Please respond to Amber:
Edalaine, this was a great presentation! I’m glad to hear that your patient was agreeable to psychotherapy as there are significantly better outcomes for patients who are on medication for depression and undergo CBT (Karrouri et al., 2021). I like the treatment option of both Wellbutrin and methylphenidate, as Wellbutrin inhibits the reuptake of norepinephrine and dopamine and can often be used off label for those with ADHD (Huecker, 2023). However, first like treatment for patients is classically what your patient is taking, a stimulant like methylphenidate (Magnus, 2023). I like how you emphasized the tragic loss of her brother and the fact that patient lives alone. You also mentioned how she was participating in a social group.
I am unsure if this patient has a syndrome associated with all three of these conditions. My question for you would be, is this patient’s insomnia secondary to undertreatment of her depression diagnosis or is this a side effect of being on a stimulant such as methylphenidate with another drug that also works to inhibit reuptake of NE, Wellbutrin. The anxiety and depression symptoms may not necessarily be attributed to the ADHD symptoms alone; however they can definitely exacerbate the underlying diagnosis. I am curious as if the recent loss of her brother is causing worsening concentration secondary to anxiety and depression and it is being misdiagnosed as ADHD. I like your thought process about the effects of her chronic health conditions such as RA and the impact it may have on her psychiatric diagnoses. For example, if her RA were not appropriately treated and she were experiencing significant pain and poor quality of life, this could definitely attribute to her underlying depression.
Thank you so much for the time and effort and the complex medical case you presented. I greatly appreciate you for this.
