From millionaire to zero and back again. A case report of specific difficulties in pharmacotherapy of a person who during COVID-19 pandemic lost high material and social position

Depression is a heterogeneous disease. Although the classification systems of mental disorders indicate a relatively uniform clinical picture of the depressive syndrome it is worth being aware that diverse processes may precede emergence of symptoms.

The paper describes a case of a patient who, during the COVID-19 pandemic, lost his business, which previously provided him with a high social and material position. As a result, he developed symptoms of depressive episode. As a result of consultations preceding the initiation of pharmacotherapy, and then treatment with vortioxetine 10 mg daily, the patient’s well-being and functioning improved. A few months later, the patient again achieved a high material position by engaging in business ventures.

Persons who lose high status sometimes experience specific problems. Their self-esteem is lowered to a level where they feel completely worthless, self-destructive tendencies and sometimes suicidal thoughts and actions appear. Therefore, in the process of initiating psychiatric help for these people, it is necessary to take into account their specific situation and the specificity of problems. This requires both more time devoted to initial consultations and the selection of pharmacotherapy appropriate to the patients’ needs.

Specific difficulties in the treatment of people who have lost their high status are often not properly recognized, which may lead to chronic symptoms or adverse events in the patient’s life.