Challenges arising from late-life depression include the impact it has on the physical and mental health of the patients. Complications such as depression related cardiovascular illnesses are expensive to manage and treat, not forgetting that they put the patients’ lives at risk. A standardized system of assessment such as diagnosis tools should be used for early detection of depression disorders, followed by immediate induction of management procedures such as psychotherapy and antidepressants. Depression can be effectively managed by the use of antidepressants, in combination with clinical and community support. However, the side effects of antidepressants are likely to be more proclaimed in adults and geriatrics suffering from depression. In this assignment, emphasis is put on the assessment and treatment of adults and geriatric clients with mood disorders. The patient is an elderly Hispanic man with major depressive disorder.
Decision One
I would recommend administering 25 mg of oral Sertraline daily.
Reason for the Selection:
The Montgomery–Åsberg Depression Rating Scale is an effective tool for the assessment of depressive disorders. The patient score is used to indicate the severity of the patient’s depression. It is important to choose a treatment option that poses the least possible harm to the patient, one that is efficient and has a low chance of drug to drug interactions. For example, other antidepressants such as Effexor are associated with risk of hypertension. Sertraline hydrochloride, commonly known as Zoloft, has been proven to be one of the safest and effective treatments of major depressive disorders in the elderly (Diniz & Reynolds, 2014). Elderly patients are at high risk of getting affected by medication used for depression management due to age-related metabolic changes. These initiate a sequence of medical complications and drug interactions.
Delegate your assignment to our experts and they will do the rest.
Expected Results
The medication is highly effective; hence, the patient would be expected to improve within a span of two weeks. Some symptoms may persist through the entire period of treatment but the majority of previously highlighted symptoms should be resolved early into the treatment. Signs of well-being expected include improved alertness, better relation to the people around him, improved intellect and increased vigor in his daily activities (Stahl et al., 2017). A significant drive to resume normal responsibilities and schedule should be observed as a sign of successful treatment.
Differences between Expected Results and Actual Results
The expected results during the course of and after treatment would include improved patient’s mental functioning ability. The patient is expected to have a better cognitive function which is to be manifested in their speech and coordinated movement. The drug is considered safe, so no major side effects are expected. Similarly, no drug-drug interactions are expected in case the patient is also on other medication (Morimoto, Kanellopoulos, Manning, & Alexopoulos, 2015). On his revisit after a span of three weeks, the patient reported a significant improvement in his mental health. He stated to perceive his environment better, attributing it to an improved ability to relax. He, however, cited some side effects such as reduced ability to function sexually, and insomnia. The difference between the actual results and expected outcomes was the fact that few or no side effects were expected at the end of the treatment. This can be justified by the patient’s body trying to adjust to the changes induced by the medication, while supportively helping to manage the depression disorder.
Decision Two
Wellbutrin XL 100 mg to be administered in the morning.
Reason for Selection
By factoring in the complaints of reduced sexual function, and problems sleeping, administration of Wellbutrin in the morning would help due to its augmenting properties. Bupropion hydrochloride, the primary compound in Wellbutrin, is a norepinephrine-dopamine reuptake inhibitor. It is well tolerated in adults making it a suitable drug with fewer fall outs during treatment. The American Psychiatric Association (2013) indicates that Wellbutrin significantly reduces insomnia and impart a certain quality to the life of the patient. Zoloft was successful in reducing the signs associated with depression, but had introduced insomnia and lower sex drive; hence, combination with Wellbutrin will prove beneficial. It is important to continue for signs of depression, especially suicidal tendencies, and sleep disorders.
Expected Results
The patient is expected to continue with the reduction of depression-related symptoms due to the combination of Wellbutrin and Zoloft. He is expected to also improve psychologically due to the resolution of some previously experienced challenges. The Wellbutrin is expected to help minimize instances of insomnia and low sex drive (Morimoto, Kanellopoulos, Manning, & Alexopoulos, 2015).
Differences between Expected Results and Actual Results
The expected result after the full period of treatment was that the patient would no longer experience adverse side effects, while also experiencing marked improvement in his mental health. The patient reported that there had been a significant control of his depression disorder, as well as an improvement but no eradication of sexual dysfunction and insomnia. The difference between the expected and actual result was that no further adverse effects were expected but mild effects were still experienced.
Decision Three
To discontinue Sertraline while increasing the Wellbutrin dosage from Wellbutrin XL 100 mg to Wellbutrin to XL 150mg each morning.
Reason for Selection
The failure to achieve the desired outcome in the second step was the main reason for this selection even with the fact that there was a decrease in the symptoms of major depressive disorder as experienced by the patient. This decision was arrived at because the side effects as a result of Sertraline could not be reduced or eliminated. Additionally, Wellbutrin XL reduces depression while doing away with the side effects associated with Sertraline (Stahl et al., 2017). This is also important in the attainment of therapeutic effect with the patient symptoms before his next visit.
Expected Results
The patient will be expected to have almost no symptom of his previous depressive disorder, while also experiencing close to zero side effects from the initial medication (Lam et al., 2017).
Differences between Expected Results and Actual Results
There were successful management and treatment of the patient suffering from major depressive disorder. As long as the patient continues responding well to the treatment without adverse effects, the patient will continue taking oral doses of 150mg until his next evaluation. The conclusion is that the treatment obtained desirable effects.
Impact of Ethical Considerations on Treatment Plan
Plan therapy in the management of psychiatric patients can make it challenging to make ethical considerations. It is important to consider dosage adjustments, perform monitoring of patient signs, and alarm signs such as suicidal tendencies. It is imperative that the practitioner finds the most suitable route for administering the drugs. The minimum possible harm must be caused to the patient and the best service offered (Ratheesh, 2017). It is vital to personalize the treatment for the management of each patient. Some drugs may be beneficial, while others may have some detrimental effects. Close monitoring of the patient status is therefore essential
References
American Psychiatric Association. (2013). 3 Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Note: 3 Retrieved from Walden Library databases.
Diniz, B. S., & Reynolds, C. F. (2014). Major depressive disorder in older adults: benefits and hazards of prolonged treatment. Drugs & aging , 31 (9), 661-669.
Lam, R. W., Ismail, Z., MacQueen, G. M., Milev, R. V., Parikh, S. V., Ravindran, A. V., & Kennedy, S. H. (2017). Response to Letter Regarding CANMAT Recommendations for the Pharmacological Treatment of Late-life Depression. The Canadian Journal of Psychiatry , 62 (5), 353-354.
Morimoto, S. S., Kanellopoulos, D., Manning, K. J., & Alexopoulos, G. S. (2015). Diagnosis and treatment of depression and cognitive impairment in late life. Annals of the New York Academy of Sciences , 1345 (1), 36-46.
Ratheesh, A., Cotton, S. M., Davey, C. G., Adams, S., Bechdolf, A., Macneil, C., ... & McGorry, P. D. (2017). Ethical considerations in preventive interventions for bipolar disorder. Early intervention in psychiatry , 11 (2), 104-112.
Stahl, S. M., Morrissette, D. A., Faedda, G., Fava, M., Goldberg, J. F., Keck, P. E., ... & Ostacher, M. (2017). Guidelines for the recognition and management of mixed depression. CNS spectrums , 22 (2), 203-219.
