Medication Guide for Patient 2: 16-Year-Old Male with Major Depressive Disorder, Severe

1. Medication Classification & Rationale

Chosen Medication: Fluoxetine (Prozac) Classification: Selective Serotonin Reuptake Inhibitor (SSRI)

Rationale:

  • SSRIs are first-line treatment for major depressive disorder (MDD) in adolescents due to their efficacy and safety profile.

  • Fluoxetine is FDA-approved for pediatric depression and has a lower risk of side effects compared to older antidepressants.

  • It helps reduce suicidal ideation and depressive symptoms over time.

2. Starting Dose & Frequency

  • Initial Dose: 10 mg once daily (morning)

  • Titration: Increase to 20 mg after 1–2 weeks if well-tolerated.

  • Maximum Dose: 60 mg/day (if needed, under close monitoring).

3. How the Medication Works

  • Fluoxetine increases serotonin levels in the brain by blocking its reabsorption (reuptake inhibition).

  • Serotonin helps regulate mood, sleep, and appetite, improving depressive symptoms over time.

  • Full effects may take 4–6 weeks.

4. Duration of Treatment

  • Minimum: 6–12 months after symptom improvement to prevent relapse.

  • Long-term use may be needed if depression is recurrent (discuss with provider).

5. Common Side Effects

  • Early (first 1–2 weeks): Nausea, headache, insomnia, dizziness.

  • Later (usually subsides): Fatigue, dry mouth, sweating, decreased appetite.

  • Rare but serious: Increased suicidal thoughts (especially in first few weeks), serotonin syndrome (agitation, confusion, rapid heart rate).

6. Urgent/Emergent Considerations

  • Seek emergency help if:

    • Suicidal thoughts worsen.

    • Signs of serotonin syndrome (fever, tremors, confusion).

    • Allergic reaction (rash, swelling, difficulty breathing).

7. Directions for Use

  • Take in the morning (to avoid insomnia).

  • Can take with or without food (food may reduce nausea).

  • Do not stop suddenly—taper with doctor’s guidance.

8. Missed Dose Instructions

  • If missed, take as soon as remembered.

  • If close to next dose, skip the missed dose.

  • Do not double dose.

9. Drug Interactions to Avoid

  • Other SSRIs/SNRIs (risk of serotonin syndrome).

  • MAOIs (dangerous interaction—must wait 14 days between use).

  • NSAIDs (e.g., ibuprofen) (may increase bleeding risk).

  • St. John’s Wort (increases serotonin dangerously).

10. Foods to Avoid

  • Grapefruit juice (may increase fluoxetine levels).

  • Alcohol (worsens depression/side effects).

11. Follow-Up Appointment

  • First follow-up: 2–4 weeks after starting.

  • Monitoring: Assess mood, side effects, and suicidal thoughts.

12. Legal & Ethical Considerations

  • Informed consent required (parent/guardian involvement for minors).

  • Confidentiality balanced with safety (mandatory reporting if suicidal risk is high).

  • Off-label use risks (if higher doses are needed, document rationale).

13. Addressing Social Determinants of Health (SDOH)

Financial Barriers

  • Options if patient can’t afford medication:

    • Prescribe generic fluoxetine (lower cost).

    • Connect patient with patient assistance programs (e.g., Pfizer RxPathways).

    • Recommend sliding-scale clinics or community health programs.

Transportation Barriers

  • Solutions for appointment access:

    • Offer telehealth visits when possible.

    • Coordinate with school-based health services.

    • Provide prescriptions with longer supplies (90-day refills if stable).

Why SDOH Matters for Prescribers

  • Financial stress and lack of transportation can worsen depression and medication adherence.

  • Addressing these barriers improves treatment success and prevents relapse.

Provider Contact: [Your Name/Clinic Info] Emergency Hotline: 988 (Suicide & Crisis Lifeline)