Week 3: Adult and Geriatric Antidepressant Therapy

The National Institute of Mental Health
estimates that approximately 15.7 million adults in the United States
have depression (NIMH, 2014), making depression one of the most common
disorders you will treat in practice. Although this disorder is so
prevalent, antidepressant therapy must be as unique as each individual
you treat. There are dozens of antidepressant medications on the market,
and you must be able to identify which medication or combinations of
medications will result in the best outcomes for your clients.

This
week, as you study antidepressant therapies, you examine the assessment
and treatment of clients with mood disorders. You also explore ethical
and legal implications of these therapies.

Learning Objectives

Students will:

• Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic
  processes in adult and geriatric clients requiring antidepressant
  therapy
• Analyze the impact of ethnicity on antidepressant therapy
• Evaluate efficacy of treatment plans
• Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through this link provided.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

• Chapter 6, “Mood Disorders”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

• amitriptyline
• bupropion
• citalopram
• clomipramine
• desipramine
• desvenlafaxine
• doxepin
• duloxetine
• escitalopram
• fluoxetine
• fluvoxamine

• imipramine
• ketamine
• mirtazapine
• nortriptyline
• paroxetine
• selegiline
• sertraline
• trazodone
• venlafaxine
• vilazodone
• vortioxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21-24. doi:02793695-20081001-0510.3928/02793695-20080901-06

Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21-24. doi:02793695-20081001-0510.3928/02793695-20080901-06

Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf

Discussion: The Impact of Ethnicity on Antidepressant Therapy

Major depressive disorder is one of the most
prevalent disorders you will see in clinical practice. Treatment for
this disorder, however, can vary greatly depending on client factors,
such as ethnicity and culture. As a psychiatric mental health
professional, you must understand the influence of these factors to
select appropriate psychopharmacologic interventions. For this
Discussion, consider how you might assess and treat the individuals in
the case studies based on the provided client factors, including
ethnicity and culture.

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following case studies to review for this
Discussion. To access the following case studies, click on the Case
Studies tab on the Stahl Online website and select the appropriate
volume and case number.

Case 1: Volume 1, Case #1: The man whose antidepressants stopped working

Case 2: Volume 1, Case #7: The case of physician do not heal thyself

Case 3: Volume 1, Case #29: The depressed man who thought he was out of options

• Review this week’s Learning Resources and reflect on the insights they provide.
• Go to the Stahl Online website and examine the case study you were assigned.
• Take the pretest for the case study.
• Review the patient intake documentation, psychiatric history,
  patient file, medication history, etc. As you progress through each
  section, formulate a list of questions that you might ask the patient if
  he or she were in your office.
• Based on the patient’s case history, consider other people in his
  or her life that you would need to speak to or get feedback from (i.e.,
  family members, teachers, nursing home aides, etc.).
• Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
• Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
• Review the patient’s past and current medications. Refer to Stahl’s
  Prescriber’s Guide and consider medications you might select for this
  patient.
• Review the posttest for the case study.

Note: For this Discussion, you are required to complete
your initial post before you will be able to view and respond to your
colleagues’ postings. Begin by clicking on the “Post to Discussion
Question” link and then select “Create Thread” to complete your initial
post. Remember, once you click on Submit, you cannot delete or edit your
own posts, and you cannot post anonymously. Please check your post
carefully before clicking on Submit!

By Day 3

Post a response to the following:

• Provide the case number in the subject line of the Discussion thread.
• List three questions you might ask the patient if he or she were in
  your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or
  get feedback from to further assess the patient’s situation. Include
  specific questions you might ask these people and why.
• Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
• List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be
  appropriate for the patient’s antidepressant therapy based on
  pharmacokinetics and pharmacodynamics. From a mechanism of action
  perspective, provide a rationale for why you might choose one agent over
  the other.
• For the drug therapy you select, identify any contraindications to
  use or alterations in dosing that may need to be considered based on the
  client’s ethnicity. Discuss why the contraindication/alteration you
  identify exists. That is, what would be problematic with the use of this
  drug in individuals of other ethnicities?
• If your assigned case includes “check points” (i.e., follow-up data
  at week 4, 8, 12, etc.), indicate any therapeutic changes that you
  might make based on the data provided.
• Explain “lessons learned” from this case study, including how you
  might apply this case to your own practice when providing care to
  patients with similar clinical presentations

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two
of your colleagues who were assigned to a different case than you. For
example, if you were assigned to Case Study 1, respond to one colleague
assigned to Case Study 2 and one colleague assigned to Case Study 3.
Explain how you might apply knowledge gained from your colleagues’ case
studies to you own practice in clinical settings.

• If your colleagues’ posts influenced your understanding of these
  concepts, be sure to share how and why. Include additional insights you
  gained.
• If you think your colleagues might have misunderstood these
  concepts, offer your alternative perspective and be sure to provide an
  explanation for them. Include resources to support your perspective.

Submission and Grading Information

Grading Criteria

To access your rubric:Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:Week 3 Discussion

Assignment: Assessing and Treating Adult and Geriatric Clients With Mood Disorders

Advances in genetics and epigenetics have
changed the traditional understanding of mood disorders, resulting in
new evidence-based practices. In your role as a psychiatric mental
health nurse practitioner, it is essential for you to continually
educate yourself on new findings and best practices in the field. For
this Assignment, you consider best practices for assessing and treating
adult and geriatric clients presenting with mood disorders.

Learning Objectives

Students will:

• Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic
  processes in adult and geriatric clients requiring antidepressant
  therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing antidepressant therapy to adult and geriatric clients

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through this link provided.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

• Chapter 6, “Mood Disorders”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

• amitriptyline
• bupropion
• citalopram
• clomipramine
• desipramine
• desvenlafaxine
• doxepin
• duloxetine
• escitalopram
• fluoxetine
• fluvoxamine

• imipramine
• ketamine
• mirtazapine
• nortriptyline
• paroxetine
• selegiline
• sertraline
• trazodone
• venlafaxine
• vilazodone
• vortioxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. Retrieved from https://www.researchgate.net/profile/Marie_Asberg/publication/22697065_A_New_Depression_Scale_Designed_to_be_Sensitive_to_Change/links/09e41513f85c708fee000000.pdf

Required Media

Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author. Note: This case study will serve as the foundation for this week’s Assignment.

To prepare for this Assignment:

• Review this week’s Learning Resources. Consider how to assess and
  treat adult and geriatric clients requiring antidepressant therapy.

The Assignment

Examine Case Study: An Elderly Hispanic Man With Major Depressive Disorder.
You will be asked to make three decisions concerning the medication to
prescribe to this client. Be sure to consider factors that might impact
the client’s pharmacokinetic and pharmacodynamic processes.

• At each decision point stop to complete the following:
  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision?
      Support your response with evidence and references to the Learning
      Resources.
    • Explain any difference between what you expected to achieve
      with Decision #1 and the results of the decision. Why were they
      different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision?
      Support your response with evidence and references to the Learning
      Resources.
    • Explain any difference between what you expected to achieve
      with Decision #2 and the results of the decision. Why were they
      different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision?
      Support your response with evidence and references to the Learning
      Resources.
    • Explain any difference between what you expected to achieve
      with Decision #3 and the results of the decision. Why were they
      different?
• Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three
academic resources. While you may use the course text to support your
rationale, it will not count toward the resource requirement.

By Day 7

Submit your Assignment.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
• Click the Week 3 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 3 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:Week 3 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:Submit your Week 3 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To submit your Assignment:Week 3 Assignment

Making Connections

Now that you have:

• Assessed adult and geriatric clients presenting with mood disorders
• Developed personalized plans of antidepressant therapy for adult and geriatric clients
• Examined factors that influence pharmacokinetic and pharmacodynamic
  processes in adult and geriatric clients requiring antidepressant
  therapy
• Explored ethical and legal implications of prescribing antidepressant therapy to adult and geriatric clients

Next week, you will build on your assessment and treatment skills as you examine clients presenting for bipolar therapy.
To go to the next week:Week 4