Advances in technology have currently increased the legitimacy and the accuracy of diagnosis of mental illnesses and disorders. Evidence-based practice ensures the best treatment modality and enhanced prognosis for various mental health conditions. Health needs that are unique to specific populations should be considered when making treatment choices. This report will be examining the rationale to the decisions made during the treatment process of a male Hispanic client with Depressive Disorder. Each decision step shall be examined for the choice of drug, all the expected outcomes and the actual and authentic outcomes for the selected patient.
Decision point 1
The initial regimen for the patient selected was Effexor XR 37.5mg which was to be taken orally. This is a significant prescription for depressive disorders. It works by boosting serotonin, blocking norepinephrine and also by weakly blocking the reuptake dopamine (Stahl, 2014b). Desired outcomes are expected within two to four weeks, depending on individuals. When the desired results are not achieved after 8weeks, then the medication may be deemed to have failed, or a higher dose may be required. The patient came back after four weeks reporting no change of symptoms. In this case, we expected some change of symptoms. However there were none. Hispanic males are more predisposed to suicidal ideations (Brennan et al., 20005). Increasing and improving the dosage of the regimen and the routine increases the risk to suicidal ideation hence, this will not be the best option in this case (A Supplement to Mental Health, 2001). This regimen was alleged to have failed, and a different regimen was to be initiated.
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Decision point 2
The routine was changed to Cymbalta 30mg per oral in a day. This is a drug of choice for major depressive disorders. Away from its antidepressant action, it is also a musculoskeletal pain reliever, a significant issue in the elderly population. This drug works within two to four weeks for onset of action (Stahl, 2014b). The aim of the change of establishment in this decision level is to achieve reduced depressive symptoms and also to mitigate associated musculoskeletal pain. The client reports no apparent change in depressive symptoms, but claims relieve of pain and requests to proceed with the regimen as it has favorable effects on his pain.
Decision point 3
The dose of Cymbalta is increased to 60mg orally daily. Increasing the dose to the optimum level is aimed at achieving desirable effects both in pain reduction and in remission of depressive symptoms. Since the client is not showing any improvement in the depressive symptoms, another option may be changing the regimen. However, Cymbalta has fewer side effects and compared to other antidepressants, it is more effective (Howland, 2008). Desirable effects of the drug can be enhanced by increasing the dosage of the drug. Increasing the dose is aimed at improving the level of desired outcomes and reducing the depressive symptoms to a desirable level.
Maintaining the client on this medication for six or more weeks may elicit desirable outcomes. The client should report reduced pain and reduce depressive symptoms. If the client reports relieve of symptoms, then the dose should be maintained for about six months for initial episodes and 12 months for recurrent events.
References
Brennan, M., Vega, M., Garcia, I., Abad, A., & Friedman, M. B. (2005). Meeting the Mental Health Needs of Elderly Latinos Affected by Depression: Implications for Outreach and Service Provision. Care Management Journals , 6 (2), 98-106. doi:10.1891/152109805780650724
Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (star*d). Journal of Psychosocial Nursing and Mental Health Services , 46 (10), 21-24. doi:10.3928/02793695-20081001-05
Office of the Surgeon General (US); Center for Mental Health Services (US); National Institute of Mental Health (US). Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2001 Aug. Chapter 6 Mental Health Care for Hispanic Americans. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44247/
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
