Posted: October 12th, 2022

Adult and Geriatric Clients with Mood Disorders

Adult and Geriatric Clients with Mood Disorders

Walden University
NURS 6630N

Adult and Geriatric Clients with Mood Disorders
Introduction
Mood disorders are detrimental to the life of adult and geriatric patients. Patients with mood disorders experience decreased quality of life due to loss of interest in daily activities. For example, patients with mood disorders experience withdrawal and lack of interaction with peers. Elderly patients also experience a lack of appetite, poor sleeping patterns, frequent panic attacks and lack of concentration (Gordon & Melvin, 2015). One of the effective and popular drugs used to treat mood disorders is Zoloft. It is approved by the FDA as an effective drug that can improve the quality of life of a patient. In the current case study, the elderly patient required Zoloft 25mg orally daily. However, when the dosage did not work, it was increased to 50mg orally daily. The increase was effective in increasing the therapeutic ability of the drug. At the end of the treatment, the patient demonstrated a significant improvement in the quality of life of the patient. Zoloft is an effective drug in the treatment of mood disorders both in pediatric and elderly patients.
Decision #1
The case study of an elderly Hispanic patient with Major Depressive Disorder requires the introduction of Zoloft Effexor. The decision was to introduce Zoloft 25mg orally daily. Zoloft is an efficient medication for depression among elderly and adult patients. It is used to treat depression and anxiety evident in Major Depressive Disorder. Another possible decision was Effexor which is used to treat the depressive disorder. However, the two drugs cannot be used together since they can trigger critical symptoms such as confusion, seizure, hallucination, and high blood pressure (Stahl, 2013). Additionally, I did not select Effexor since Zoloft is a popular and FDA-approved medication used effectively to treat depression. Zoloft also requires a minimal dosage in the initial stages of treatment according to FDA guidelines. The purpose of the minimum dosage is to prevent side effects such as suicidal thoughts (Gordon & Melvin, 2015). The age of the patient is also a consideration since a higher drug may affect the metabolism, distribution, absorption, and excretion of the drug.
Zoloft is an effective decision in reducing depression symptoms. The expected outcomes of the prescribing the drug was to increase the interaction of the patient and minimize withdrawal symptoms. Another expected outcome was to enhance the appetite of the patient. The reason is that depressed patients experience low appetite levels which can lead to malnutrition (Crocco et al., 2017). Patients during these stages also require high nutrition to cope with the conditions associated with depression. Zoloft also works by increasing the level of serotonin in the brain. Serotonin is effective in regulating various actions such as sleep, mood, and memory (Crocco et al., 2017). Therefore, the purpose of prescribing Zoloft was to improve sleeping patterns, memory, and mood.
The patient came back to the clinic after two weeks. The expected outcomes were not met despite the adherence to taking the drug. For example, the patient did not improve the appetite levels, sleeping patterns or interaction with peers. One of the reasons why the expected outcome was different from the results is the dosage (Crocco et al., 2017). Zoloft can achieve various expected outcomes if the dosage is increased to 50mg.
Decision #2
The second decision was to increase the dosage to 50mg. Research studies and evidence-based practices indicate that an increase in dosage can achieve the expected results. For example, Zoloft 50mg orally daily is effective in promoting better sleeping patterns, improve the appetite, enhance the mood and reduce anxiety levels (Potter, 2019). Another major expected outcome is to promote interaction with other people. FDA guidelines also indicate that it is safe to prescribe 50mg to depressed patients to reduce the symptoms significantly (Potter, 2019). Research studies also indicate that it is safe to increase the dosage to 50mg since a higher dosage increases the therapeutic ability.
The patient reported back to the clinic after two weeks. The expected outcomes were significantly met since the patient demonstrated improved mood and appetite levels. The patient also had better interaction with peers compared to the first time he reported to the clinic. The general well-being of the patient was better.
The expected outcomes and the results were similar since the depressive symptoms had reduced by 50percent. One of the reasons why the results were similar is due to the increased dosage. FDA guidelines indicate that a higher Zoloft dosage increases the therapeutic ability (Potter, 2019). The therapeutic ability of Zoloft 50mg orally daily is to boost interaction levels, appetite, and mood. Notably, the results were not different compared to the first clinic. Additionally, the patient did not show any negative outcomes relating to high dosage. One of the precautionary measures was to avoid disrupting the metabolism, absorption, and excretion (National Alliance on Mental Illness, 2017). The reason is that elderly patients have weak body organs such as the liver and heart which are critical in the metabolism, distribution, absorption, and excretion of drugs.
Decision #3
The third decision was to continue with the Zoloft 50mg orally daily for another two to four weeks. The patient will report back to the clinic after two weeks for further assessment. Randomized control trials indicate that Zoloft can manifest positive results after two weeks of administration (Potter, 2019).
One of the expectations continuing with the prescription of the medication was to promote appetite levels, interaction with peers, reduce panic and anxiety levels, and improve sleeping patterns. Research shows that Zoloft is one of the best medications to treat Major Depressive Disorder (National Alliance on Mental Illness, 2017). According to the previous decision, there was a 50 percent decrease in symptoms. However, in the third decision, the expectation is to reduce the negative symptoms and promote positive behavior by 100 percent. The outcome should be to help the patient to resume their normal life and interaction with other people. They should also continue with life normally by participating in daily chores.
The outcome of the decision was similar to the expectations. The patient reported back to the clinic after two weeks. According to the expectations, they demonstrated positive interaction with peers, high appetite levels, and better sleeping patterns. The patient also did not report any anxiety or panic that could disrupt sleeping patterns (Potter, 2019). Therefore, the patient can now be monitored for another two weeks to assess the outcome before withdrawing medication or reducing the dosage.
Ethical Considerations
Ethical considerations are important in the prescription of drugs, especially in the treatment of mood disorders. One of the ethical considerations is to inform the patient about the possible side effects of the drug (Potter, 2019). For instance, Zoloft can trigger suicidal thoughts among patients which can put their life at risk. It is also essential for clinicians to monitor the patients to reduce the possibility of side effects. For instance, the FDA requires pharmaceutical companies to label the drug with the appropriate side effects to caution patients. According to FDA guidelines, patients who are below 18 years should receive approval from a parent before prescription of Zoloft (National Alliance on Mental Illness, 2017). Another ethical consideration is the age of the patient. Elderly patients process drugs differently compared to young people. Therefore, elderly patients require a low dosage before prescribing a higher dosage. Clinicians should observe the outcomes to assess if the drug is negatively affecting the patient (National Alliance on Mental Illness, 2017). The ethical guidelines are important in balancing between effective treatment and the possible side effects of the drug.
Conclusion
Adult or elderly patients of mood disorders require immediate treatment to about the critical deterioration of their quality of life. Mood disorders reduce the quality of life by affecting interest in daily activities, reducing interaction from peers, diminishing the appetite, and affecting sleeping patterns. Patients also experience high levels of panic or anxiety. The symptoms can significantly affect the quality of life of an elderly patient. The first decision was to prescribe Zoloft which is a popular and effective medication for mood disorders. Initially, 25mg orally daily was not effective until it was increased to 50mg orally daily. In the second decision, the patient demonstrated a 50 percent improvement in depression symptoms. Therefore, the third decision involved maintaining the dosage, which was effective in making improvements. Eventually, the patient demonstrated positive change since they improved the interaction with peers, better appetite and sleeping patterns and no panic or anxiety attacks. Mood disorders are common disorders among elderly patients and can negatively affect the quality of their lives until they begin treatment.

References
Crocco, E. A., Jaramillo, S., Cruz-Ortiz, C., & Camfield, K. (2017). Pharmacological management of anxiety disorders in the elderly. Current treatment options in psychiatry, 4(1), 33-46.
Gordon, M. S., & Melvin, G. A. (2015). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. DOI:10.1111/jpc.12655
National Alliance on Mental Illness. (2017). What Is Sertraline and What Does It Treat? Retrieved from: https://www.nami.org/learn-more/treatment/mental-health-medications/sertraline-(Zoloft)
Potter, D. R. (2019). Major Depression Disorder in Adults: A Review of Antidepressants. International Journal of Caring Sciences, 12(3), 1936.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

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