The A 40 Year Old Woman Presents With Fatigue

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A 40-year-old woman presents with fatigue. She has felt very run down for the past 3 months and has had no interest in participating in her usual activities and sporting events. She has had sleeping problems and low appetite. She is constantly feeling low and has frequent crying spells. Her physical examination is normal and thyroid function is normal. She is diagnosed with major depression and is referred for counseling and started on fluoxetine.

• What is the mechanism of action of fluoxetine? Fluoxetine is an “antidepressant belonging to the selective serotonin reuptake inhibitor (SSRI) class of drugs used mainly for the treatment of major depression, obsessive-compulsive, disorder, and panic disorder”(Nordqvist, 2014, p. 1). SSRI work by increasing the levels of serotonin, norepinephrine, and dopamine in the brain. Serotonin is a “neurotransmitter that regulates several aspects of brain function such as mood, sleep, and emotion”(Mandal, 2014, p. 1). Fluoxetine works by blocking the absorption (reuptake) of serotonin, which helps to regulate and stabilize mood. “Since uptake is an important mechanism for removing released neurotransmitters and terminating their actions on adjacent nerves, the reduced uptake caused by fluoxetine increased the free serotonin that stimulates nerve cells in the brain”(Ogbru, 2014, p. 1).
• Why is fluoxetine the drug of choice? This medication is the drug of choice for this patient since the use in treating depression is well established.

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