Question 1
My first step would be to prescribe selective serotonin reuptake inhibitors (SSRIs). The SSRIs have been used since 1987 and have come to be known as one of the primary antidepressants. As such, they have an impact in mitigating depression and most importantly, stabilizing an individual's mood. Compared to most other drugs, it has relatively fewer side-effects. The drugs eliminate depression by heightening the levels of serotonin in a person's brain. The serotonin is an example of a neurotransmitter responsible for carrying chemicals between brain cells. The drug also blocks the reuptake of serotonin, thus making it more available (Lehne, 2013). The drugs are referred to as selective due to their tendency to focus on only one neurotransmitter-serotonin. The SSRI of choice, in this case, would be fluoxetine. I would begin by a low dose, followed by a re-assessment session after a couple of weeks.
Question 2
If the patient comes back after two weeks stating that she has not noticed any change in her mood, several aspects would be taken into consideration. I would ensure that the patient understands that the maximum therapeutic impact begins in the second week and could extend up to the fourth week. The improvement of the symptoms will follow a sequence starting with the vegetative symptoms to the arousal symptoms. The third and final step will encompass the relief of any mood symptoms she might be experiencing. It is therefore incumbent for Angela to continue with her medication and an effective follow-up for at least one month. Recent research established that between 40% and 60% of patients who took antidepressant medication noticed an improvement in their symptoms within the first eight weeks (Wenthur, Bennett, & Lindsley, 2014). However, if no improvement has been witnessed within this period, I would consider adding the dosage.
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Question 3
As a medication, fluoxetine can come with a plethora of unintended side effects on the part of the patient. The side effects could range from nausea, sexual dysfunction, insomnia, headache, anxiety, and nervousness, among others. Angela would need to know that discontinuing her medication could lead to withdrawal symptoms. As such, it is crucial to take the medications to the latter. Some of the withdrawal symptoms that Angela could face include headache, dizziness, tremor, anxiety, disturbances, and dysphoria, among others. In some instances, the drug could be tapered gradually to minimize any withdrawal symptoms (Wenthur, Bennett, & Lindsley, 2014). However, it is essential to note that fluoxetine has minimal chances of causing withdrawal. This is due to the fact that it possesses a prolonged half-life. It is also imperative to allow Angela to note that once she begins the medication, she might experience weight gain. Therefore, I would advise her to consider creating an exercise plan to cater to her physical activity needs.
Question 4
The aim of the treatment in the first few weeks and months is to eliminate the symptoms of the disorder. After achieving this, the treatment should be continued for up to nine months. For the case of Angela, I would recommend that she continues with the treatment plan for up to a year. After this, a thorough follow-up session would be performed to assess whether or not she the medication needs to be discontinued. It is important to note that the medication could, in some instances, take longer to prevent incidences of relapses. Her condition will, therefore, be the biggest determinant of how long the medication plan will continue.
References
Lehne, R. (2013). Pharmacology for nursing care. 8th edition. St. Louis, Missouri: Elsevier/Saunders
Wenthur, C. J., Bennett, M. R., & Lindsley, C. W. (2014). Classics in Chemical Neuroscience: Fluoxetine (Prozac). ACS Chemical Neuroscience, 5(1), 14–23. http://doi.org/10.1021/cn400186j
