Reference no: EM133720798

Question

The patient is a 13-year-old girl who developed depressive symptoms over a period of 6 months, with depressed mood, excessive sleepiness (12 hours/night plus napping), amotivation, low energy, and withdrawal from friends Prior to her symptoms she had done well in school, earning As and Bs, and had always had a small group of friends She was active in a local archery club and in 4-H (positive youth development and mentoring organization) She was treated with interpersonal therapy for adolescents (IPA-A) for 4 months and felt somewhat better but continued to experience significant depressive symptoms She began to take fluoxetine 10 mg/day in the morning while continuing her psychotherapy; one week after starting fluoxetine she felt "amazing" and had rapid and significant improvement in all of her depressive symptoms as well as complete resolution of her previously reported Columbia Suicide Severity Rating Scale (CSSRS) 1-2 suicidal ideation She was seen for a follow-up appointment two and a half weeks after initiating fluoxetine, at which she reported feeling "better than ever" However, her parents were concerned by several recent events, including that the patient: Stole her mother's credit card and purchased $900 worth of underwear Was engaging with several older men.