Treating Geriatric Clients with Major Depressive Disorders
Name
Walden University
NURS 6630:
Psychopharmacologic Approaches to Treatment of Psychopathology
2022
Introduction
This week’s case involves an elderly Hispanic man with major depressive disorder. The
major depressive disorder is prevalent and is estimated to have an incidence of six months and
7% due primarily to absenteeism / ill day, short-term disability, and loss of performance costs,
with a projected 12 months incidence of 6.7%. This is a challenge for medical professionals to
successfully treat patients with major depressive disorder and completely overcome all
symptoms (Buoli,6Cumerlato, Caldiroli & Altamura,62014). Each antidepressant drug has similar
levels of efficacy but patient reactions differ.
As we have expanded our understanding of the neurobiology of major depressive
disorders, individualization of treatment has strengthened. Psychiatric signs are now known to
associate with dysfunctional brain circuits (Magalhães,6Alves,6Llerena,6& Falcão, 2014).
Understanding the effects of the patient's treatment is important because variations in underlying
neurology, including variations in neurotransmitter-related disorders, may represent different
effects. The collection of medicines or other therapies which have effective action mechanisms
for patients is assisted by such understanding. Applying the concepts of neurobiology is a
justification for choosing individual therapies (Poluzzi,6et al. 2013).
Decision # 1
The first decision would be going for an antidepressant. Zoloft, Effexor and Phenelzine
are more effective in treating major depressive disorders due to the fact that they are responsible
for desensitization of serotonin receptors especially Zoloft. The first dose will comprise of
Effexor XR 37.5 mg which has low reaction mechanism hence a higher dose is recommended.
Decision #2
I would consider increasing the dosage after 4 weeks of slow reaction. The recommended initial
dosage of Effexor XR is 75 mg each day. Dosage rises to no more than 225 mg / day will help
patients who have not responded to the initial 75 mg / day dose. After 4 weeks, the symptoms
slowed down and patient showed indication of recovery. In reference to Varatharaj,6and Moran,6
(2014) the effectiveness of the antidepressant with depression rating scales is conventionally
calculated. Depression scales may be used for diagnosis of depression, quantification of severity,
or time shift assessment, including treatment response.
Decision 3
I would recommend Wellbutrin IR on a dosage of XL 150MG orally daily. The enantiomers '
pharmacological actions and pharmacokinetics are not investigated. On average, delivery takes
3-4 hours. Bupropion removal is 21 (±9) hours after chronic injection and bupropion plasma
stable is achieved during eight days (Guzman, 2018).
Ethical Considerations
In short time trials of major depressive disorders (MDD) and other clinical conditions,
antidepressants have raised their risk in contrast with the placebo in adolescence, adolescent and
young adult suicidal thought and actions (suicidality). Where an infant, teenager or young adult
is considering using WELLBUTRIN or some other antidepressant, this risk must equalize to
clinical necessity (Varatharadj and Moran 2014). Increases in the risk of suicides are themselves
caused by depression and many other mental conditions. A proper follow up and evaluation of
psychiatric regression and irregular behavioral changes should be carried out in patients of all
ages starting antidepressant therapy.
References
Buoli,6M., Cumerlato Melter,6C., Caldiroli,6A., & Altamura,6A.6C. (2014). Are antidepressants
equally effective in the long-term treatment of major depressive disorder?6Human
Psychopharmacology: Clinical and Experimental,630(1), 21-27. doi:10.1002/hup.2447
Magalhães,6P., Alves,6G., Llerena,6A., & Falcão,6A. (2014). Venlafaxine pharmacokinetics
focused on drug metabolism and potential biomarkers.6Drug Metabolism and Drug
Interactions,629(3). doi:10.1515/dmdi-2013-0053
Miskovic,6M. (2015). Comparison of tolerance of Venlafaxine, Paroxetine and Amitriptyline in
depression therapy.6Medical Archives,669(2), 107. doi:10.5455/medarh.2015.69.107-109
Poluzzi,6E., Piccinni,6C., Sangiorgi,6E., Clo,6M., Tarricone,6I., Menchetti,6M., & De Ponti,6F.
(2013). Trend in SSRI-SNRI antidepressants prescription over a 6-year period and
predictors of poor adherence.6European Journal of Clinical Pharmacology,669(12),
2095-2101. doi:10.1007/s00228-013-1567-8
Varatharaj,6A., & Moran,6J. (2014). Pendular nystagmus associated with venlafaxine overdose: a
forme fruste of the serotonin syndrome?6Case Reports,62014(feb06 1), bcr2013202106-
bcr2013202106. doi:10.1136/bcr-2013-202106
