Case Study
Diagnosis (ICD Number and Name)
F32.5 Major depressive disorder, in fullremission
FI 9.981 Medication-induced sexualdysfunction
Evidenced by: ?
Presenting Problem
Gerhard Palmer, a 55-year-old married accountant, presented to apsychiatrist for a second opinion in the context of recurrent majordepression. He had not responded to two 3-month antidepressanttrials, one with fluoxetine and another with sertraline, both athigh dosages. He had not been taking medications for about a monthfollowing the last failed trial.
The evaluation revealed a severely depressed man with profoundpsychomotor retardation, poor concentration, early insomnia, mildlydiminished libido, and anhedonia. Mr. Palmer denied substanceabuse, drank minimally, and did not smoke. He had started takingpropranolol for hypertension about 6 months previously. Hisphysical examination was unremarkable. Basic laboratory tests werewithin normal limits. His blood pressure was 135/85.
Treatment with clomipramine was initiated, and the dose wasquickly titrated to 250 mg/day. Buspirone 30 mg/day was added.After 5 weeks of treatment, Mr. Palmer reported feeling muchimproved. He was sleeping and eating well, was participating inenjoyable activities with increasing enthusiasm, and, for the firsttime in many months, felt a return of his sexual interest.
After not having had sexual intercourse in months, Mr. Palmertried unsuccessfully to have sex several times. He was distressedto find that for the first time in his life, he was unable tomaintain an erection during intercourse and was unable toejaculate, even during masturbation. These problems persisted for amonth. He recalled having had slightly delayed ejaculation whiletaking fluoxetine. He did not recall sexual problems during a priortrial of bupropion.
What are the treatment goals and objectives for thiscase?
Treatment Goals
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Prescribed Frequency of Treatment
