7 hours ago Lydia Asafo-Agyei
Initial Post- The man whose antidepressants stopped working
The Impact of Ethnicity on Antidepressant Therapy
Major depression is a mood disorder that affects a person’s ability to think, target their daily activities including, eating and working. Depression can occur at any age but most commonly develop in adulthood. Treatments are mostly with psychotropic medications such as antidepressants, and patients are encouraged not to stop taking them unless instructed by their healthcare provider (National Institute of Mental Health, 2018). According to Sansone and Sansone (2012), depression can be relatively difficult to treat, and patients’ adherence to prescribed antidepressant therapy is very critical for the effective management of the disorder. Research demonstrates 50% of patients stop their medications prematurely, nearly six months of initiation based on factors such as fear of addiction, lack of quality education, forgetting to take medication, poor follow up as well as side effects associated with antidepressants (Sansone & Sansone, 2012).
I chose case study # one: The man whose antidepressants stopped working. The patient is a 63-year-old married man with three children, and he is experiencing severe depression and anxiety.
Target Questions for the Patient
What factors precipitate your depression? The patient knowing the trigger factors is essential to help avoid them as possible for example, if it is stress patient may be encouraged to take measures to control these stressors.
When you feel like your depressive symptoms are under control, do you stop taking your antidepressant without consulting your healthcare provider? It is important to note that patient history indicates he has not been adherent with his antidepressants, for example, he stopped taking Venlafaxine XR, which was working for him within one year of initiation (Stahl, 2013), so assessing the reasons for non-adherence will help plan care.
Do you have difficulty remembering to take your medications?
Knowing some of the hindrances of the patient taking his medication will help the provider to collaborate with the patient and family to schedule medication at a convenient time, or if possible, with other medication times, which will help him be compliant.
Target Questions for the Patients’ Wife
Do you know the medications your husband is taking, and for what reasons he takes them? Assessing a family members’ knowledge on patients’ medication helps the nurse practitioner (NP) to know the support system of the patient with regards to the medication monitoring, side effects as well as any changes which may occur which they can report in case the patient missed them.
Have you noticed your loved one giving away their valuable possession or express any sign of harming himself? It is vital to evaluate patients on antidepressants for suicidal thoughts and behaviors because it is a common side effect associated with taking antidepressant medications (Stahl, 2013).
Do you have weapons at home, and if yes, are they secured? This question helps the NP to educate the family on safety measures in securing weapons in a lock.
Physical Examination and diagnostic tests
Assess for signs and symptoms such as anxiety, sad mood, a feeling of hopelessness, slow movement and talking, difficulty concentrating and remembering, loss of appetite, and weight (National Institute of Mental Health, 2018). The severity of the symptoms helps determine the stage of the illness and the type of medication to prescribe. Laboratory tests, including a complete blood count (CBC) and thyroid testing, may be ordered to rule out anemia and thyroid disease as a cause of the disorder. Also, a depression screening/test is done to identify the type of depression (U. S. National Library of Medicine, 2016).
Organic conditions such as hypothyroidism
Drug-induced mood disorder
A bipolar disorder-A patient with major depression exhibiting the mood of sadness, motor retardation, hypersomnia, and suicidal thoughts are usually comparable to the signs and symptoms experienced by a patient in a depressive episode of bipolar disorder (ULifeline, n.d.).
Pharmacological Agents and Contraindications Based on Ethnicity
Zoloft would have been a great choice of antidepressant for this patient but his past medication history review he was on this medication which was on and of successful and patient was non-adherent to it because of the side effect of sexual dysfunction (Stahl, 2013). I will recommend Cymbalta (Duloxetine) 30mg orally once daily for the first two weeks and titrate to 60mg once or twice daily, the recommended dose of an adult patient (Drugs.com, n.d.). Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI), which is effective in the treatment of a major depressive disorder (MDD) and generalized anxiety disorder (GAD). The medication works on restoring chemical balance in the brain by increasing dopamine neurotransmission (Stahl, 2013). Any monoamine oxidase inhibitor patient is on must be stopped for 14 days before starting the patient on Cymbalta (Drugs.com, n.d.).
I will also start the patient on Seroquel 25mg orally twice daily. Seroquel is known to be used in combination with antidepressants for treating depression (Stahl, 2013). According to Drugs.com (n.d.), in the older population, Seroquel is recommended to be started at a lower dose and titrate as tolerated in older adults. It is metabolized by the liver and excreted in urine. It works on multiple receptors in the brain to reduce psychotic symptoms, and this may help patients sleep patterns as well as anxiety. However, using Seroquel in combination with Cymbalta may increase the risk of confusion, concentration, and drowsiness especially, in older adults, therefore, it is essential to teach patients to avoid alcohol as well as operating hazardous machinery after taking medications (Drugs.com, n.d.). The patient is on Aspirin, and Cymbalta increases the risk of bleeding (Drugs.com, n.d.), so teach the patient to report any sign of bruising or active bleeding noted. There has not been any specific contraindication of Cymbalta and Seroquel concerning ethnicity or race (Drugs.com, n.d.).
In a follow up at four weeks, the NP should monitor the patient blood pressure and triglyceride levels, as Seroquel can lower blood pressure and with a high risk of metabolic complications (Stahl, 2013).
Lessons Learned from the Case Study
Patients with MDD most often are on antidepressants for the rest of their lives for the management of the disorder, and the body may be resistant to some of these medications, which may need readjustment and monitoring often. Sansone and Sansone (2012) analyze that because of high patient non-adherence to antidepressants, it is crucial as health care professionals to involve patient and family before the initiation of medication, teach them on side effects and the need to report any suicidal thoughts, explore questions that they may have, and encourage regular follow-ups.
Drugs.com. (n.d.). Retrieved from https://www.drugs.com/
National Institute of Mental Health. (2018). Depression. Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml
Sansone, R. A., & Sansone, L. A. (2012). Antidepressant adherence: are patients taking their medications? Innovations in clinical neuroscience, 9(5-6), 41–46. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398686/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix-x
ULifeline. (n.d.). What is the difference between bipolar depression and depression? Retrieved from http://www.ulifeline.org/articles/399-bipolar-depression-vs-unipolar-depression
U. S. National Library of Medicine. (2016). Depression. Retrieved from https://medlineplus.gov/depression.html
PLEASE REPLY WITH 3 ARTICLES CITE PROPER APA
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we\'ll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.