NURS 6521 Week 8 : Depression Discussion
When patients experience changes in their behavior, mood swings, changes in thoughts, and an overall decline in their health, they will be diagnosed with depression, which is a chronic mental disorder. Depression can range from mild to severe disease. It disrupts a person’s ability to handle day to day tasks and the ability to enjoy life (Fekadu, Shibeshi, & Engidawork, 2017). The occurrence of depressed mood, loss of interest in activities that were once pleasurable in the past for at least two weeks are some characteristic signs of major depressive disorder (MDD). The previous symptoms will be joined by at least four of the following indicators, including recurrent thoughts of death or suicide, changes in weight, loss of appetite, changes in sleep patterns, feeling of irrelevance or guilt, problems concentrating, altered psycho motor activity, and difficulty making decisions. Patients may experience a majority of the symptoms nearly every day and cause significant distress and impaired social life and occupation performance (Fekadu, Shibeshi, & Engidawork, 2017).NURS 6521 Week 8 : Depression Discussion
In the chosen interactive, the patient is a 70-year-old Hispanic American male that reports remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last two months, and is having trouble sleeping and concentrating at work (Laureate Education, 2019a). The patient has scored a 51 on “Montgomery- Asberg Depression Rating Scale (MADRS),” indicating severe depression (Laureate Education, 2019a). Decision point one the initialization of Zoloft 25mg will be given once daily. After four weeks of therapy, the patient returns for a follow-up visit and reports only a 25% decrease in symptoms and is concerned about the new onset of erectile dysfunction. The decision is made to continue medication at the same dose and counsel the patient. The patient returns for a follow-up appointment and reports that he has stopped medication because of his inability to perform sexually. The third decision was to re-start Zoloft at 50% of the starting dose (12.5mg), to determine whether or not a side effect is dose-dependent. If the side effect of erectile dysfunction returns once the drug is returned to the full dose, you would need to change the drug. Changing to Wellbutrin XL may be appropriate at this point, but may worsen his insomnia. Additionally, guidelines tell us that another SSRI should be attempted for an adequate trial before switching drug classes (Laureate Education, 2019a).
When medications for depression are being prescribed, the provider must consider several factors, including the severity of symptoms, type of depression, duration of therapy, the age of the patient, comorbid conditions, gender, and associated medications (Arcangelo & Peterson, 2017). Serotonin-norepinephrine reuptake inhibitors, such as venlafaxine, duloxetine, and duloxetine, are used as the first-line therapy for depression. They have improved tolerability, reduced lethality in overdose, and the need for few titrations. Age is a significant patient factor that must be considered due to reduced renal and hepatic function, decreased serum albumin, reduced muscle mass, and distribution, metabolism, and excretion of a variety of drugs. Geriatric patients are prescribed one-third to one-half of the usual adult dose (Arcangelo & Peterson, 2017). NURS 6521 Week 8 : Depression Discussion
Some come side effects include nausea, erectile dysfunction, dry mouth, insomnia, dizziness, drowsiness, and constipation (Anderson et al., 2012). Doses should be started low and slowly increased as tolerated to minimize nausea. The patient or family should understand the goals of the prescribed medications and potential side effects of medication, which may include worsening behavior or suicidal thoughts. If the patient’s condition gets worsens, the patient and family must know the step to take to get in contact with their provider. Educate the patient abruptly stopping the medication can cause withdrawal symptoms, including headache, seizures, nausea, and vomiting. Consulting the healthcare provider is essential when thinking about the discontinuation of the drug (Davis & Lockhart, 2017).NURS 6521 Week 8 : Depression Discussion