeks after starting the medication. Although part of the literature uses monotherapy or small combinations of drugs, in clinical practice, several patients need two or more drug strategies to achieve remission of symptoms. There are evidences that after the first use of a Selective Serotonin Reuptake Inhibitor without success, switching to the same class or to a different class is plausible. Conclusion: Given the proportion of depressed patients who do not achieve the optimal outcome with the first selection of antidepressants and damage done, it is critical to know and track new tools to chance this inappropriate response.
Key-words: Depression, Adults, Antidepressants, Treatment Failure.
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