Author name: Zoë Kopp

How do you counsel patients about taking medications for depression during pregnancy?

Sophia is a 33-year-old woman with a history of major depressive disorder (MDD). She is currently euthymic and taking sertraline 100mg daily. She has had 3 lifetime severe major depressive episodes and has taken sertraline on and off for the past 13 years. She has never participated in psychotherapy. During your most recent visit, she tells […]

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How do you manage the side effects of SSRIs?

What do you do when a patient taking an SSRI presents with anorgasmia, bruxism, or hyponatremia? Firstly – believe your patient. Your 60 yo may experience an increase in suicidal thoughts even though the textbook says that she shouldn’t. In general, your options for managing side effects from medication are: The balance between the medication benefits

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How do you get started with patients with chronic pain?

Dr. Link is a 35-year-old primary care physician, who recently joined an academic faculty practice in a new city. Today, she is seeing Martha, a 70-year-old woman, who has been cared for by this clinic for >10 years. She has chronic pain in her back from osteoarthritis, diabetes (A1c 7.5), obesity, depression, hypertension, and sleep

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How do you counsel an older patient about the risks of benzodiazepines?  

Mr. Davis is a 75-year-old man with a history of hypertension, type 2 diabetes (A1c 6.8), and insomnia. He recently moved to be closer to his grandchildren and is establishing primary care with you. His medications are amlodipine 10 mg daily, metformin 500 mg twice daily, semaglutide 1 mg weekly, atorvastatin 40 mg daily, and

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How do you treat insomnia with medications if CBTi doesn’t help?

Part 2 of “When the sheep are gone, how do you treat insomnia?” In a prior PsychSnap, we met Ms. Rose, a 65 year old woman with diabetes who is the primary caregiver for her adult son. She has been struggling with sleep maintenance, waking up multiple times in the middle of the night and taking 30-90

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How can we help depressed but not (majorly) depressed patients?

Eric is a 60 year old man presenting with a depressed mood, low energy, and low appetite for the past 2 months. He notes increasing conflict with his partner, but no anhedonia, insomnia, difficulty concentrating, or thoughts of worthlessness or suicide. A year ago, he experienced a depressed mood and low energy for 2 months that

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Is this physician experiencing burnout or something else?

A 35-year-old intensivist feels powerless and guilt-ridden. At times, her senses are heightened, and at other times, she feels numb. Sometimes when she is speaking with patients’ family members, she feels like she is no longer present in her body.  She currently has a patient who is dying of liver failure, and despite multiple phone

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How long should a patient with recurrent major depressive disorder continue their antidepressant?

Your patient is a 40 year old woman with a history of recurrent major depressive disorder. When she presented initially, she was feeling low, with decreased motivation, poor concentration, low energy, trouble sleeping, and thoughts of death. She had no plans to hurt herself. You referred her to therapy and started escitalopram, titrated to 10mg daily. At

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