The Impact Of Ethnicity On Antidepressant Therapy Essay.
TO REPLY 1 COMMENT TO EACH POST WITH CITATION AND TWO REFERENCE EACH COMMENT APA ABOVE 2013.
POST 1
Three Questions for the Patient
After reviewing the material presented in this case study, there are some concerning questions regarding this patient’s psychiatric history. Additional questions would include:The Impact Of Ethnicity On Antidepressant Therapy Essay.
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After each discontinuation of medication after an episode of depression, was this decision the choice of a physician or self -initiated? This question would provide knowledge of the patient’s medication compliance. For example, does the patient stop taking prescribed medication on symptoms are alleviated?
What were the circumstances prior to each depressive episode? his question would enlighten the practitioner on triggers and factors that personally affect the patient before a depressive episode occurs.The Impact Of Ethnicity On Antidepressant Therapy Essay.
There appears to be history of alcohol abuse and depression in your family, has anyone in your family received treatment? This question would provide a view into the patient’s understanding of psychiatric treatment. Since the patient does not believe in psychotherapy due to religious reason, the patient may not know what treatments were, are or will be available to him. The Impact Of Ethnicity On Antidepressant Therapy Essay.
Feedback from People in Patient’s Life
The patient has been married for 33 years. Assuming his spouse is around before, during and after an episode, she may provide information the patient failed to share or may not have been honest about. The first person to be questioned would be the patient’s wife. Some of the questions for the patient’s wife would include onset of symptoms. What occurs before each episode of depression? Is there conflict between you and your spouse? Are there any stressors, such as financial plaguing your spouse and you? The Impact Of Ethnicity On Antidepressant Therapy Essay.
The patient also has three children. All three of his children suffer from some form of depression. Questioning the patient’s children may provide a historical history of the patient. For example, the children may have noticed symptoms leading to the patient’s depression years ago. Questions for the children may include did your parent’s argue often while you were growing up? Did your father ever lose interest in your childhood years? Did you feel love or rejection while growing up from your father? What were your father’s behaviors? Did you ever notice any alcohol or drug abuse while growing up?
Physical and Diagnostic Exams for Patient
Unfortunately, there is not a certain test for depression. The primary goal of physical exam and diagnostic testing would to rule out other conditions causing similar symptoms. A physical exam should be preformed assessing respiratory and cardiovascular system. Vital signs should be taken as well.
Certain labs should be assessed in the patient. The practitioner should check the patient’s thyroid levels. Thyroid hormones have been linked to depression (Stahl, 2008). Depression can be caused by an underactive or overactive thyroid.
Another lab test to consider would be dexamethasone suppression test. This test assesses the negative affect of dexamethasone. Once given dexamethasone, in a small dose, cortisol levels are decreased in healthy adults, but may remain elevated in depressed patients (Smith, et al., 2013). The Impact Of Ethnicity On Antidepressant Therapy Essay.
Depressive disorders have been linked to certain inflammatory biomarkers. This blood test assesses nine biomarkers, alpha-1 antitrypsin, apolipoprotein CIII, BDNF, cortisol, epidermal growth factor, myeloperoxidase, prolactin, resin, and soluble tumor necrosis factor α type II. These biomarkers represent the inflammatory and metabolic pathways associated with depression (Serra et al., 2015). The Impact Of Ethnicity On Antidepressant Therapy Essay.
Three Differential Diagnosis
Based on the symptoms listed by the patient, there a multiple diagnosis this patient could be suffering from. Recurrent Major Depressive Disorder with melancholic features. This diagnosis is due to the patient’s major depressive symptoms, such as depressed mood most of the day, increased anxiety, and suicidal thoughts (Zaninotto et al., 2016). The specifier of melancholic features is based on the patient’s symptoms being worse in the morning, inability to function and lack of pleasure (Zaninotto et al., 2016). Other diagnoses for the is patient could be a thyroid imbalance or panic disorder
Two pharmacologic agents
Since this patient has become resistant to first line and second line drug therapy for depression, Phenelzine, an MAOI should be started for this patient. Phenelzine 45mg daily, divided into three doses throughout the day. Another suggestion for this patient would be Isocarboxazid. The dosage would start at 10mg BID, if tolerated the dosage could increase to another 10mg every 2-4 days until the dosage of 40 mg was achieved with tolerance. If therapeutic response is achieved, this medication should be slowly decreased without affecting therapeutic response (Arcangelo et al., 2013). Due to the pharmacokinetics and pharmacodynamics of Isocarboxazid, Phenelzine, should be prescribed to this patient. Since there is an increased to patients who have cardiac issues such as atrial fibrillation. The pharmacodynamics of Isocarboxazid are not clearly understood, but this may be due to the inhibition of MAO to the heart (Drugs, 2018).
MAOIs and Ethnicities
With many MAOIs, hypertensive crisis is a major concern for nay race. Since minorities are diagnosed with hypertension at higher rates, this causes a greater concern. This is the reason for a tyramine restricted diet. Foods such as aged chees, yeast and tap beer should be avoided ()
Changes in Therapy
After review of further data with this patient, changes would not be made to the suggested treatment. The Impact Of Ethnicity On Antidepressant Therapy Essay.
Lessons Learned
Throughout this case study many lessons were present. The lesson of medication compliance was the first lesson learned. Another lesson learned was the lesson of proper medication selection in a patient, especially after a recurrent episode of depression. Assessment and presentation of psychiatric treatment for patients was another lesson learned from this case study. The Impact Of Ethnicity On Antidepressant Therapy Essay.
Conclusion
In conclusion, this case study involved a 63-year-old male with recurrent depression. The patient has had success and failures with medication and treatment. These failures may be due to medication compliance or improper cessation of medications from a physician. After two years, the patient is finally on the right track. Hopefully, this will continue.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Three questions that I might ask our patient are:
- Tell me when you take your medication? [The reason for this question is to establish his adherence to his medication. Tachyphylaxis aka poop out, may occur due to medication nonadherence. It is therefore important to assess if the client is experiencing tachyphylaxis related to medication nonadherence] (Targum, 2014). The Impact Of Ethnicity On Antidepressant Therapy Essay.
- Do you feel a lack of motivation about life? [The Rothschild Scale for Antidepressant Tachyphylaxis suggests a conceptualization of antidepressant tachyphylaxis that is characterized by symptoms of apathy.] (Targum, 2014).
- Are you experiencing patterns of sleep disturbance? [This is also a symptom of poop out. It is important to assess these symptoms in order to proceed with his plan of care. Another important question is to assess the client for is substance abuse which was already addressed within the case study.) The Impact Of Ethnicity On Antidepressant Therapy Essay.
According to our case study, our client is a 69-year-old retired male who is married with children and grandchildren. In my opinion, it would be most important to speak to those that are the closest to him (his wife) who can observe him for any signs of activation of bipolar disorder such as: lack of impulse control, irritable and agitated mood lasting longer than a week (Bail, Dains, Flynn, Solomon, & Stewart, 2015). Activation of bipolar disorder would require his antidepressant to be discontinued and switched to a mood stabilizer (Stahl, 2013).
Physical exams and diagnostic tests relevant to our client’s care would be testing his blood pressure before/during initiating treatment and testing for plasma levels of O-desmethylvenlafaxine (ODV) which is an active metabolite of venlafaxine formed as a result of CYP450 2D6 (Stahl, 2013). Plasma levels of ODV will determine if the provider may safely increase his dose based on results. It is imperative to assess our client’s blood pressure related to the effects of the norepinephrine in the SNRI. Based on the check points for his first follow up, I would have changed his phone follow up to a face to face follow up to assess our client better and would have ordered his plasma ODV sooner to properly assess the effectiveness of his medication therapy.The Impact Of Ethnicity On Antidepressant Therapy Essay.
According to the American Psychiatric Association (2013), three differential diagnoses that I am giving our client are: 1. mood disorder due to another medical condition 2. Sadness 3. Adjustment disorder with depressed mood. The one that I think is more likely is sadness. My thought is sadness because our client’s history from the case study reveals a long, waxing and waning major depressive episode where he feels like he is out of options (Stahl, 2013).The Impact Of Ethnicity On Antidepressant Therapy Essay.
Two pharmacologic agents that would be appropriate for our client’s therapy would be Mirtazapine 15 mg PO nightly or Bupropion 75 mg PO BID. Bupropion is an NDRI which is a good augmenting combination with Venlafaxine. It is a powerful enhancer of noradrenergic action. Mirtazapine is a dual serotonin and norepinephrine combination which also works well with Venlafaxine but it may further increase his high cholesterol; for this reason, I would choose the Bupropion.
Lessons that I learned from this case study are certain drugs may not be as effective due to noncompliance, pharmacokinetic failures or even genetic variants. I have also learned the seriousness of how severe depression can be and the importance of knowing not necessarily all of the drugs out on the market for depression but more so the pharmacokinetics and pharmacodynamics of how they work.
The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
After reviewing the material presented in this case study, there are some concerning questions regarding this patient’s psychiatric history. Additional questions would include:The Impact Of Ethnicity On Antidepressant Therapy Essay.
After each discontinuation of medication after an episode of depression, was this decision the choice of a physician or self -initiated? This question would provide knowledge of the patient’s medication compliance. For example, does the patient stop taking prescribed medication on symptoms are alleviated?
What were the circumstances prior to each depressive episode? his question would enlighten the practitioner on triggers and factors that personally affect the patient before a depressive episode occurs.The Impact Of Ethnicity On Antidepressant Therapy Essay.
There appears to be history of alcohol abuse and depression in your family, has anyone in your family received treatment? This question would provide a view into the patient’s understanding of psychiatric treatment. Since the patient does not believe in psychotherapy due to religious reason, the patient may not know what treatments were, are or will be available to him. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
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Feedback from People in Patient’s Life
The patient has been married for 33 years. Assuming his spouse is around before, during and after an episode, she may provide information the patient failed to share or may not have been honest about. The first person to be questioned would be the patient’s wife. Some of the questions for the patient’s wife would include onset of symptoms. What occurs before each episode of depression? Is there conflict between you and your spouse? Are there any stressors, such as financial plaguing your spouse and you?
The patient also has three children. All three of his children suffer from some form of depression. Questioning the patient’s children may provide a historical history of the patient. For example, the children may have noticed symptoms leading to the patient’s depression years ago. Questions for the children may include did your parent’s argue often while you were growing up? Did your father ever lose interest in your childhood years? Did you feel love or rejection while growing up from your father? What were your father’s behaviors? Did you ever notice any alcohol or drug abuse while growing up? The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Physical and Diagnostic Exams for Patient
Unfortunately, there is not a certain test for depression. The primary goal of physical exam and diagnostic testing would to rule out other conditions causing similar symptoms. A physical exam should be preformed assessing respiratory and cardiovascular system. Vital signs should be taken as well.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Certain labs should be assessed in the patient. The practitioner should check the patient’s thyroid levels. Thyroid hormones have been linked to depression (Stahl, 2008). Depression can be caused by an underactive or overactive thyroid.
Another lab test to consider would be dexamethasone suppression test. This test assesses the negative affect of dexamethasone. Once given dexamethasone, in a small dose, cortisol levels are decreased in healthy adults, but may remain elevated in depressed patients (Smith, et al., 2013).
Depressive disorders have been linked to certain inflammatory biomarkers. This blood test assesses nine biomarkers, alpha-1 antitrypsin, apolipoprotein CIII, BDNF, cortisol, epidermal growth factor, myeloperoxidase, prolactin, resin, and soluble tumor necrosis factor α type II. These biomarkers represent the inflammatory and metabolic pathways associated with depression (Serra et al., 2015).
Three Differential Diagnosis
Based on the symptoms listed by the patient, there a multiple diagnosis this patient could be suffering from. Recurrent Major Depressive Disorder with melancholic features. This diagnosis is due to the patient’s major depressive symptoms, such as depressed mood most of the day, increased anxiety, and suicidal thoughts (Zaninotto et al., 2016). The specifier of melancholic features is based on the patient’s symptoms being worse in the morning, inability to function and lack of pleasure (Zaninotto et al., 2016). Other diagnoses for the is patient could be a thyroid imbalance or panic disorder. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Two pharmacologic agents
Since this patient has become resistant to first line and second line drug therapy for depression, Phenelzine, an MAOI should be started for this patient. Phenelzine 45mg daily, divided into three doses throughout the day. Another suggestion for this patient would be Isocarboxazid. The dosage would start at 10mg BID, if tolerated the dosage could increase to another 10mg every 2-4 days until the dosage of 40 mg was achieved with tolerance. If therapeutic response is achieved, this medication should be slowly decreased without affecting therapeutic response (Arcangelo et al., 2013). Due to the pharmacokinetics and pharmacodynamics of Isocarboxazid, Phenelzine, should be prescribed to this patient. Since there is an increased to patients who have cardiac issues such as atrial fibrillation. The pharmacodynamics of Isocarboxazid are not clearly understood, but this may be due to the inhibition of MAO to the heart (Drugs, 2018).
MAOIs and Ethnicities
With many MAOIs, hypertensive crisis is a major concern for nay race. Since minorities are diagnosed with hypertension at higher rates, this causes a greater concern. This is the reason for a tyramine restricted diet. Foods such as aged chees, yeast and tap beer should be avoided (). The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Changes in Therapy
After review of further data with this patient, changes would not be made to the suggested treatment.
Lessons Learned
Throughout this case study many lessons were present. The lesson of medication compliance was the first lesson learned. Another lesson learned was the lesson of proper medication selection in a patient, especially after a recurrent episode of depression. Assessment and presentation of psychiatric treatment for patients was another lesson learned from this case study.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Conclusion
In conclusion, this case study involved a 63-year-old male with recurrent depression. The patient has had success and failures with medication and treatment. These failures may be due to medication compliance or improper cessation of medications from a physician. After two years, the patient is finally on the right track. Hopefully, this will continue.The Impact Of Ethnicity On Antidepressant Therapy Essay.
POST 2
Three questions that I might ask our patient are:
- Tell me when you take your medication? [The reason for this question is to establish his adherence to his medication. Tachyphylaxis aka poop out, may occur due to medication nonadherence. It is therefore important to assess if the client is experiencing tachyphylaxis related to medication nonadherence] (Targum, 2014).
- Do you feel a lack of motivation about life? [The Rothschild Scale for Antidepressant Tachyphylaxis suggests a conceptualization of antidepressant tachyphylaxis that is characterized by symptoms of apathy.] (Targum, 2014).
- Are you experiencing patterns of sleep disturbance? [This is also a symptom of poop out. It is important to assess these symptoms in order to proceed with his plan of care. Another important question is to assess the client for is substance abuse which was already addressed within the case study.)
According to our case study, our client is a 69-year-old retired male who is married with children and grandchildren. In my opinion, it would be most important to speak to those that are the closest to him (his wife) who can observe him for any signs of activation of bipolar disorder such as: lack of impulse control, irritable and agitated mood lasting longer than a week (Bail, Dains, Flynn, Solomon, & Stewart, 2015). Activation of bipolar disorder would require his antidepressant to be discontinued and switched to a mood stabilizer (Stahl, 2013). The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Physical exams and diagnostic tests relevant to our client’s care would be testing his blood pressure before/during initiating treatment and testing for plasma levels of O-desmethylvenlafaxine (ODV) which is an active metabolite of venlafaxine formed as a result of CYP450 2D6 (Stahl, 2013). Plasma levels of ODV will determine if the provider may safely increase his dose based on results. It is imperative to assess our client’s blood pressure related to the effects of the norepinephrine in the SNRI. Based on the check points for his first follow up, I would have changed his phone follow up to a face to face follow up to assess our client better and would have ordered his plasma ODV sooner to properly assess the effectiveness of his medication therapy.The Impact Of Ethnicity On Antidepressant Therapy Essay.
According to the American Psychiatric Association (2013), three differential diagnoses that I am giving our client are: 1. mood disorder due to another medical condition 2. Sadness 3. Adjustment disorder with depressed mood. The one that I think is more likely is sadness. My thought is sadness because our client’s history from the case study reveals a long, waxing and waning major depressive episode where he feels like he is out of options (Stahl, 2013).The Impact Of Ethnicity On Antidepressant Therapy Essay.
Two pharmacologic agents that would be appropriate for our client’s therapy would be Mirtazapine 15 mg PO nightly or Bupropion 75 mg PO BID. Bupropion is an NDRI which is a good augmenting combination with Venlafaxine. It is a powerful enhancer of noradrenergic action. Mirtazapine is a dual serotonin and norepinephrine combination which also works well with Venlafaxine but it may further increase his high cholesterol; for this reason, I would choose the Bupropion. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Lessons that I learned from this case study are certain drugs may not be as effective due to noncompliance, pharmacokinetic failures or even genetic variants. I have also learned the seriousness of how severe depression can be and the importance of knowing not necessarily all of the drugs out on the market for depression but more so the pharmacokinetics and pharmacodynamics of how they work.
Leonie
Reference
Targum, S. D. (2014). Identification and treatment of antidepressant tachyphylaxis. Innovations in Clinical Neuroscience, 11(24), 3-4. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008298/
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Retrieved from Walden Library databases.The Impact Of Ethnicity On Antidepressant Therapy Essay.
The Impact of Ethnicity on Antidepressant Therapy
Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in adult and geriatric clients requiring antidepressant therapy
Analyze the impact of ethnicity on antidepressant therapy
Evaluate efficacy of treatment plans
Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Review the following medications:
amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05
Note: Retrieved from Walden Library databases.
Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from http://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf
To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Case 1: Volume 1, Case #1: The man whose antidepressants stopped working
Case 2: Volume 1, Case #7: The case of physician do not heal thyself
Case 3: Volume 1, Case #29: The depressed man who thought he was out of options
Review this week’s Learning Resources and reflect on the insights they provide.
Go to the Stahl Online website and examine the case study you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
Review the posttest for the case study.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
By Day 3
Post a response to the following:
Provide the case number in the subject line of the Discussion thread.
List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.The Impact Of Ethnicity On Antidepressant Therapy Essay.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentationsThe Impact of Ethnicity on Antidepressant Therapy
Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in adult and geriatric clients requiring antidepressant therapy
Analyze the impact of ethnicity on antidepressant therapy
Evaluate efficacy of treatment plans
Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Review the following medications:
amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05
Note: Retrieved from Walden Library databases.
Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from http://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf
To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Case 1: Volume 1, Case #1: The man whose antidepressants stopped working
Case 2: Volume 1, Case #7: The case of physician do not heal thyself
Case 3: Volume 1, Case #29: The depressed man who thought he was out of options
Review this week’s Learning Resources and reflect on the insights they provide.
Go to the Stahl Online website and examine the case study you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Review the posttest for the case study.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
By Day 3
Post a response to the following:
Provide the case number in the subject line of the Discussion thread.
List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.The Impact Of Ethnicity On Antidepressant Therapy Essay.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Go to the Stahl Online website and examine the case study you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
Review the posttest for the case study.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!The Impact Of Ethnicity On Antidepressant Therapy Essay.
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Provide the case number in the subject line of the Discussion thread.
List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations
Discussion: The Impact of Ethnicity on Antidepressant Therapy
Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Learning Objectives
Students will:
Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients
Analyze factors that influence pharmacokinetic and pharmacodynamic processes in adult and geriatric clients requiring antidepressant therapy
Analyze the impact of ethnicity on antidepressant therapy
Evaluate efficacy of treatment plans
Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05
Note: Retrieved from Walden Library databases.
Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf
To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Case 1: Volume 1, Case #1: The man whose antidepressants stopped working
Case 2: Volume 1, Case #7: The case of physician do not heal thyself
Case 3: Volume 1, Case #29: The depressed man who thought he was out of options
Review this week’s Learning Resources and reflect on the insights they provide.
Go to the Stahl Online website and examine the case study you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Review the posttest for the case study.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!The Impact Of Ethnicity On Antidepressant Therapy Essay.
Provide the case number in the subject line of the Discussion thread.
List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.The Impact Of Ethnicity On Antidepressant Therapy Essay.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations
Read a selection of your colleagues’ responses.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Depression is the commonest mental illness in the world yet only a few can tell you what exactly it is. Most people can well enough to recognise signs and symptoms of heart attack, diabetes, breast cancer and many more medical conditions. This statement is not only true for the general population, medical practitioner are no exclusion. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Many different impression, perception and thought about depression from one person to another person, from one culture to another culture and from one place to another place. For me what is common throughout the world about this mental illness is ignorant. No wonder why John Kirwan, former New Zealand All Black rugby player, now rugby coach, recently said about his depression:The Impact Of Ethnicity On Antidepressant Therapy Essay.
“Beating that was the hardest thing I had to do in my life. I didn’t have a clue what was wrong with me, nor did lots of the doctors I saw. I finally found a doctor who really got it, understood. That’s what you need. There are so many preconceptions out there about mental illness”.
Before I learn this psychiatry module about a year ago, I like many of my friends thought that depression is not so common and it is actually not an illness of any kind. However after knowing that approximately about 20% of women and 12% of men worldwide suffer from depression1, which is higher than prevalence of other common disease such as diabetes where worldwide prevalence is about 2.8% in year 20002, it changes my perspectives on depression. Interestingly even though depression is very common I rarely encounter any patient who was diagnosed with depression during my medical and surgical attachment. I only saw one patient with depression for the whole attachment. This totally contradicts with what I learn where prevalence for depression among patient in hospital is about 10%1.The Impact Of Ethnicity On Antidepressant Therapy Essay.
This makes me think why such a gap occurs between what I learn and what I encounter in a real world. I began to question myself in lots of different ways in order to answer this question. I start looking back to myself first how my perception toward depression before I learn about this mental illness. I was clueless about depression. I used to have perception that depression has the same meaning to sadness. Depression is a normal thing to happen to someone that encounter unfortunate event in their life. I never knew depression is a mental illness that needs to be diagnosed and treated accordingly. I never heard people went to a doctor because they feel their life miserable and I also never heard a doctor prescribing a medication to patient because of depression. That was me before I learn this psychiatry module.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Majority people in my country, Malaysia, have the same perception like me. There never knew that depression is a mental illness where it has specific criteria to diagnose and need to be treated accordingly like other disease. Why it is like this? In my opinion this is very much related to how culture in my country which is eastern culture where a lot of people believe in mysticism. Even though majority of them will seek medical practitioner when they get other physical illness but when it come to the illness related to mood, feeling or behaviour where there is no obvious physical pain, they prefer to go to shaman or spiritual healer. They believe some other spirit are harming and controlling their inner self. Although many of them are Muslim where they shouldn’t believe in such away but a very long history of mysticism in that part of the world has made it hard to be washed away from people perception. This is the perception about depression in this part of the world. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Here in Ireland or in the western culture, I find people’s perception toward depression is quite different. Many of people here know the depression is part of mental illness. However a lot of them as other place in the world don’t know what exactly we called depression as a mental illness. If they do get depression they don’t know to whom they should consult, how to deal with it and what the treatment option are available. Not many advertisements about the illness can be found out there in the public. Apart from that depression as other mental illness carry some stigma in the community here. Stigma that there is no cure for the depression, the depressed person will never come back to normal and they are dangerous to public.The Impact Of Ethnicity On Antidepressant Therapy Essay.
It seems clear to me that many factors why people are less likely to seek medical attention when they have depression. As many as two thirds of the people with depression do not realize that they have a treatable illness and do not seek treatment3. Lack of knowledge together with misconception what exactly the depression is unable people to distinguish and determine whether they are having depression or something else. As bad as ignorant about the disease itself, people don’t know what to do when they know they have depression. Stigma that surrounding the depression also contribute to this phenomenon. The evidence for this is clearly stated in the conclusion of the research done by Lisa J. Barney et al where they wrote “self- and perceived-stigmatizing responses to help-seeking for depression are prevalent in the community and are associated with reluctance to seek professional help”4.The Impact Of Ethnicity On Antidepressant Therapy Essay.
Then I start to question myself it is only because of the public that do not seek medical treatment that contribute to the under diagnose of depression or there are others factor determine it. When I read an article title Depression over and under diagnosed in primary care4, it make me realise that most GPs have difficulty in diagnosing depression. According to the article “a meta-analysis of more than 50,000 patients has shown that general practitioners (GPs) have great difficulty separating those with and without depression, with substantial numbers of missed and misidentified cases of depression”5. Doctors in the primary care is the first medical person that patient will come and complaint about their depression symptoms. However if most of these doctors fail to recognise and diagnose it, this will bring the number of undiagnosed depression further up. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
Why is this happen? Why depression is so common to be unrecognised even by a doctor? I don’t know the exact reason but for me may be because of the symptom of depression is a lot and varies from one person to another person make it harder to diagnose. According to the DSM-IV-TR diagnostic criteria for a major depressive episode includes at least 5 of the symptoms which are low mood, anhedonia, significant weight loss, insomnia, loss of energy, psychomotor agitation, feeling worthlessness, low concentration and recurrent thoughts of death for the same 2-week period, representing a change from previous functioning, must include either low mood or anhedonia1.
Apart from this criteria patient also present with atypical presentation where major depressive disorder may not initially present. In primary setting patient with depression often come with symptoms such as fatigue, headache, abdominal discomfort or change in weight1. Patients can become more irritable rather than low mood or sad. Initial symptoms of depression in children is harder to recognise and can be misleading as the children may present with irritability, decline in school performance or social withdrawal1. Misdiagnose depression in patients in primary care will lead to inappropriate treatment and poorer outcomes6.The Impact Of Ethnicity On Antidepressant Therapy Essay.
In term of treatment of depression, I learnt about biopsychosocial approach which is for me is very unique module of treatment. This type of treatment helps to tackle each aspect of the depression including brain pathophysiology, psychological state and social circumstances of the patient. For most patients with mild to moderate depression psychotherapy (cognitive behavioural therapy, interpersonal therapy) is the treatment of choice. However, the combined approach with medication generally provides the patient with the quickest and most sustained response1. Usually, antidepressant medication such as SSRIs is used for severe depression.The Impact Of Ethnicity On Antidepressant Therapy Essay.
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In conclusion, learning psychiatry module has change a lot of my perspective toward depression and mental illness generally. It has exposed me to a different and new perception in this topic. Before this I see depression as something that not important to diagnose and treat but now I see depression as a very serious illness that can lead to fatality if left untreated. I will make sure that in the future, I always put depression as part of my differential diagnosis for most medical or surgical cases that I encounter as a doctor. The Impact Of Ethnicity On Antidepressant Therapy Essay Paper
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