“Mr. A,” a 24-year-old man, presents for evaluation of worsening depression. He describes a history of depression since adolescence, although he notes that he suffered a troubled childhood, including emotional neglect. He believes a recent breakup and having been denied a promotion precipitated this episode. “I’m sleeping all the time, and my body feels heavy,” he adds. He also reports increased appetite, weight gain, and “urges to cut, which I have not done in years.” However, he remains social and actively involved in several hobbies. He discontinued bupropion and escitalopram in the past because of “terrible headaches and irritability.” Initially, you consider starting lamotrigine. However, your office recently implemented a clinical decision support system that recommends a trial of phenelzine. The patient’s symptoms remit entirely on the medication suggested by the system. Curious as to how the system decided on this treatment, you download several papers on its development.

“先生。A，”一名 24 岁的男子，因评估抑郁症恶化而就诊。他描述了自青春期以来的抑郁病史，尽管他指出自己的童年很痛苦，包括情感上的忽视。他认为最近的分手和被拒绝晋升促成了这一事件。“我一直在睡觉，我的身体感觉很重，”他补充道。他还报告说食欲增加、体重增加和“渴望减肥，这是我多年来从未做过的事”。然而，他仍然保持社交并积极参与多种爱好。过去，他因为“可怕的头痛和易怒”而停用了安非他酮和艾司西酞普兰。最初，您考虑开始使用拉莫三嗪。但是，您的办公室最近实施了一个临床决策支持系统，建议对苯乙肼进行试验。患者的症状完全取决于系统建议的药物治疗。对系统如何决定这种处理方式感到好奇，您下载了几篇有关其开发的论文。