Choosing a Medication

The Art of Psychopharmacology, let's keep it simple.

Imagine a 32 year old male, he presents to your clinic and you are sitting down to speak with him. He is in good physical health. He appears to be a great historian. He offers specific information regarding the onset of his symptoms and how they have affected him. He presents as depressed and cites symptoms such as low motivation, fatigue, difficulty falling asleep, hopelessness and poor concentration. He states that depression runs in his family. He states that he has been treated for depression in the past, but unfortunately does not remember which medications he took. He denies presence of any psychotic symptoms or perceptual disturbances.

Due to his seemingly great report, which was entirely congruent with his presentation you diagnose the patient with F33.2. You start him on Prozac 20 mg daily. Of course you offer relevant medication education, including potential side effects (sexual, nausea, diarrhea, insomnia, anxiety and headache).

2 weeks later, his wife calls the office. She complains, my patient is bouncing off of the walls. He hasn’t slept in 3 days and is begging me to let him start a rental car business (He knows nothing about cars!!). Concerned, you schedule a follow up and ask that the patient stops taking his prozac and comes into the office as soon as possible.

What happened?