W6-Depression Scenarios

Post#1: Depression Scenarios by Jimmy Smith

The purpose of this discussion is to build on the treatment plan for the video patient from week 5 and describe the treatment plan modifications related to the reported symptoms during the 6 week follow up visit.

1. There is no response to the medication?

My rational drug choice for this patient was Sertraline 50mg by mouth daily with increase up to 200mg taper as needed for effect There is no reported response related to depression for the patient at the 6 week follow up. I would continue with the medication after discussing with the patient related to other symptom decrease such as anxiety, quality of life and a overall rating from the patient of whether he feels it is helping. Sertraline may not reduce symptoms of depression at the six week mark as it may not have had time to reach therapeutic level (Lewis, et. al., 2019). Increasing the dosage to 100 mg per day and re-evaluation at next 6 week follow up would be suggested (Woo & Robinson, 2020)..

2. There is a partial response to the medication. Mood has lifted but energy and motivation are still poor.

Continue with medication dosage at current dose and suggest group therapy activities and group therapy sessions (Corey, 2017). Addition of group therapy session could increase motivation and allow networking as well as acknowledgement that there are many that suffer from similar symptoms. Learning how others manage symptoms is an important treatment goal for patients with depression (Thimm & Antonsen, 2014).

3. Mood is improved but the patient has sexual side effects that interfere with quality of life.

Discussing possible and actual sexual side effects of anti-depressive medications with the patient and gaining an understanding of the extent of sexual dysfunction. It is important to for the patient to make an informed decision on whether to change medications at the 6 week follow up or to continue with current medication for an additional 6 weeks to insure that there is not improvement with dysfunction and with mood. Increasing the mood and overall mental health has been shown to improve joy for patients (Jing & Wilson, 2016).

References:

Lewis, G., Duffy, L., Ades, A., Amos, R., Araya, R., Brabyn, S., Button, K. S., Churchill, R., Derrick, C., Dowrick, C., Gilbody, S., Fawsitt, C., Hollingworth, W., Jones, V., Kendrick, T., Kessler, D., Kounali, D., Khan, N., Lanham, P., Pervin, J., … Lewis, G. (2019). The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. The lancet. Psychiatry, 6(11), 903–914. https://doi.org/10.1016/S2215-0366(19)30366-9

Jing, E., & Straw-Wilson, K. (2016). Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review. The mental health clinician, 6(4), 191–196. https://doi.org/10.9740/mhc.2016.07.191

Woo, T. M., Wynne, A. L., & Robinson, M. V. (2020). Pharmacotherapeutics for Advanced Practice Nurse Prescribers. F.A. Davis Company.