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DEPRESSION: A 41-year-old woman presents to an outpatient mental health clinic on referral by her family...

DEPRESSION: A 41-year-old woman presents to an outpatient mental health clinic on referral by her family physician. She has complaints, signs, and symptoms indicative of a major depressive episode with melancholic features. She has undergone treatment for alcoholism within the last year. She is experiencing severe family stressors, namely, her children have moved out of the home. She is already receiving antidepressant therapy, mirtazapine, prescribed by her family physician, without improvement, and complains of weight gain as a side effect.

To be answered

1)Symptoms; List two pertinent signs and symptoms

2)Recommended Drugs: Provide list of recommended drugs as indicated for this diagnosis

3)Drug Categories and Subcategories: Identify the category of each recommended drug

4)Choose one drug of choice

5)Rationale: Provide rationale, clinical guidelines, or evidence for the selected drug of choice

6)Contraindications and/ or Risks, as appropriate: Identify contraindications and risks as appropriate

7)What Patients Must Understand: Identify at least three appropriate teaching points for the patient and/or family

Expert Solution

1. ANS: List two pertinent signs and symptoms

Signs: irritability and difficulty concentrating

Symptoms; List two pertinent signs and symptoms,

2. ANS: Recommended Drugs:

Mirtazapine,

Fluoxetine

Amitriptyline

3. ANS: Drug Categories and Subcategories:

Atypical antidepressant- mirtazapine,

Selective serotonin reuptake inhibitors (SSRIs) -Fluoxetine

Tricyclic antidepressants (TCAs)- Amitriptyline

4. ANS: Choose one drug of choice

Mirtazapine: It is a newer antidepressant that exhibits both noradrenergic and serotonergic activity. It is at least as effective as the older antidepressants for treating mild to severe depression.

5. ANS: Rationale: Provide rationale, clinical guidelines, or evidence for the selected drug of choice

The SSRIs are preferred over older classes of antidepressants such as tricyclic antidepressants and MAOIs because their adverse effects are less severe

6. ANS: Contraindications and/ or Risks, as appropriate: Identify contraindications and risks as appropriate

SSRIs are contraindicated in patients with Closed Angle Glaucoma, Recent Heart Attack, Very Rapid or slow Heartbeat, Suddenly Serious Symptoms of Heart Failure, Abnormal EKG with QT changes from Birth, Hardening of the Liver, Liver Problems, Bleeding from Stomach,

7. ANS: What Patients Must Understand: Identify at least three appropriate teaching points for the patient and/or family

SSRIs can cause an increase in suicidal thoughts and behaviors

The SSRIs can also cause serious withdrawal symptoms if you stop taking them abruptly

SSRIs can easily react with other drugs, so physician consultation is important before taking other drugs with SSRIs

References:

http://www.webmd.com/depression/selective-serotonin-reuptake-inhibitors-ssris-for-depression

http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

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Nightingale answered 2 years ago

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