Posted: December 20th, 2021

Decision Making When Treating Psychological Disorders

Decision Making When Treating Psychological Disorders

Psychological disorder such as depression among seniors is a serious mental health issue that poses significant hurdles for healthcare providers and will continue to remain the case as life expectancy continues to expand and aging population increases (Blackburn, Wilkins-Ho, &Wiese, 2017). This post will shed light on geriatric depression case and the decision steps employed in the treatment plan.

Geriatric Depression Case

A 70 year-old Hispanic American male who migrated to the US in his early teens presents complaints of depression. He largely kept to himself when growing up. He came from a good home. In the last 2 months, he’s lost interest in normal routines and has gained 15 pounds. He’s is battling lack of sleep for the past 6 months and is progressively getting worse. The client is exhibiting diminished concentration. The client was examined and he is alert, oriented to person, place, time and event. No issues with speech. He only makes brief eye contact and is endorsing feelings of depression. He claims he is not experiencing any loss in visual or hearing, no abnormal delusional or no paranoia, and no suicidal temptations. The client appears to have sound judgement. Montgomery-Asberg Depression Rating Scale (MADRS) was administered and scored 51, representing a severe case of depression.

Decision Steps Applied in Treatment

The Montgomery-Asberg Depression Rating Scale (MADRS) is widely employed to evaluate depressive symptoms in clinical settings (Hobden, Schwandt, Carey, Lee, Farokhnia, Bouhlal, & Leggio, 2017). MADRS ranges from 0 to 60 with higher scores of over 34 indicating severe case of depression. The client scored 51 which points to severe depression. Arcangelo and Peterson(2017) define major depression disorder (MDD) as “a mood disorder characterized by alterations in cognition, behavior, and physical functioning”.

The first decision based on what the client presented was to start him with Zoloft 25mg orally every day to subdue symptoms of depression. The prescription appeared to be effective as the client returned back to the clinic after four weeks with a 25% reduction in symptoms. The client however reported new concerns of initial stages of erectile dysfunction. With this new development, the decision was then made to half the dose to 12.5 mg of oral Zoloft daily. The client returns again after another four weeks and presents worsening case of depression and subdued erectile dysfunction after the halved dosage from the initial one. The decision was then made to revert back to the initial 25 mg of oral Zoloft daily to control the depressive mood as there was no assurance the side effect will come back. Changing to Paxil 20 mg may be next appropriate decision to make in the event the side effect returns as not all selective serotonin reuptake inhibitor (SSRI) have the same side effects.

Pathophysiology and Suggested Treatment Plans

There are multitudes of antidepressants that have demonstrated to be efficacious in elderly patients being treated for a major depressive moods without psychotic features (Wiese, 2011). Wiese (2011) explains that, in deciding the appropriate antidepressant, it is recommended that selection be based on the most favorable side effect profile, previous response to treatment, the type of depression, other medical problems, other medications to ensure lowest risk of drug-drug interactions, and the potential risk of overdose. According Wiese (2011), common adverse effects of SSRIs include nausea, dry mouth, insomnia, somnolence, agitation, diarrhea,ex­cessive sweating, and, less commonly, sexual dysfunction. Roughly 10% of elderly patients on SSRI tend to develop hyponatremia secondary to a syndrome of inappropriate antidiuretic hormone secretion (Wiese, 2011).

According to the current guidelines, when client does not show improvement in depressive symptoms after 4 weeks or insufficient improvement in symptoms after 8 weeks on the maximum recommended or tolerated dose of an antidepressant, then the antidepressant ought to be replaced (Wiese, 2011). In this case, the client should meaningful reduction in symptoms of depression the side effect of erectile dysfunction. Client education on the gradual resumption of planned activities to encourage engagement will also be an integral part of the treatment.

Conclusion

Depression in the older adults is a serious, pervasive, and ballooning epidemic that requires medical care. It bares detrimental implications for the affected, family, and society. Identification followed by a robust Assessment can facilitate the choice of an effective antidepressant prescription. There are multitudes of factors to take into account when choosing, tweaking, and replacing antidepressants in the elderly. These considerations can advance the safe use of antidepressants in the elderly.

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advance practice: A practical approach. (4th ed.).

Blackburn, P., Wilkins-Ho, M., &Wiese, B. (2017). Depression in Older Adults: Diagnosis and Management. Issue: BCMJ, vol. 59 , No. 3 , April 2017 , Pages 171-177 Clinical Articles. Retrieved from: https://www.bcmj.org/articles/depression-older-adults-diagnosis-and-management.

Hobden, B., Schwandt, M. L., Carey, M., Lee, M. R., Farokhnia, M., Bouhlal, S., Leggio, L. (2017). The Validity of the Montgomery-Asberg Depression Rating Scale in an Inpatient Sample with Alcohol Dependence. Alcoholism, clinical and experimental research, 41(6), 1220–1227. doi:10.1111/acer.13400. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550296/

Wiese, B. (2011). Geriatric Depression: The Use Of Antidepressant In The Elderly. Issue: BCMJ, vol. 53 , No. 47. Retrieved from: https://www.bcmj.org/articles/geriatric-depression-use-antidepressants-elderly

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