Darcey Ward is a 30-year-old accountant working in the City of London. She recently split from her husband and there was some uncertainty about her job, with a possible takeover and reorganisation of...

Darcey Ward is a 30-year-old accountant working in the City of London. She recently split from her husband and there was some uncertainty about her job, with a possible takeover and reorganisation of the company and her role. She was aware of feeling very stressed, being off her food, and sleeping poorly with vivid dreams, waking frequently, and not being able to get back to sleep after about 4 a.m. She started to feel that everything was “on top” of her and that she was no good at her job; she found herself crying every day. She didn’t enjoy her social life and was becoming short-tempered with her friends, but she thought she should force herself to “put on a brave face”. She visited her general practitioner (GP) who prescribed fluoxetine. After 3 months, there was little improvement in Darcey’s mental health and she requested a change of medication. Her GP switched her from fluoxetine to venlafaxine and asked her to come back for a checkup in 2 weeks. As Darcey got to know her GP a little better, she said that she had not been taking her medication every day because of the effect on her sex life. Her GP took a detailed alcohol history – Darcey said that she was drinking most nights, either entertaining clients or socially after work, and they estimated a total of over 50 units per week.

1. What neurochemical and receptor changes are associated with depression?

2. What factors in Darcey’s history may have contributed to her depression?

3. What type of antidepressant is fluoxetine? How does it act and what are the most common side effects of this group of antidepressants?

4. What type of antidepressant is venlafaxine and how does it act?

5. What is the evidence for the efficacy of antidepressants and what other types of therapy could Darcey try?