jabbrv-ltwa-all.ldf jabbrv-ltwa-en.ldfPatient 1
Patient 1 is a 57-year-old male who first came into contact with psychiatry at age 33, presenting with depressive symptoms including rumination and social withdrawal. He was diagnosed with major depressive disorder (MDD, Table 1). He also had a childhood onset of anxiety and was diagnosed with GAD in adulthood. Over time, the depressive symptoms worsened, leading to suicidal ideation, and he was hospitalized after a suicide attempt. He subsequently developed alcohol and benzodiazepine dependence, requiring treatment from an addiction psychiatry unit. Despite achieving three years of remission from alcohol and benzodiazepine use disorder, the depression and anxiety symptoms persisted, continuing to meet the criteria for MDD and GAD. Patient 1 also had a history of thyrotoxicosis and underwent a thyroidectomy at age 38. He later developed type II diabetes mellitus, \soutand sarcoidosis and suffered from chronic lumbar pain.
Throughout his contact with specialized psychiatric care, he tried numerous medications for depression and GAD, including antidepressants (paroxetine, mirtazapine, citalopram, escitalopram, tranylcypromine, and venlafaxine), lamotrigine, and lithium, all with insufficient antidepressant effect. Electroconvulsive therapy (ECT) was administered on three separate occasions, providing only temporary relief of symptoms lasting from a few hours to a few days. He also underwent several rounds of psychotherapy and physiotherapy treatments. Over the years, benzodiazepines (e.g. oxazepam, alprazolam), pregabalin, and gabapentin were prescribed for anxiety symptoms, but without long-lasting effects. Ultimately, due to the severity and treatment-resistant nature of his depressive and anxiety symptoms, he was referred for DBS.