Adult Clients with Mood DisordersAdult Clients with Mood Disorders Student’s Name
Date Adult Clients with Mood Disorders
Major Depressive Disorder (MDD) is a common mental disorder that triggers a loss of interest in daily activities causing significant impairment. The symptoms of MDD affect the mood, the thought process, and response to daily activities. For instance, mood disorder affects daily activities, including sleep, appetite, and daily chores. According to the National Institute of Mental Health, a person is diagnosed with MDD if the symptoms are persistent for two weeks (Oliveira et al., 2018). The institute also states that the disorder can cause significant impairment in life, which requires immediate treatment. Although the condition is common among adults or the elderly, it is not part of aging. PMHNP prescribe antidepressant medications to alter the mood, reduce stress, and improve brain functioning. Clinicians also administer various medications before settling on an effective drug. The following paper examines a case study of a 32-year old Hispanic male with severe depression.
Prescribe Zoloft 25mg orally daily, begin Effexor XR 37.5 PO daily, and begin Phenelzine 15mg PO TID.
My Decision: The first decision is to prescribe Zoloft 25mg orally daily.
Why I Selected the Drug: The reasons for selecting Zoloft is due to the available evidence that the drug is effective in treating mood disorders. The second-generation SSRI has minimal side effects among adults. Clinicians recommend the drug as a first-line medication in the treatment of depression and mood disorders (Stahl, 2013). It has relatively severe side effects compared to other antidepressants such as tricyclics antidepressants and Monoamine oxidase inhibitors. The drug is highly recommended since it lacks sedative effects and has high safety levels compared to tricyclics. Zoloft 25mg is one of the recommended doses while beginning treatment. The reason is that a high dose can cause significant side effects (Stahl, 2013). However, the goal of the treatment is to reduce depressive symptoms and prevent reoccurrence of the mood disorder.
The decision to select Zoloft was after rejecting other potential drugs such as Effexor XR. I did not select the drug due to the high potential to abuse the drug. Effexor XR is one of the standard and most available drugs in the market (Strawn et al., 2017). Due to ease of access, the drug is easily abused. Although it is non-addictive, it can cause a reoccurrence of anxiety or mood disorders (Strawn et al., 2017). Additionally, Effexor XR has poor interaction with other drugs such as aspirin. It can cause bruising and bleeding, high blood pressure, and muscle tremors.
I did not prefer Phenelzine since it interferes with other pain killer drugs and antibiotics. It can also cause serotonin syndrome when the drug is used alongside other mental disorder drugs (Strawn et al., 2017). Phenelzine also requires patients to take precautions such as avoid fermented food or foods rich in thymine since it is a monoamine oxidase inhibitor. Patients should also avoid cheese, chocolate, or caffeine.
Expectations: The expectations while prescribing the medication is that the depressive symptoms would subside. For example, I expected that the patient would resume daily duties, including normal eating habits, sleep, and interest in diverse activities.
Outcome: When the patient returns to the clinic, he reports a decrease in the symptoms, but indicates that he recently experienced erectile dysfunction. Sexual dysfunction is a common side effect among adult patients taking antidepressants (Stahl, 2013). The dysfunction can significantly affect the quality of life of an individual.
The patient should return to the clinic after four weeks for further assessment to determine whether to continue with the drug or not.
The outcome shows there is a variance between expectations and results. For example, it was not expected that the patient could have erectile dysfunction. The differences in similarities are due to the side effects of the drug.
The patient returns the clinic after four weeks. He reports that although the depressive symptoms had abated, his erectile dysfunction prompted him to stop taking the medication. His self-esteem has also deteriorated over the four weeks.
My Decision: Due to the side effects, one of the best alternatives is Wellbutrin IR 150mg orally in the morning. The change is necessary since the previous antidepressants triggered adverse effects on the health of the patient. The adverse effects, such as erectile dysfunction, are also not acceptable, thus necessitating the need to change the drug (Jaworska & Rybakowski, 2019). One of the best strategies while switching from one drug to another is to reduce the withdrawal effects. For instance, a washout period of five days is sufficient.
The decision to switch the drug did not prefer medications such as Paxil 20mg. The reason is that Paxil 20mg also triggers sexual dysfunction.
Outcome: The patient returns to the clinic after four weeks of taking the new medication. The patient reports a decrease in erectile dysfunction. The patient, however, reports side effects such as feeling jittery or nervousness. It is essential to explain to the patient that the side effects of Wellbutrin IR 150mg resolve within 1-2 weeks (Castrén & Kojima, 2017).
The expectation was that the change of the drug would reduce erectile dysfunction. The outcome indicated that the selection of the drug was accurate. However, the results were different since the patient experienced anxiety. Anxiety is one of the side effects that occur during the treatment, and it will require another medication to relieve the symptoms.
The third decision was to add Ativan 0.5mg orally TID/PRN. The purpose of prescribing and extra medication is to reduce the level of anxiety. A reduction in anxiety will consequently improve the quality of sleep (Castrén & Kojima, 2017).
My Decision: My decision after consultation with the patient is to continue with the prescription of Wellbutrin IR. The reason is that the patient reported that the depressive symptoms had improved significantly. For example, the patient describes progress, including enhanced quality of sleep, interest in daily activities, and improved appetite. The patient also reports that erectile dysfunction which occurred upon the prescription of Zoloft 25mg has not abated (Castrén & Kojima, 2017). However, the patient indicates their only concern is high anxiety levels.
Expectations: The expectations are that in the next four weeks, the patient will improve in various ways. One of the ways is a reduction in anxiety levels leading to quality sleeping time. The reason is that Lorazepam/Ativan is a minor tranquilizer used to relieve stress and anxiety (Khouzam, 2016). The medication is approved for use among adults to improve their quality of sleep (Khouzam, 2016). However. Due to the high risk of addiction or abuse, Lorazepam/Ativan should not be used for a long period. The patient should only take the medication when necessary to avoid addiction or dependence.
If the patient does not show considerable improvement, there is a need to change the drugs or increase the dose depending on the outcome (Khouzam, 2016). However, the decision will be made based on the assessment of the patient after four weeks.
Outcome: The outcome shows that depressive symptoms reduced significantly. The patient reported that the anxiety levels had abated and that he was now enjoying quality sleep. According to the patient’s report, it is evident that the various drugs are effective. Evidence-based practice shows that Wellbutrin is appropriate for major depressive disorders. Stahl insists that it is important for a PMHNP to consider the outcomes to determine whether to continue with the prescription or change the drug (Khouzam, 2016). The reason is that various dynamics, such as age or gender, may affect the impact of the drug on a patient. For example, while Zoloft causes suicidal thoughts to young people, to the patient in the case study, it triggered sexual dysfunction.
The outcome and expectations had major similarities. The expectation was that the depressive symptoms would decrease considerably, which is what happened. For example, the patient started enjoying quality sleep.
Ethical considerations are necessary to ensure clinicians provide quality care to patients, reduce the risk of poor patient outcomes, and avoid lawsuits. In the current case study, before prescribing antidepressants, a comprehensive diagnostic test and evaluation of a patient’s history are required (Stahl, 2013). Clinicians are required to prescribe medication only when it is necessary and when there is strong evidence that the depressive symptoms require medication. It is also essential to start the Zoloft dose with 25mg compared to starting with 50mg (Oliveira et al., 2018). The purpose of starting with a small dose is to reduce the risk of suicidal thoughts or other side effects such as erectile dysfunction.
Another ethical consideration is to determine the patient’s motivations, concerns, and goals. The patient’s preferences are essential in developing a personalized and appropriate therapeutic strategy. For example, personal preferences may lead to the use of psychopharmacological agents. The patient in the case study is an adult, so they should enjoy confidential and privacy rights (Oliveira et al., 2018). Confidentiality is necessary to avoid sharing information about the illness of the patient. Clinicians are also obliged to warn patients about the possible side effects. The warning will ensure patients are ready for the medication (Strawn et al., 2017). Clinicians are also required to prescribe medication approved by the FDA or drugs with reliable evidence of treating mood disorders among adult patients.
The cases of patients with mood disorders require critical attention to prevent adverse effects. One of the adverse effects of MDD is the loss of interest in daily activities. Patients with MDD thus require immediate treatment with reliable drugs. The various reliable drugs are administered in the three decisions made in the case study of a 32-year old Hispanic male with severe depression. All three decisions focused on administering antidepressants, which are the mainstay of treatment. Antidepressants are reliable in the treatment of mood disorders among patients of different ages. PMHNP decides the medication to use on patients based on their age, medical history, and side effects. PMHNP should develop a supportive relationship for all depressed patients to improve compliance with the treatment plan. Clinicians should also educate the client on the need to comply with the treatment until full recovery. Compliance helps in assessing the changes in a patient and determining the best medication to improve the outcomes.
Castrén, E., & Kojima, M. (2017). Brain-derived neurotrophic factor in mood disorders and antidepressant treatments. Neurobiology of Disease, 97, 119-126.
Jaworska, P., & Rybakowski, J. K. (2019). Childhood trauma in mood disorders: neurobiological mechanisms and implications for treatment. Pharmacological Reports, 71(1), 112-120.
Khouzam, H. R. (2016). Psychopharmacology of chronic pain: a focus on antidepressants and atypical antipsychotics. Postgraduate Medicine, 128(3), 323-330.
Oliveira, A. S., Martinez-de-Oliveira, J., Donders, G. G., Palmeira-de-Oliveira, R., & Palmeira-de-Oliveira, A. (2018). Anti-Candida activity of antidepressants sertraline and fluoxetine: effect upon pre-formed biofilms. Medical Microbiology and Immunology, 207(3-4), 195-200.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Strawn, J. R., Dobson, E. T., & Giles, L. L. (2017). Primary pediatric care psychopharmacology: focus on medications for ADHD, depression, and anxiety. Current Problems in Pediatric and Adolescent Health Care, 47(1), 3-14.