A 42-year-old woman sees her physician because she has been depressed for the past three months. She also notes that she has gained 20 lb without trying to. She says that she does not take pleasure in the activities that she once enjoyed and seems fatigued most of the time. These symptoms have caused the patient to withdraw from many of the social functions that she once enjoyed. The physician diagnoses the patient with hypothyroidism and starts her on thyroid supplementation. Six weeks later, the patient’s thyroid hormone levels have normalized, but she still reports feeling depressed. Which of the following is the most appropriate next step in the management of this patient?
a. Recommend that the patient begin psychotherapy
b. Increase the patient’s thyroid supplementation
c. Start the patient on an antidepressant medication
d. Tell the patient that she should wait another six weeks, during which time her mood will improve
e. Take a substance abuse history from the patient
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care. Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is c; Start the patient on an antidepressant medication.
This patient is likely suffering from a mood disorder secondary to a general medical condition, characterized by a depressed mood and loss of interest in activities she usually enjoyed.
It is interesting to note that many of these mood disorders, especially those caused by an endocrine disorder, persist even after the underlying medical condition has been treated. In that case (and in the case described in this question), the physician should begin the patient on antidepressant medication.