107) A 24-years old man with history of Hepatitis C is brought to the ER with history of attempted suicide by cutting his veins with a knife. His family members spotted him while trying to cut his wrist and could save him. He was immediately admitted to psychiatric ward of the hospital. On examination, his vitals are stable. The patient appeared very depressed. The wrist was bandaged and there is no significant bleeding. The patient has a history of depression for the past three years which was adequately controlled on Fluoxetine. Laboratory investigations revealed ALT: 95 IU/ml , AST: 65 IU/ml, , Hemoglobin: 15.2 gr/dl, Platelet count: 345000/ml, WBC count: 6500/ml. Approximately 4 weeks ago, the patient was diagnosed with HCV infection after screening due to intravenous drug addiction history. At that time, HCV – RT PCR was positive, HIV ab and Hepatitis B Surface antigen were negative. The patient was started on Interferon and ribavirin for Hepatitis – C infection. The patient denied any recent drug use. He has been compliant with his Fluoxetine. He reports increased suicidal thoughts over the past few days. The most important next step in controlling this patient’s depression :
A) Electroconvulsive therapy
B) Discontinue Fluoxetine
C) Start Cyproheptadine
D) Discontinue Interferon
E) Start Clozapine to reduce suicidal tendency
B
Anti deppressants are notorious for increasing suicidal ideations in young adults.
D
Interferon can induce depression
D
d- more likely
ddd
The pt. has suicidal ideation, shouldn’t he be treated with ECT ,answer A
Discontinue interferon as it can induce or add on to depression that is why before starting interferon the pt is asked about depression and also sometimes psychiatric consultation is recommended