Week 5 Discussion 1: Depression Case Study Reply to Cassandra Antoine
Reply Post Instructions:
Critique the decision making of your peer in your response post.
1. Do you agree/disagree with their medication choice? Why?
2. Is there anything else you recommend including?
3. Compare peer’s decision making to yours—what are the advantages and disadvantages of each?
Your response should include evidence of review of the course material through proper citations using APA format.
Please refer to the Grading Rubric for details on how this discussion will be graded. The described expectations meet the passing level of 80%. Students are directed to review the Discussion Grading Rubric for criteria which exceed expectations.
Cassandra Antoine Post
Depression Case Study
1. What information, if any, would you like to know that was not included in the case?
Depression, also known as major depressive disorder, is a common and serious health issue that can negatively impact how an individual feels, thinks or acts. It may impact their daily activities as it causes a feeling of sadness and loss of interest in certain events. Due to this issue, depression may also lead to other emotional and physical problems that will eventually impact their daily functioning. This disorder ranges from mild to severe, depending on the symptoms, and the patient must constantly report them for at least two weeks in order to be diagnosed with depression ( APA, 2021). In the case of Alison, Dr. Taylor did a very good job interviewing her. However, I would like to know if she’s had family members with depression, as it can run in families; if she’s experiencing continuous exposure to violence, neglect, abuse or poverty, as these environmental factors can make individuals more vulnerable to depression; and if she’s experienced low self-esteem, is generally pessimistic or gets overwhelmed easily (APA, 2021).
2. Which psychiatric symptoms are a treatment priority for this case?
Suicide risk is inherent to depression, therefore requires appropriate treatment in place to prevent it.. Alison reported a past attempt to overdose on tablets and was unsuccessful. She still reports feeling better off dead and off her misery. These are concerning remarks and require treatment priority. In this case, clinicians must create an environment where the patient feels safe and able to speak without fear of reprisals, and implement an individualized care plan (Lewis, 2007). The patient has also reported poor appetite and weight loss, this must be prioritized as it can lead to malnutrition or electrolyte deficiencies which can lead to life-threatening complications, if left unresolved.
3. What are the non-pharmacologic issues in this case (problems/complaints that cannot be addressed by medication)?
The non-pharmacologic issue that cannot be addressed by medication is her inability to cope. This can be assessed and resolved through psychotherapy. This will also help her build her confidence.
Medication Choice 1
4. List one medication that would be appropriate for this case. Include the name and starting dose.
Prozac (Fluoxetine) 20mg/day orally in the morning.
A dose increase may be considered after several weeks if there are no clinical improvements in her symptoms. The maximum dose should not exceed 80 mg per day (RxList, 2020).
5. Describe your clinical decision making. What is your rationale for choosing this medication? Also, include the mechanism of action for this medication choice, and the neurotransmitters and areas of the brain in which the medication is proposed to act on.
Selective Serotonin Reuptake Inhibitors or SSRIs, work by inhibiting the transporter on the presynaptic neurons that take serotonin and back up into the cell effectively increasing the amount of serotonin active and available in the synaptic Cleft. Prozac was the first and most immediately successful of the SSRIs to be released in the late 1980s (Stahl, 2013). It has one of the longest half-lives of any SSRIs, therefore it stays in the bloodstream longer and works great for individuals who aren’t great at remembering to take medications regularly, like Alison with the memory loss.. Fluoxetine “exerts its effects by blocking the reuptake of serotonin into presynaptic serotonin neurons by blocking the reuptake transporter protein located in the presynaptic terminal. Fluoxetine also has a mild activity at the 5HT2A and 5HT2C receptors” (Sohel et al., 2019, p.1). Due to its long half-life, the initial depressant effects start within 2 to 4 weeks.
6. What laboratory testing/monitoring is needed for safely prescribing this medication?
Prior to starting this medication on a woman of child bearing age, it is crucial to order a urine pregnancy test to prevent any complications as it is not the first drug of choice in pregnancy. Other labs monitoring is not required unless the patient is having signs and symptoms of bleeding, hyponatremia and osteoporosis, therefore requiring CBC, NA monitoring and routine bone density screenings (RxList, 2020).
7. Are there any contraindications or safety issues associated with this medication?
Fluoxetine has several drug to drug interactions due to its metabolism at the CYP2D6 (Sohel et al., 2019). The use of Prozac or stopping it within 5 weeks of starting MAOIs is contraindicated as it increases the risk of serotonin syndrome. Other contraindications include the use of Prozac with Pimozide and Thioridazine, as it increases their level through inhibition of CYP2D6, and prolongs the QT interval (RxList, 2020).
Non Pharmacologic Interventions
8. What nonpharmacologic interventions do you recommend? Do you recommend including but not limited to psychotherapy, complementary and holistic therapies?
The core element of treating depression is to help the individual identify and understand the source of the illness and the consequences of these problems on their health. Both pharmacological and non-pharmacological treatments are necessary to formulate a care plan that is suitable for Alison. Cognitive Behavioral therapy (CBT) is one of the first choices of treatment for Depression, as it teaches patients new skills and techniques to help them take control of their symptoms. Another Non-pharmacological treatment is Acupuncture, a traditional Chinese medicine technique that is used to reduce depressive symptoms and other symptoms of various conditions (Rodriguez, 2019).
Safety Risk Assessment
9. What are the safety concerns, if any, associated with this case? How will you address safety?
The safety concerns that I have is in regards to the suicidal ideations that she’s had and also the safety of her children, being that she is all alone in the house. Even though she stated that she would never harm the kids, with her lack of concentration and loss of memory, she can unintentionally place herself and the kids in danger. Due to this safety issue, I would recommend an extra set of eyes in the home to look over the children and herself, and continue with the pharmacological along with non-pharmacological treatments until stable.
10. When would you follow up with this patient?
I would follow the patient in one week to assess symptoms. Even though SSRIs will not reach its full desirable effect until after 4-6 weeks, I would like to assess any worsening of symptoms and implement an immediate plan to alleviate them as much as possible, in the hope of better health outcomes.
Stahl, S. (2013). Essentials of Psychopharmacology, (4th edition). United Kingdom, Cambridge University Press, ISBN-13: 978-1107025981
APA. (2021). What Is Depression? https://www.psychiatry.org/patients-families/depression/what-is-depression.
Lewis, L. M. (2007). No-harm contracts: A review of what we know. Suicide and Life-Threatening Behavior, 37(1), 50-57.
RxList. (2020). Prozac (Fluoxetine Hcl): Uses, Dosage, Side Effects, Interactions, Warning. RxList. https://www.rxlist.com/prozac-drug.htm#dosage.
Sohel, A. J., Shutter, M. C., & Molla, M. (2019). Fluoxetine. StatPearls [Internet].
Rodriguez, T. (2019). 5 Non-Pharmacological Treatments for Depression. MedShadow. https://medshadow.org/5-treatments-for-depression-without-meds/.
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Week 5 Discussion 1: Depression Case Study Reply to Cassandra Antoine
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