21.Wk8DisRe1

Respond to a colleague who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

Post:

Adult Geriatric Depression

The adult geriatric depressive male 70 years old presented with c/o depression referred from a primary physician after r/o of an organic basis for depression. The patient has 15lb weight gain in a few months and has diminished interest in previous activities with poor concentration at work. The Montgomery Aspberg Scale rating is a 51 indicating severe depression. The further review with the patient of any over the counter medications that he may be taking, alternative medicines or any other medication should be discussed to prevent any interactions, as the geriatric population the prevalence is high that they are taking multiple oral medicines (Varghese & Dahale, 2018).

Decision Steps

The decision I chose first was to start Zoloft 25mg rather than the Effexor Xr 37.5mg or the Phenelzine 15mg TID. I chose the SSRI as my first choice due to the age of the patient and this classification does not cause hypotension or anticholinergic effects, with the exception of fluvoxamine, do no cause sedation (Rosenthal & Burchum, 2018). Effexor being a SNRI has to have monitoring of blood pressure due to possibility of diastolic hypertension side effect and Phenelzine can cause a hypertensive crisis by eating foods high in tyramine.

The next decision I chose when the patient presented in four weeks with a 25% decrease in symptoms but, concerned with erectile dysfunction was to add Welbutrin IR 150mg in the morning. Welbutrin is an atypical antidepressant with a similar structure to amphetamine and may be related to blockade of dopamine and NE uptake, it is often used as an SSRI adjunct in the treatment of depression to increase libido (Yasin, et. al, 2019).

The following decision when the patient returned in the next 4 weeks and had further improvement in his depression but, c/o feeling jittery and nervous was to change the Welbutrin to XL 150mg to extend the dosage over a time period. The plasma peak of Welbutrin IR is before 2 hours while the Welbutrin XL is after 5 hours so that will most likely reduce the jittery feeling of the patient (Huecker, et. al, 2020).

****Here’s the link to the interactive step approach if you want to check this out. Just pick a different process and write 2 paragraphs about it. Just do your best I just need something to post. Thanks Jane!

http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_03/index.html