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Case study: This is a 36-year-old African American male self-presented to the clinic for psychiatric evaluation. The patient looks to be a trustworthy source of information and wants to establish care for his depression. The patient states that he has suffered from depression and anxiety most of the days since he divorced his wife six months ago but feels braked and cannot handle it anymore. He claims to be feeling sad, apprehensive, agitated, and hungry practically every day for the previous six months. He gained over 15 pounds and is overeating, especially when he feels anxious as eating calms him down. Also, he is having difficulty concentrating on his work in the gas station. He sleeps more than 12 hours per day, which is unusual for him, but he feels tired most of the day and lacks the energy to do his normal activities. He also lost interest in several things that used to make him happy, like music and friends, and constantly felt guilty and miserable. He also claims that he cannot manage his worries, and he struggles to focus on his future or a solution to his problems. He is from Maryland and doesn’t have any family in Florida. With his divorce, he lost his house and his savings, became homeless, and is living in his car. The patient states that he was forced to pay a high amount of child support for his son and regularly experienced issues and arguments with his ex-wife, and the police were frequently involved. Now his kid is avoiding him, and this feeling of rejection exacerbates all his symptoms. He used to play baseball with his son, which relaxes him, but he refuses to share time with him and lacks the energy to do that. “He denies having suicidal or homicidal thoughts, has never used psychiatric medications but thinks he needs to take something to improve his mood.”
The Psychiatric nurse practitioner started the patient on Celexa 40mg PO QD for depression and anxiety.
Explain why an SSRI such as Celexa is appropriate treatment for the management of depressive symptoms as well as his anxiety. What precaution, if any, should be taken by the provider prior to initiating medication therapy?
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