Geriatric Depression Therapy

Geriatric Depression Therapy

Geriatric Depression Therapy

Among the elderly, depression has been associated with several negative impacts to both the patient and his or her family members. It is the role of the healthcare workers to familiarize themselves with depression’s causative variables to be able to identify patients who may require screening with instruments like Montgomery- Asberg Depression Rating Scale (Vuorilehto, Melartin, Riihimäki, & Isometsä, 2016). A clear understanding of the depression symptoms among the elderly forms the first basis for the development of appropriate interventions and the best choice of drugs to include in a patient’s care plan. The choice of a drug depends on its effectiveness and safety profile. Nonetheless, when the first choice seems to fail, an alternative drug within the same class might be combined with the first drug, or the medication can be entirely replaced. At this point, the nurse might consider a psychotherapeutic approach (Cowen, 2017; Stahl, 2013). Depression is diagnosed differently since the condition exists on varied scales. Thus, inasmuch as pharmacotherapy and psychotherapy are the main interventions used to manage the condition, electroconvulsive intervention might be considered in severe cases of depression. In the current paper, the case scenario provided is of a 31-year-old Hispanic man who was diagnosed with a severe depressive state, as per his scores on the Montgomery-Asberg Depression Rating Scale, which was 51. All the options of drug regiments that can be utilized in managing the patient’s symptoms of depression will be revealed in the present discussion. As a result, the analysis of this case will offer a comprehensive understanding of the therapeutic management of depression among geriatrics.

Decision Point One

Selected Decision

Begin Zoloft 25 mg OD

Reason for Selection

The first line choice of drug for the treatment of depression is usually Zoloft, which belongs to the broad class of

SSRIs. The Hispanic male patient was diagnosed with severe depression as per the scale that was used. Hence, the best choice of drug, in this case, based on the provided options, is Zoloft. The drug has proven to be the most effective and safest compared to other SSRIs (Polatin, Bevers, & Gatchel, 2017: Stahl, 2014b). On the other hand, the PMHNP can only recommend phenelzine if Zoloft, among other drugs, has proven to be ineffective, but not as a first line choice of treatment. Further, Effexor XL is usually associated with several side effects and should only be used as a last resort.

Expected Results

Most studies show that the effects of Zoloft start showing after continuous use for at least 14 days. By the end of week two, the drug should have been able to improve the patients sleeping patterns and concentration. Generally, most of the patient’s symptoms will be relieved after two weeks of using the drug (Coplan, 2015). Additionally, the patient should be able to interact appropriately with other people by this time with a reduced recollection of past mistreatments showing.

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Geriatric Depression Therapy

Differences between Expected Results and Actual Results

The patient came back to the hospital after two weeks with a 25% reduction of the depression symptoms just as expected by the PMHNP. However, the patient reported erectile dysfunction, which is one of the side effects of Zoloft. This effect was however not anticipated by the PMHNP since erectile dysfunction is usually very rare as compared to other side effects of Zoloft (Cipriani et al., 2016).

Decision Point Two

 Selected Decision

Add augmenting agent such as Wellbutrin IR 150 mg in the morning

Reasons for the Selection

After two weeks, the patient responded appropriately to Zoloft with a 25% reduction in depression symptoms. However, he also reported signs of erectile dysfunction, which needs to be addressed if the patient continues using the drug. In this case, the best intervention would be to include Wellbutrin, which is an effective augmenting agent that helps in the management of Zoloft induced erectile dysfunction. The two-drug combination therapy has been used over the years to prevent drug-induced erectile dysfunction in young and elderly men (Linde, Kriston, & Rucker, 2015). The other drugs provided for this case study cannot be used as they do not have the requ