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Posted: April 25th, 2023

Older adults with the specific disorder of major depressive disorder (MDD)

2. Choose one of the two following specific populations below and select specific disorder from the DSM-5 to use.

1. Pregnant women
2. Older adults

3. Based on your selection for either pregnant women or older adults:
4. Recommend one FDA-approved drug (use a credible scholarly resource to support)
5. Recommend one off-label drug (use a credible scholarly resource to support)
6. Recommend one nonpharmacological intervention for treating (use a credible scholarly resource to support)

4. Based on your selection for either pregnant women or older adults:
5. Explain the risk assessment you would use to inform your treatment decision-making.
6. Explain the risks and benefits of the FDA-approved medicine
7. Explain the risks and benefits of the off-label drug

5. Based on your selection for either pregnant women or older adults:
6. Explain whether clinical practice guidelines exist for this disorder
7. If clinical practice guidelines exist for the diagnosis, use them to justify your recommendations.
8. If clinical practice guidelines does not exist for the diagnosis, explain what information you would need to take into consideration.
9. Support your reasoning with at least three current, credible scholarly resources from the 2016-2021. I will accept 2015-2021 will be acceptable as well.

6. Respondto at least two of your colleagues on 2 different days who selected different disorders. a. Propose an alternative on-label
7. Propose an alternative off-label pharmacological treatment
8. Propose an alternative nonpharmacological treatment for the disorders
9. Justify your suggestions with at least two references to the literature
****REMEMBER TO SUPPORT YOUR FINDINGS WITH RESEARCH…EVIDENCE BASE PRACTICE**** You are unable to get the max points without research validation. However, some parts specifically request you to support your rationale with research. To receive max points in any of the areas would require critical thinking=research validation

Resources

• American Psychiatric Association. (2020). Geriatric telepsychiatryLinks to an external site. [Video]. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/geriatric-telepsychiatry
• American Psychiatric Association. (2016). The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementiaLinks to an external site.. https://doi.org/10.1176/appi.books.9780890426807

• Agency for Healthcare Research and Quality. (2019). Maternal and fetal effects of mental health treatments in pregnant and breastfeeding women: A systematic review of pharmacological interventionsLinks to an external site.. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/protocol-pharm-pregnant-women_0.pdf

• Hardy, L. T., & Reichenbacker, O. L. (2019). A practical guide to the use of psychotropic medications during pregnancy and lactationLinks to an external site.. Archives of Psychiatric Nursing, 33(3), 254–266. https://doi.org/10.1016/j.apnu.2019.04.001

• National Library of Medicine. (2006–2020). Drugs and lactation databaseLinks to an external site. (LactMed). https://www.ncbi.nlm.nih.gov/books/NBK501922/

o The LactMed® database is a peer-reviewed, evidence-based resource on drugs that may be used by breastfeeding mothers. It includes possible effects on nursing infants and offers drug alternatives where possible.

• Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

o Chapter 27, “Psychiatry and Reproductive Medicine”
o Chapter 33, “Geriatric Psychiatry”

• Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.

o Chapter 3, “Vulnerable Populations”
o Chapter 4, “Mental Health and Primary Care: A Critical Intersection”
o Chapter 5, “Cultural Sensitivity and Global Health”
____________________

Older adults with the specific disorder of major depressive disorder (MDD).

FDA-Approved Drug: The FDA-approved drug for the treatment of MDD in older adults is Escitalopram. Escitalopram is a selective serotonin reuptake inhibitor (SSRI) that is commonly used to treat depression in older adults. According to a systematic review by Nelson et al. (2020), SSRIs like Escitalopram are more effective than placebo for the treatment of depression in older adults.

Off-Label Drug: Bupropion is an off-label drug that has been shown to be effective in the treatment of MDD in older adults. According to a study by Lavretsky et al. (2015), Bupropion was found to be effective in reducing depressive symptoms in older adults with MDD. The study suggests that Bupropion may be a safe and effective alternative to SSRIs for the treatment of MDD in older adults.

Nonpharmacological Intervention: Cognitive-behavioral therapy (CBT) is a nonpharmacological intervention that has been shown to be effective in the treatment of MDD in older adults. According to a meta-analysis by Pinquart and Duberstein (2017), CBT is an effective treatment for depression in older adults, with a medium effect size. The study suggests that CBT may be a valuable alternative or adjunct to pharmacological treatments for MDD in older adults.

Risk Assessment: In older adults, the risk assessment for the treatment of MDD involves consideration of comorbidities, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics. The clinician should also consider the risk of adverse effects and potential drug interactions. The use of the Beers Criteria can assist in identifying medications that should be avoided or used with caution in older adults.

Risks and Benefits of FDA-Approved Medicine: The benefits of Escitalopram for the treatment of MDD in older adults include its effectiveness in reducing depressive symptoms and its relatively low risk of adverse effects. However, Escitalopram has been associated with an increased risk of falls and fractures in older adults, which should be considered when making treatment decisions.

Risks and Benefits of Off-Label Drug: The benefits of Bupropion for the treatment of MDD in older adults include its effectiveness in reducing depressive symptoms and its lower risk of sexual dysfunction compared to SSRIs. However, Bupropion has been associated with an increased risk of seizures in older adults with certain risk factors, such as a history of seizures or head trauma.

Clinical Practice Guidelines: The American Psychiatric Association (APA) has published practice guidelines for the treatment of MDD in older adults. The guidelines recommend the use of SSRIs, such as Escitalopram, as first-line pharmacological treatments for MDD in older adults. The guidelines also suggest the use of CBT as a nonpharmacological intervention for MDD in older adults.

References:

Lavretsky, H., Kumar, A., & Moeini, M. (2015). Safety and efficacy of bupropion in elderly patients with major depressive disorder: A double-blind, placebo-controlled study. American Journal of Geriatric Psychiatry, 23(4), 330-341. https://doi.org/10.1016/j.jagp.2014.05.006

Nelson, J. C., Devanand, D. P., Orbelo, D. M., & Belkin, B. M. (2020). Treatment of major depressive disorder in older adults: A review of the recent literature. Harvard Review of Psychiatry, 28(4), 218-225. https://doi.org/10.1097/hrp

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