SEVERE DEPRESSIVE EPISODE WITH INSOMNIA AND SUICIDAL IDEATION MANAGED WITH MULTIMODAL PHARMACOTHERAPY: A CASE REPORT

Dr. Mekla Anusha, Sahoo Monalisa, Uppari Sai Prasad

ABSTRACT

Background: Severe depression often presents with profound sleep disturbances, psychomotor retardation, and suicidal ideation, requiring a combination of pharmacological and psychotherapeutic interventions. Case Presentation: We report a case of a female patient presenting with severe depressive symptoms, insomnia, and suicidal thoughts. Her Hamilton Depression Rating Scale (HAM-D) score was 19 at presentation. She exhibited persistent low mood, reduced social interaction, and inability to sleep throughout the night. A combination pharmacotherapy regimen including haloperidol, promethazine, quetiapine, naproxen, zolpidem, tofisopam, and duloxetine was initiated to address mood symptoms, anxiety, insomnia, and psychomotor agitation. Outcome: Symptom stabilization and improved sleep were observed over the subsequent weeks, with gradual reduction in depressive features and suicidal ideation. Conclusion: This case highlights the therapeutic challenge in managing severe depression with insomnia and suicidality, underscoring the value of multimodal pharmacologic management and vigilant monitoring.

Keywords: Severe Depression; Insomnia; Suicidal Ideation; Duloxetine; Quetiapine; Case Report.