The primary care provider asks Angela to fill out a Beck Depression Scale, which indicated she has moderate depression
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SOUTH UNIVERSITY
The primary care provider asks Angela to fill out a Beck Depression Scale, which indicated she has moderate depression
Paper Instructions
Angela is a 54-year-old married woman with three adult children. She has been the office manager of a small law firm for 20 years and has enjoyed her work until this past year. She has rheumatoid arthritis with minimal impairment that has been managed well with NSAIDs.
She has been taking conjugated estrogens for 8 years and decided to stop taking them because of her concern of their risks without sufficient medical benefit. She has tolerated the discontinuation without difficulty.
Assessment
At her annual medical checkup appointment, she told her primary care provider that she seemed to be tired all the time, and she was gaining weight because she had no interest in her usual exercise activities and had been overeating, not from appetite but out of boredom. She deniedthat she and her husband have had marital difficulties beyond the ordinary and she was pleased with the achievements of her children.
She noticed that she has difficulty falling asleep at night and awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep even though she still feels tired. She finds little joy in her life but cannot pinpoint any particular concern. Although she denies suicidal feelings, she does not feel that there is meaning to her life
My husband and kids would go on fine if I died and probably wouldn miss me that much.
The primary care provider asks Angela to fill out a Beck Depression Scale, which
indicated she has moderate depression.
- What medication would you first prescribe to this patient?
- She comes back in 2 weeks and states she has not noticed and change in her mood since starting on the medication. What would be your response?
- What are the possible problems with the medication you prescribed?
- How long should you continue the treatment regimen?
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Sample Answer
Pharm Week 9
The patient in the case study has moderate depression based on her presenting symptoms and scores from the Beck’s Depression Scale. I would initiate the patient on Fluoxetine (Prozac). Fluoxetine is a Selective serotonin reuptake inhibitor (SSRI) approved by the FDA for treating MDD. It is recommended as a first-line drug for treating uncomplicated MDD cases (Park & Zarate, 2019).
Fluoxetine acts by selectively inhibiting presynaptic serotonin reuptake but with minimal or no effect on the reuptake of dopamine or norepinephrine (Park & Zarate, 2019). I would prescribe Fluoxetine because it has less prominent side effects owing to its minimal anticholinergic effects.
If the patient came back in two weeks with reports of no changes in mood, I would inform her that antidepressant medications usually take 2-12 weeks at therapeutic doses and adherence to demonstrate the desired clinical response (Bauer et al., 2017). I would also inform her that the treatment would be altered if she does not demonstrate an adequate response treatment after eight weeks of treatment.
Besides, I would educate the patient that treatment failure can occur if there is noncompliance and taking a less dose than the prescribed (Park & Zarate, 2019). Potential adverse effects of Fluoxetine include nausea, diarrhea, somnolence, nervousness, anorexia, insomnia, and changes in energy levels such as body weakness, fatigue, and restlessness.
The treatment regimen with the initial dose of Fluoxetine should take eight weeks before changing the drug or dose. If the patient demonstrates clinical response and has no side effects, the dose can be increased gradually by 20mg/day, but not to exceed 80 mg/day (Bauer et al., 2017).
Treatment should continue until the depressive symptoms have fully abated. To discontinue the drug, I would taper the dose gradually over 4-6 months to reduce the incidence of withdrawal symptoms and to monitor re-emerging symptoms.
References
- Bauer, M., Severus, E., Möller, H. J., Young, A. H., & WFSBP Task Force on Unipolar Depressive Disorders. (2017). Pharmacological treatment of unipolar depressive disorders summary of WFSBP guidelines. International journal of psychiatry in clinical practice, 21(3), 166-176. https //doi.org/10.1080/13651501.2017.1306082
- Park, L. T., & Zarate, C. A., Jr (2019). Depression in the Primary Care Setting. The New England journal of medicine, 380(6), 559–568. https //doi.org/10.1056/NEJMcp1712493
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