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All Journal Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Jurnal Psikiatri Surabaya (Surabaya Psychiatry Journal)
Phernando, Nicholas Kevin
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Biochemistry, Genetics & Molecular Biology Education Health Professions Medicine & Pharmacology Public Health

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Treatment of Depression With Psychotic Features in Maltreated Adolescents: Evidence-Based Case Report Setiawan, Feronia Augustine; Phernando, Nicholas Kevin; Ulya, Zuhrotun
Jurnal Psikiatri Surabaya Vol. 12 No. 2 (2023): November
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jps.v12i2.37125

Abstract

Introductions: Depressive disorders are expected consequences of experiencing child maltreatment. Many depressive disorders can occur with or without psychosis, which has different implications for treatment and prognosis. This condition raises the challenge of treating depression in maltreated adolescents because the patient has inadequate family and social support. Consequently, it is difficult for the patient to undergo psychotherapy that involves family.  Case: A 17-year-old female was diagnosed with psychotic depression. The patient had symptoms of depression, accompanied by hallucinations, since five years ago. The patient was hospitalized for suicidal ideation and food refusal for days. Patient had a history of child maltreatment by family and experienced bullying since elementary school. Patient believes that her family, especially her mother, had hated her from the beginning. Discussions: After stabilization of the patient's general condition, psychopathology exploration was done together with selection of appropriate treatment. Combined Cognitive Behavioral Therapy (CBT), Selective Serotonin Reuptake Inhibitor (SSRI) and atypical antipsychotic treatment are the evidence-based treatments for psychotic depression in maltreated adolescents. Studies involving patients with psychotic depression which were treated by combination of sertraline and olanzapine showed significant improvement of depression and psychotic symptoms and reduced the risk of relapse over 36 weeks, compared to sertraline plus placebo. Conclusion: Combination of SSRI, atypical antipsychotic and CBT with a trauma-informed approach should be considered as treatment for psychotic depression in maltreated adolescents.
Laporan Kasus Berbasis Bukti: Depresi pada Epilepsi Putri, Frilya Rachma; Runtuk, Kresna Septiandy; Ghaydaqila, Calista Felicia; Phernando, Nicholas Kevin
Majalah Kedokteran Indonesia Vol 75 No 5 (2025): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.75.5-2025-1578

Abstract

Introduction: Depression affects approximately 22.9% of people with epilepsy (PWE), substantially higher than the general population. This comorbidity is mediated by complex neurobiological mechanisms including neuroinflammation, GABA-glutamate imbalance, and hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and is further exacerbated by psychosocial stigma.Case Presentation: We report the case of a 19-year-old woman with epilepsy diagnosed at age 6 who had been treated with phenytoin for 12 years. She developed depressive symptoms following prolonged bullying and social stigma, presenting with persistent sadness, anhedonia, self-harm behaviors, and subsequent psychotic features. Initial management included sertraline and aripiprazole. A drug-drug interactions between sertraline and phenytoin resulted in ataxia and gait imbalance, necessitating a switch in antiepileptic therapy to levetiracetam, carbamazepine, and clobazam.Methods: A systematic literature review using PubMed, Cochrane, and Google Scholar databases, focusing on studies published between 2018 amd 2023 evaluating antidepressant treatment in PWE.Result: Selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line treatment for depression in epilepsy (recommendation level B). Venlafaxine reduced Hamilton Depression Rating Scale (HAMD) scores by 7.59 points compared with no treatment (RR 3.25; 95%CI 1.19–8.90; NNT = 4). Paroxetine versus doxepin demonstrated an RR of 1.16 (95%CI 0.88–1.52; NNT = 9), while amitriptyline versus nomifensine showed an RR of 0.55 (95%CI 0.28–1.06; NNT = 3). SSRIs (sertraline or citalopram) reduced Beck Depression Inventory (BDI) scores by 4.90 points compared with cognitive behavioral therapy.Conclusion: SSRIs are effective to reduce depressive symptoms in PWE, with venlafaxine representing a viable alternative for non-responders. However, clinicians should carefully consider potential drug-drug interactions, particularly CYP450 enzyme inhibition, which may increase antiepileptic drug levels and require dose adjustments and close monitoring.
Co-Authors Ghaydaqila, Calista Felicia Putri, Frilya Rachma Runtuk, Kresna Septiandy Setiawan, Feronia Augustine Ulya, Zuhrotun