W5- DEPRESSION CASE STUDY

W5- DEPRESSION CASE STUDY

W5- Depression Case Study

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Case Study Questions

1. What information, if any, would you like to know that was not included in the case

Some of the other information that I would like to know include; the patient’s past medical and psychiatric history, family history, and substance use history. For instance, it would be necessary to inquire from the patient whether she has a history of any chronic disease or psychiatric illness. This would help in determining whether her symptoms are associated with any other medical condition or psychiatric illness. Moreover, it would be necessary to inquire from the patient about her substance use history. This would help in determining whether the use of drugs/substances may have contributed to the development of her problems. More importantly, it would be necessary to obtain information about the patient’s family history and inquire if she has a family history of any psychiatric illness.

2. Which psychiatric symptoms are a treatment priority for this case?

The psychiatric symptoms that are treatment priority for this patient include; sleep disturbances, loss of interest, mood swings, impaired concentration, and memory problems. The treatment of these symptoms would help in improving the patient’s level of functioning and engagement in her daily activities.

3. What are the non-pharmacologic issues in this case (problems/complaints that cannot be addressed by medication)?

Some of the non-pharmacological issues that cannot be resolved or addressed by the use of medications include; ineffective coping, negative beliefs and feelings, and social withdrawal.

Medication Choice 1

4. List one medication that would be appropriate for this case. Include the name and starting dose.

Sertraline is one of the most appropriate medications that would help in improving the symptoms of this patient. As such, it would be prudent to start the patient on sertraline (50 mg per day) to help in improving her symptoms. The starting dose of this medication for the treatment of the major depressive disorder is 50 mg orally and taken once per day (Gartlehner et al., 2017).

5. Describe your clinical decision-making. What is your rationale for choosing this medication? Also, include the mechanism of action for this medication choice, and the neurotransmitters and areas of the brain on which the medication is proposed to act on.

Based on the information provided in the case study, it is apparent that the patient has a major depressive disorder. The treatment of this disorder involves the use of antidepressant medications and SSRI (Selective serotonin reuptake inhibitors) like sertraline are usually considered as the first-line medication used in the treatment of this disorder, hence the selection of this medication. Moreover, SSRI medications like sertraline are usually considered to be safer and they have fewer adverse effects compared to the other antidepressants (Fekadu, Shibeshi & Engidawork, 2017).

The mechanism of action for sertraline involves increasing the amount and level of serotonin in the brain, which helps in maintaining serotonin balance thereby improving the depression symptoms (Huddart et al., 2020). This medication usually acts on a chemical neurotransmitter that is known as serotonin, which is involved in the transmission of electrical impulses or signals from one nerve cell to the next (Huddart et al., 2020). Under normal circumstances, serotonin is reabsorbed quickly (Huddart et al., 2020). However, the use of an SSRI medication allows serotonin to stay longer in the synaptic cleft between the neurons, which enables this chemical neurotransmitter to convey additional messages or signals to the receiving nerve cells that help in improving the boosting an individuals’ mood and improving the depression symptoms (Huddart et al., 2020).

6. What laboratory testing/monitoring is needed for safely prescribing this medication?

The laboratory testing/monitoring that is required to ensure safe prescription of this medication include; liver function tests like ALT, ALP, albumin, and AST tests, GFR (Glomerular filtration rate) test, thyroid test, blood pressure test, and the Hemoglobin A1c test. For instance, the use of this medication among individuals with kidney problems may affect their kidney function or result in severe side effects (Huddart et al., 2020). Therefore, it is necessary to perform a GFR test to assess the patient’s renal function that would help in ensuring the safe prescription of this medication. The liver function test would also help in determining whether the patient’s body would be able to process this mediation efficiently, which would help in minimizing the risk of severe side effects (Huddart et al., 2020).

7. Are there any contraindications or safety issues associated with this medication?

The use of sertraline is contraindicated in patients who have certain medical problems or conditions like liver disease, cardiovascular diseases, kidney diseases, seizure disorders, bleeding problems, and glaucoma (Huddart et al., 2020). Therefore, it would be prudent to determine whether the patient has a history of any of these problems.

Non pharmacologic Interventions

8. What non-pharmacologic interventions do you recommend? Do you recommend including but not limited to psychotherapy, complementary and holistic therapies?

Some of the non-pharmacological interventions that may be recommended to this patient include; psychotherapeutic interventions like interpersonal or cognitive behavioral therapy, counseling, stress-reduction or mind-body techniques like meditation, aerobic exercises, and guided imagery (Gartlehner et al., 2017). For example, psychotherapeutic intervention like cognitive behavioral therapy could help the patient findings appropriate ways to solve and cope with her problems and adopt healthy and positive behaviors (Gartlehner et al., 2017).

Safety Risk Assessment

9. What are the safety concerns, if any, associated with this case? How will you address safety?

Some of the safety concerns, in this case, include; the risk of self-harm, injury or suicide, and medication overdose. For instance, the patient states that she has tried to kill herself once by medication overdose, hence the risk of medication overdose and self-harm. Thus, it would be necessary to ensure close monitoring of the patient to ensure her safety. For instance, it would be necessary to inform her sister of the need to ensure that she takes her medication as prescribe and monitor her closely for unusual behavior to ensure her safety.

10. When would you follow up with this patient?

To ensure effective monitoring of the patient, it would be necessary to follow up with her through telephone calls, home visits, and clinical appointments.

References

Fekadu, N., Shibeshi, W., & Engidawork, E. (2017). Major depressive disorder: pathophysiology and clinical management. J Depress Anxiety, 6(1), 255-257.

Gartlehner, G., Wagner, G., Matyas, N., Titscher, V., Greimel, J., Lux, L., … & Lohr, K. N. (2017). Pharmacological and non-pharmacological treatments for major depressive disorder: review of systematic reviews. BMJ open, 7(6), e014912.

Huddart, R., Hicks, J. K., Ramsey, L. B., Strawn, J. R., Smith, D. M., Babilonia, M. B., … & Klein, T. E. (2020). PharmGKB summary: sertraline pathway, pharmacokinetics. Pharmacogenetics and genomics, 30(2), 26.

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