Dienogest

Abstract

Major depressive disorder with suicidal ideation: case reportA 41-year-old woman developed major depressive disorder (MDD) with suicidal ideation during treatment with dienogest for endometriosis (EM).The woman presented to the psychiatric department due to depressed mood and insomnia. Six months prior to presentation, she had undergone left salpingo-oophorectomy for EM. She had received leuprorelin [leuprorelin acetate] for two months for the treatment of EM. Post-operatively, dienogest 2 mg/d was prescribed for 3 months to control EM symptoms [route not stated]. She had insomnia almost daily for 2 months since starting dienogest. On presentation, she reported sleep problems and feelings of depression, lethargy, hopelessness and anger. She had no pleasure or desire for daily life and had suicidal thoughts. She wept throughout the psychiatric interview and said that she was unable to control her weeping. She had no history of psychiatric disorders. Her physical or neurological examinations were unremarkable. The severity of depression and anxiety was evaluated by the following scales. The score on the Patient Health Questionnaire-9 and the Beck Depression Inventory scales indicated severe depression. The Beck Anxiety Inventory score indicated severe anxiety. Considering the progression of the mood symptoms related to medication and her personal history, the psychiatrist diagnosed her as a treatment-related severe MDD, single episode.The woman started receiving treatment with desvenlafaxine and zolpidem, and her dienogest was stopped. After two weeks, she showed significant improvement in the symptoms associated with MDD. She had a decreased frequency of crying spells and suicidal thoughts. Her desvenlafaxine treatment was switched to escitalopram due to high blood pressure [aetiology no stated] detected during the visit. At the 4-week follow-up, she was in a stable mood and could perform daily activities. However, some sleep problems persisted, although with no more suicidal thoughts. She was in a state of remission for MDD at the 16 weeks of psychiatric consultation and was on maintenance therapy for 9 months. Subsequently, the psychiatrist recommended discontinuation of the antidepressant medication.