Adult and Geriatric Antidepressant Therapy Prescribing Essay

Adult and Geriatric Antidepressant Therapy Prescribing Essay

Adult and Geriatric Antidepressant Therapy Prescribing Essay

 

Among the elderly, depression has been associated with several negative impacts to both the patient and his or her family members. It is the role of the healthcare workers to familiarize themselves with depression’s causative variables to be able to identify patients who may require screening with instruments like Montgomery- Asberg Depression Rating Scale (Vuorilehto, Melartin, Riihimäki, & Isometsä, 2016). A clear understanding of the depression symptoms among the elderly forms the first basis for the development of appropriate interventions and the best choice of drugs to include in a patient’s care plan. The choice of a drug depends on its effectiveness and safety profile. Nonetheless, when the first choice seems to fail, an alternative drug within the same class might be combined with the first drug, or the medication can be entirely replaced. At this point, the nurse might consider a psychotherapeutic approach (Cowen, 2017; Stahl, 2013). Depression is diagnosed differently since the condition exists on varied scales. Thus, inasmuch as pharmacotherapy and psychotherapy are the main interventions used to manage the condition, electroconvulsive intervention might be considered in severe cases of depression. In the current paper, the case scenario provided is of a 31-year-old Hispanic man who was diagnosed with a severe depressive state, as per his scores on the Montgomery-Asberg Depression Rating Scale, which was 51. All the options of drug regiments that can be utilized in managing the patient’s symptoms of depression will be revealed in the present discussion. As a result, the analysis of this case will offer a comprehensive understanding of the therapeutic management of depression among geriatrics.

Decision Point One

Selected Decision

Begin Zoloft 25 mg OD

Reason for Selection

The first line choice of drug for the treatment of depression is usually Zoloft, which belongs to the broad class of SSRIs. The Hispanic male patient was diagnosed with severe depression as per the scale that was used. Hence, the best choice of drug, in this case, based on the provided options, is Zoloft. The drug has proven to be the most effective and safest compared to other SSRIs (Polatin, Bevers, & Gatchel, 2017: Stahl, 2014b). On the other hand, the PMHNP can only recommend phenelzine if Zoloft, among other drugs, has proven to be ineffective, but not as a first line choice of treatment. Further, Effexor XL is usually associated with several side effects and should only be used as a last resort.

Expected Results

Most studies show that the effects of Zoloft start showing after continuous use for at least 14 days. By the end of week two, the drug should have been able to improve the patients sleeping patterns and concentration. Generally, most of the patient’s symptoms will be relieved after two weeks of using the drug (Coplan, 2015). Additionally, the patient should be able to interact appropriately with other people by this time with a reduced recollection of past mistreatments showing.

Differences between Expected Results and Actual Results

The patient came back to the hospital after two weeks with a 25% reduction of the depression symptoms just as expected by the PMHNP. However, the patient reported erectile dysfunction, which is one of the side effects of Zoloft. This effect was however not anticipated by the PMHNP since erectile dysfunction is usually very rare as compared to other side effects of Zoloft (Cipriani et al., 2016).

Decision Point Two

 Selected Decision

Add augmenting agent such as Wellbutrin IR 150 mg in the morning

Reasons for the Selection

After two weeks, the patient responded appropriately to Zoloft with a 25% reduction in depression symptoms. However, he also reported signs of erectile dysfunction, which needs to be addressed if the patient continues using the drug. In this case, the best

intervention would be to include Wellbutrin, which is an effective augmenting agent that helps in the management of Zoloft induced erectile dysfunction. The two-drug combination therapy has been used over the years to prevent drug-induced erectile dysfunction in young and elderly men (Linde, Kriston, & Rucker, 2015). The other drugs provided for this case study cannot be used as they do not have the required pharmacological activity to manage erectile dysfunction. In this scenario, Wellbutrin will be administered slowly at first, while slowly withdrawing Zoloft, to be able to correct the erectile dysfunction as the depression symptoms of the patients are managed as well. Consequently, low doses of Zoloft are ineffective, hence cannot be recommended by the nurse. Continuous use of the drug might also worsen the erectile dysfunction among other side effects; hence, it is best to withdraw the use of Zoloft.

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Adult and Geriatric Antidepressant Therapy Prescribing Essay

Expected Results

Augmentation of Zoloft with Wellbutrin is expected to reduce the erectile dysfunction side effects. The depression symptoms of the patient are also expected to reduce even further from the results of the first two weeks. A combination therapy comprising of Wellbutrin and Zoloft has shown great synergism in the past, with one drug boosting the effect of the other, hence having maximum benefit in the management of depression (Linde, Kriston, & Rucker, 2015). At the end of the treatment period, the patient should negligible depression symptoms with resolved erectile dysfunction.

Differences between Expected Results and Actual Results

The patient came back to the hospital later, after the introduction of Wellbutrin, with positive results. His erectile dysfunction had been resolved. He also claimed that he felt better, with significantly reduced symptoms of depression. This was precisely what was expected after the intervention. The patient, however, complained of a feeling of nervousness and jittery in some cases (Arroll et al., 2016). This was not strange as they are the main side effect of most antidepressants. In this case, both Zoloft and Wellbutrin could have been the reason behind these side effects. The synergistic effect on the dose of both drugs could have been a factor that led to these symptoms.

Discussion Point Three

Selected Decision

Change Wellbutrin to XL 150 mg orally daily in AM

Reasons for the Selection

During follow up assessment, the patient only reported signs of jittery, as the side effect of the combination therapy. Both the antidepressants can cause this side effect. However, the side effect most likely came as a result of Wellbutrin’s mode of release, given that the drug is formulated as an immediate release. Hence, the most appropriate intervention, in this case, is to change the formulation of Wellbutrin to extended release, instead of slow release, to track down the main cause of the jittery feeling displayed by the patient. The slow release formulation has also proven to be effective in managing depression symptoms (Linde, Kriston, & Rucker, 2015). Ativan should be avoided, as the introduction of a new pharmacological agent as a result of the side effects of another drug is greatly discouraged. Moreover, withdrawal of Zoloft is also not necessary as the drug is not the reason behind the displayed side effects.

Expected Results

If the feeling of jittery was as a result of the Wellbutrin’s immediate release formulation, then the formulation change to extended-release should be able to resolve the problem. The depressions symptoms will be reduced even further as both drugs are maintained. The patient’s confidence will be improved once the jitteriness has been resolved, which is one of the main goals of the intervention. Additionally, other symptoms of depression are expected to be entirely resolved by the end of the prescribed duration.

Differences between Expected Results and Actual Results

The treatment outcome of the patient was consistent with the nurse’s expected results. Just like the intervention made by the PMHNP nurse, most side effects are usually managed by altering the formulation of the drug first, rather than changing the drug regimen. Introduction of another drug, or replacing the existing one, could result in other side effects which will also become a problem (Linde, Kriston, & Rucker, 2015).

Impact of Ethical Consideration on Treatment Plan

From an ethical perspective, the management of depression using the most appropriate antidepressants surpasses the administration of other drugs. It is the moral obligation of the PMHNP nurse to provide the patient with adequate information on the drugs used in terms of both the benefits and side effects. Consequently, before picking on a specific drug to use, the nurse is obliged to utilize the patient’s past medical history and comprehensively evaluate the prompt diagnosis. The nurse must also inform the patient about the reasons behind the use of different pharmacological agents (Lee, 2013). On the other hand, the nurse needs to be aware of the hopes of the patient, what motivates them and their most significant concerns, to create a root basis for psychotherapeutic interventions in addition to pharmacological especially in the management of specific depression symptoms. Consequently, concerning evidence-based practice, drugs with high suicidal risks should be eliminated from the patients care plan.

Conclusion

Depression can cause substantial impacts on the patient’s social and economic status, in addition to that of their family. Hence, the management of this condition should be taken very seriously with proper diagnostic assessment methods to be able to come up with the most appropriate intervention. Additionally, the choice of drugs for such cases are usually based on several factors and might even require altering in the course of treatment depending on the treatment outcome. Other pharmacological agents in addition to psychotherapy might also be used in the management of depression.

Adult and Geriatric Antidepressant Therapy
To prepare for this Assignment:
•
Review this week’s Learning Resources. Consider how to assess and treat adult and geriatric clients requiring
antidepressant therapy.
The Assignment Examine Case Study: An
Elderly Hispanic Man with Major Depressive
Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client.
Be sure to consider factors that might impact the client’s pharmacokinetic and
pharmacodynamic processes.
•
At each decision point stop to complete the following :
•
Decision #1
o
Which decision did you select?
o
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o
Explain any difference between what you
expected to achieve with Decision #1 and the
results of the decision. Why were they different?
•
Decision #2
o
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o
Explain any difference between what you
expected to achieve with Decision # 2
and the results of the decision. Why were they different?
•
Decision #3
o
Why did you select this decision? Support your response with evidence and references to the Learning Resources.
o
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
o
Explain any difference between what you
expected to achieve with Decision #3 and the
results of the decision. Why were they different?
© 2015
Laureate Education, Inc.
Page 13 of 45 Week 3
Adult and Geriatric Antidepressant Therapy
•
Also include how ethical considerations might impact your treatment plan and communication with clients.
Note:
Support your rationale with a minimum of three academic
resources. While you may use the course text to support your rationale, it will not count toward the resource requirement