Assessing Treating Adult and Geriatric Clients with Mood Disorders

Assessing and Treating Adult and Geriatric Clients with Mood Disorders Essay Assignment Paper

Introduction

Although the frequency of mood disorders among the elderly population is low in comparison to young adults, bipolar and depression are associated with negative health outcomes which are linked to deficits in cognition, high risk of suicides and mortalities. The mechanisms which influence these associations are pathological and either directly or indirectly related to the condition itself changing between psychosocial and biological factors. Mood disorders are a leading cause of psychiatric illnesses in the elderly population. Aging in itself causes depressive symptoms with high rates of adverse outcomes in treatment, poor recovery, and high relapse rates.Assessing and Treating Adult and Geriatric Clients with Mood Disorders Essay

This paper is a comprehensive pharmacologic evaluation of a 32-year-old Hispanic male who presented with severe depression. A comprehensive discussion of the pharmacokinetic and pharmacodynamics outcomes of antidepressant medications in geriatric and adult patients will be discussed. Three major decisions related to the medications to be prescribed to the client will be assessed. For each decision made, an explanation of why the drug was the best choice, the expected outcomes and any differences between the actual outcome and expected outcome will be provided. A description of how legal and ethical issues may impact treatment and communication with the client and his families will also be provided.

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Decision #1

Decision Selected

Begin Effexor XR 37.5mg orally daily

Reason for Selecting This Decision

Effexor is a selective serotonin reuptake inhibitor (SSRI) which is indicated for the management of the major depressive disorder. SSRI’s are the recommended first choice of drugs that should be used in the management of depression. It has shown efficacy and proved to be effective in improving mood and energy levels. It also helps to restore interest in daily life. According to the FDA, Effexor also reduces anxiety, fear, panic attacks, and unwanted thoughts. According to Ellingrod (2017), Effexor is also effective in managing neuropathic pain and he will be significant for the clients back pain and stiff shoulders. It functions by restoring the balance of the neurotransmitters norepinephrine and serotonin in the brain (Mulsant, Kales & Sajatovic, 2017). Since this client had been diagnosed with severe depression based on a 51 score of the MADRS, Effexor would, therefore, be the most recommended drug. Assessing and Treating Adult and Geriatric Clients with Mood Disorders Essay

Zoloft (sertraline) 25mg daily could be a good choice since it is also an SSRI antidepressant which works by inhibiting the uptake of serotonin in the CNS and impedes its uptake in the platelets (Khazaie et al., 2015). When administered consistently, it down-regulates the receptors of norepinephrine in the brain to improve mood and depressive symptoms. However, Zoloft has adverse side effects which impair health such as erectile dysfunction, impotence, difficulty to have an orgasm, insomnia, and drowsiness (Khazaie et al., 2015). As compared to Effexor, these side effects are adverse and can potentially contribute to non-adherence to medication making it difficult to attain therapeutic outcomes.

Phenelzine 15 mg orally TID could also be a good choice since it is a Monoamine Oxidase Inhibitor (MAOI) that was found to be effective in atypical depressed patients who have the features of phobia and depression. However, its efficacy and effectiveness in patients who are severely depressed have not yet been proven (Newman, 2016). According to the FDA, phenelzine is not recommended for use as a first line drug for managing depression. Instead, it is recommended for use in patients who initially failed to respond to the commonly used drugs in what is also known as treatment-resistant depression. Phenelzine also has adverse side effects such as insomnia, dizziness, sedation and orthostatic hypotension which can potentially make a patient not to adhere to medications (Newman, 2016).Assessing and Treating Adult and Geriatric Clients with Mood Disorders Essay

Expected Outcome

By starting the client on Effexor XR 37.5mg orally daily, it was expected that his energy levels will increase and depressive symptoms would subside within two-four weeks after the initiation of therapy (Mulsant, Kales & Sajatovic, 2017). By the fourth week of clinical appointment, the client was expected to have significant improvement in his symptoms and an improved quality of life.

Difference between the Actual outcome and Expected Outcome

After four weeks, the client returned to the clinic with reports that there were totally no changes in his depressive symptoms. There is a high likelihood that the starting dosage of 37.5mg was lower than the recommended starting single dosage of 75mg as per the guidelines provided by the FDA. Alternatively, what the PMHNP could do was to start the 37.5mg per day for 4-7 days to give the patient time to adjust to the drug before gradually increasing it to 75mg per day (Rosenberg & deLima, 2016).

Decision #2

Decision Selected

Increase dosage to Effexor XR 75mg orally daily

Reason for Selecting this Decision

During the first visit, it was evident that the client reported no adverse side effects from Effexor XR 37.5mg orally daily that was initially prescribed other than noting that there was no significant improvement in his depressive symptoms which was as a result of dosage lower than the recommended 75mg for severe depression (Mulsant, Kales & Sajatovic, 2017). Therefore, the only best option, in this case, is not changing the medications but to increase the dosage in order to obtain the much needed therapeutic outcome.Assessing and Treating Adult and Geriatric Clients with Mood Disorders Essay

Augmenting with a typical antipsychotic is not an appropriate decision at this point of treatment since the maximum recommended a dosage of Effexor which is 225mg per day has not yet been reached. In this case, it should also be noted that the dosage of 75mg is still small and at lower dosages, it tends to exert a lot of effects on the serotonergic receptors as compared to norepinephrine in low dosages (Rosenberg & deLima, 2016).

Similarly, changing to Cymbalta 30mg orally daily cannot be an alternative choice since it is a small dose yet its effectiveness ranges from a dosage of 60-120 mg orally daily for therapeutic outcomes to be realized. By prescribing it, the likelihood of the patient being relieved from stiffness and pain and no relief from depressive symptoms is high (Wang et al., 2016). This would be contrary to the focus of treatment which is to ensure that the patient is also able to overcome his depressive symptoms.Assessing and Treating Adult and Geriatric Clients with Mood Disorders Essay

Expected Outcome

By increasing the patient’s dosage to Effexor XR 75mg orally daily, it was expected that the client will have some relief in his depressive symptoms with a lot of renewed energy and interest in daily activities. 75mg of Effexor is the recommended starting dose in managing patients with severe depression (Mulsant, Kales & Sajatovic, 2017). Therefore, this drug will help to restore the balance of the neurotransmitters norepinephrine and serotonin in the brain and help to reduce his anxiety, fear and unwanted thoughts thus increasing mood and energy levels.

Difference between the Actual Outcome and Expected Outcome

It is worth mentioning that there was a huge difference between the expected outcome and the actual outcome. While it was expected that the client will only show some little improvement in his depressive symptoms, his improvement was very significant (Rosenberg & deLima, 2016).

After four weeks, the client returned to the clinic with reports about some improvement in his depressive symptoms. This was evidenced by a 25% reduction of the Montgomery-Asberg Depression Rating Scale (MADRS) from 51-38.