Late Life Depression Treatment - Essay Example

Case Study

In terms of gender, men are more likely to be affected by depression compared to men. This being the case resolving mental health is a crucial step, especially depression; hence improving the care is vital. Depression can cause a drastic change in behavior and negative feelings like worthlessness, hopelessness, and unhappiness, and thoughts like suicide to the people affected (Stahl, 2014). It can also make the patient lose interest in the things they used to enjoy and can lead to Major Depressive Disorder (MDD) and clinical disorder (Diniz, 2014). From the scientific research acquired from the past, incidences have shown that depression and the changes in the behavior have a substantial impact on the family, the community of the patient, and the patient as well. Over the past year’s depression has been a mental disorder that has been on the rise among the young and the elderly. However, before the management, comprehensive diagnostic undertakings, including the Geriatric Depression Scale, are necessary to identify the kind of condition that a PMHNP nurse will address. In this situation, our client seems to be suffering from Late Life depression (LLD), depression, which starts at a young age and resurfaces at an old age (Stahl, 2014). If left unresolved, it can lead to cognitive impairment, functional impairment, and vascular dementia and having attained a reading of 51 in the "Montgomery- Asberg Depression Rating Scale (MADRS)" which indicate a severe depression the patient is as the risk of these diagnoses (Stahl, 2014). Therefore, mental health sessions with a professional and a prescription of antidepressants is a crucial thing for my patient. Alternative methods are also required to solve the client's depression in case one way does not prove to be effective.

Decision 1

Being PMNHPto solve this case, I chose to give the patient Begin Effexor XR 37.5 mg orally daily. (Client returns to the clinic in four weeks. Client reports that there is no change in depressive symptoms at all). Because of its component, venlafaxine hydrochloride Effexor is a Serotonin and Norepinephrine Reuptake Inhibitor (SNRI), and it has proven to be active on patients with severe stress over the years (Stahl, 2017). My patient score of the MADRS scale reads at 51, showing that he has very severe anxiety. Therefore, this drug should work effectively since it has serotonin and norepinephrine inhibitors effective in restoring the balance to the patient. This is comparable to other medicines, Zoloft, and Phenelzine (Stahl, 2017). Zoloft has only one inhibitor, the serotonin reuptake inhibitor, and therefore will be less effective. At the same time, Phenelzine is the strongest and should only be given to the patient as the last option when the other two drugs prove ineffective. Since it is the first decision on the patient, Effexor proofed to be the best option (Stahl, 2017). Upon taking, the drug should exhibit therapeutic actions to my patient within 2 – 4 weeks from the onset of receiving it. Eventually, it should complete the remission of the symptoms experienced by my patient and prevent the symptoms' recurrence. The patient would continue with the treatment until the depression is gone making my patient mentally healthy again. When all the signs are gone, the patient would take the drug for one year and stop completely. On the fourth week's visit, the patient shows no improvement in their symptoms. This is because the patient may be nonresponsive to the drug. Or there may be a need to increase the quantity of the drug.

Decision 2

Decision made: Increase dose to 75 mg of Effexor XR orally daily. I chose to increase the dosage for the patient since the patient proof to be nonresponsive to the drug. Among the medications given, Effexor XR still proves to be the most effective drug to treat my patient for the depression. According to the research done over the last couple of years, it has shown that when the drug seems irresponsive, then the dosage should be increased gradually until a certain level. Statistically, about 30% to 50% of patients with major depression issues, refuse to respond to the standard dosage but may respond to a more massive dosage (Moret, 2005). Instead of experimenting with another drug on my patient, I decided to increase the dosage for my patient. My patient’s response proves that the level of depression was too high for my patient. As much as Cymbalta serves the same purpose as that of Effexor, it has side effects like insomnia, which, to begin with, is one of the symptoms of my patient (Comerford, 2015). Since it is not clear whether my patient is irresponsive to the Effexor, it is not wise to augment an atypical antipsychotic as we need to evaluate his response to the drug first (Moret, 2005).

My expectation for this decision is that my patient will be responsive and at least show a decrease in the symptoms experienced at the beginning. The drug seemed to reduce the symptoms of the patient and has diminished the Asberg Depression Rating Scale (MADRS) decreased from 51 to 38 (25% reduction) (Laureate, 2016). Therefore, this drug seems to work. This is because the drug dose was doubled up from the first dose and, thus, proved useful (Comerford, 2015).

Decision 3

Decision made: Continue the same dose of medication. My client has no side effects on the medicine, and he experiences a decrease in al the symptoms he had. Therefore, as his PMHNP, he chooses to maintain the same dosage. So far, it proves to be useful as it lowered the MADRS by 25%. However, this is not the final prescription for the patient. This decision will be made during his last choice. Through this decision, I hope by the next visit will report a further decrease in his symptoms as well as register a reduction in his MADRS scaling test (Berney, 2005). Finally, I expect my patient to recover fully and clear all the symptoms, returning to his usual self. This will show that the patient is fully responsive to the dosage given (Philip, 2005). The outcome of the measures was in alignment with my expectations. The patient showed improvements as I expected, and he acknowledged that his symptoms had already decreased by far.

The patient has no record of chronic illness, so the drug pharmacokinetics and pharmacodynamic processes are okay. He does not have any side effects. In this particular case, I had to apply my work ethics of having conceit from my client before beginning the therapy and other ethical values.

Through this study, it is conclusive to say that every PMHNP should always begin treatment with the best drug option for the client, but at the same time, they should keep in mind the client's history. Moreover, one should evaluate the effect of the medicine on the client and watch out for any side effects the client experiences.