Assessing and Treating Vulnerable Populations for Depressive Disorders Discussion Paper

Assessing and Treating Vulnerable Populations for Depressive Disorders Submission Date

Introduction

Depression among the older population is a significant public health concern in the United States. It is estimated that by 2030, the older adult generation will be above 20% of the US residents, and thus a higher number will likely suffer from depressive disorders. According to Cheruvu & Chiyaka (2019), the prevalence rate of depressive disorder among older adults in the United States is between 5 and 10%. As such, the condition is predicted to be the second cause of disease and financial burden in healthcare. The risk factors associated with depression in the ageing population include chronic illnesses, disabilities, inadequate social support, and socioeconomic status. Therefore, assessment and treatment of depressive disorder among the older population must be conducted early and timely to prevent other related complications. This paper discusses causes, signs, assessment, treatment, medical considerations, and special considerations of depressive disorder in older adult populations. Assessing and Treating Vulnerable Populations for Depressive Disorders Discussion Paper

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Causes and Symptoms of Depressive Disorder in Older Adults

The leading causes of depression in older adults include poor physical health, lack of social support, and loss of old age. The high prevalence of chronic conditions among the elderly affects their physical, mental, and emotional well-being, which may lead to depression. During the old period, individuals become isolated from friends, families, and the community. Thus, they lack adequate physical and emotional support, therefore feeling lonely, which could affect their mental well-being, leading to depression (Avasthi & Grover, 2018). Lastly, with old age, individuals might experience a frequent loss of loved ones, loss of jobs, loss of money, and pets, among others. The experience of repeated loss contributes to the development of depressive disorders. The signs and symptoms of depression may be physical or emotional. The physical symptoms of depression among older adults include insomnia, weight loss, loss of appetite, frequent migraines, apathy, loss of interest, and other somatic symptoms (Avasthi & Grover, 2018). Other behavioural symptoms associated with depression are regular drinking of alcohol.

Diagnosis for Depression in Older Adults

The two screening tools used to diagnose depressive disorder among older adults are the geriatric depression scale and a Cornell Scale for Depression in Dementia. Diagnosis among older adults is conducted by first assessing the physical and behavioural signs and symptoms. In addition, a psychiatrist also considers predisposing and precipitating risk factors associated with the condition. The precipitating risk factors to be considered include recent bereavement, residence change, adverse life events causing trauma, financial crisis, separation and marital issues. The predisposing risk factors include previous depression, chronic conditions, substance use and persistent sleep difficulties. After establishing the symptoms, either of the two screening tools is diagnosed among the population. The Geriatric Depression Scale is a validated questionnaire of self-rated assessment. It contains a 30-item long set of questions and 15 short-form sets of questions (Avasthi & Grover, 2018). The long form used an 11-point cutoff score, and the short form used a 7-point cutoff score for the diagnosis of depression. However, its reliability decreases with increasing cognitive impairment; thus, a Cornell Scale for Depression in Dementia is used. The tool utilizes information from family members, caregivers, and patients. Assessing and Treating Vulnerable Populations for Depressive Disorders Discussion Paper

Medication Treatment Options

When choosing medication treatment for depression in older adults, it is essential to consider various factors. Such factors include patients’ response to previous therapies, type of depression, allergic reactions, other pre-existing comorbidities, and medications. Among older adults, antidepressants have been identified as the most effective treatment of depressive disorders as they do not worsen the condition or cause severe health events. For example, in patients with dementia, diabetes, and cardiovascular problems, selective serotonin reuptake inhibitors are recommended for depression treatment rather than anticholinergic drugs. The SSRIs include bupropion, mirtazapine, and venlafaxine can be used in older patients as they are safe. They have relatively low anticholinergic effects; thus, the side effects are not adverse (Lenze & Ajam Oughli, 2019). The common side effects include nausea, dry mouth, insomnia, diarrhoea, and agitation, which are manageable. The FDA approves the use of citalopram, escitalopram, venlafaxine, and bupropion as they have a lower potential of the drug to drug interaction compared to fluoxetine, paroxetine, and fluvoxamine.

Laboratory and Comorbidity Medical Issues to Monitor

Specific lab tests need monitoring to diagnose and treat depression in older adults. Such tests include creatinine and blood urea levels, liver functioning, glucose levels and complete blood count. The creatinine and blood glucose levels are essential to establish if the kidney is working well, as it affects the metabolism of certain medications. Monitoring the liver functioning is also necessary as it will influence the metabolism of the treatment drugs, consequently influencing how the drugs will work. It is also required to monitor the glucose level associated with diabetes, as certain medications cannot be used in patients with diabetes. Specific comorbid issues are crucial to monitoring. Such conditions include dementia, diabetes, and cardiovascular problems, as they affect the treatment options used in patients. Patients with such pre-existing conditions are recommended to use bupropion, mirtazapine, and venlafaxine, which are safer compared to fluoxetine, paroxetine, and fluvoxamine which have a high risk of the drug to drug interactions. In addition, bupropion, mirtazapine, and venlafaxine share general safe side effects, including nausea, dry mouth, insomnia, diarrhoea, and agitation, which are manageable. Assessing and Treating Vulnerable Populations for Depressive Disorders Discussion Paper

Special Considerations in Treatment for Depression

The ethical consideration in treatment is the right to self-determination and individual autonomy. The aspect entails the patient exercising the choice of therapy and other alternatives available or getting no treatment; thus, the psychiatric resonates with the patient’s values. However, the patient must have the mental capacity to make such a decision (Vajawat et al., 2021). The legal consideration that applies during the treatment of older patients with depression is advanced directives. According to Vajawat et al. (2021), a person is entitled to give an advanced medical charge if they are mentally incapacitated. As such, an older adult with a depressive disorder can have someone make health decisions which the providers must respect. The cultural consideration should be considered the different values and norms associated with other cultures. The psychiatrist must consider different cultural beliefs, attitudes, languages and preferences when administering treatment.

How to Write a Prescription

Selective Serotonin Reuptake Inhibitors

Conclusion

In conclusion, depressive disorder in older adults is a leading cause of disease and financial burden in the United States. The impacts of the condition on patients, families and communities are detrimental; thus, effective psychotherapeutic and pharmacologic interventions must be established early. Early and timely diagnosis effectively reduces the financial burden associated with depression complications. Psychiatric patients identify the physical and emotional symptoms of depression among older adults. A geriatric depression scale or a Cornell Scale for Depression in Dementia is used for the correct diagnosis of the condition. By establishing the type of depression and considering other comorbid and lab issues, a treatment option is recommended for the patient. Selective Serotonin Reuptake Inhibitors (SSRIs) are the most effective treatment for depression in older patients. The safest pharmacologic drugs include bupropion, citalopram, escitalopram, mirtazapine, and venlafaxine. In addition, it is essential to consider the dosage for each treatment to ensure effective health outcomes. Therefore, psychiatrists should consider several factors in determining the most effective treatment option for the condition. Assessing and Treating Vulnerable Populations for Depressive Disorders Discussion Paper

References

Avasthi, A., & Grover, S. (2018). Clinical practice guidelines for management of depression in elderly. Indian Journal Of Psychiatry, 60(7), 341. https://doi.org/10.4103/0019-5545.224474

Cheruvu, V., & Chiyaka, E. (2019). Prevalence of depressive symptoms among older adults who reported medical cost as a barrier to seeking health care: findings from a nationally representative sample. BMC Geriatrics, 19(1). https://doi.org/10.1186/s12877-019-1203-2

Lenze, E., & Ajam Oughli, H. (2019). Antidepressant Treatment for Late‐Life Depression: Considering Risks and Benefits. Journal Of The American Geriatrics Society, 67(8), 1555-1556. https://doi.org/10.1111/jgs.15964

Vajawat, B., Hegde, P., Malathesh, B., Kumar, C., Sivakumar, P., & Math, S. (2021). Palliative Care and Legal Issues in Geriatric Psychiatry. Indian Journal Of Psychological Medicine, 43(5_suppl), S31-S36. https://doi.org/10.1177/02537176211031077

Assignment: Assessing and Treating Vulnerable Populations for Depressive Disorders
To prepare for this Assignment:
Review this week’s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.
The Assignment: 5 pages  pediatri
For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources. Assessing and Treating Vulnerable Populations for Depressive Disorders Discussion Paper

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In your patient guide, include discussion on the following:

Depressive disorder causes and symptoms
How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable
Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
Medication considerations of medication examples prescribed (see last bullet item)
What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
Where to follow up in your local community for further information
Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy. Assessing and Treating Vulnerable Populations for Depressive Disorders Discussion Paper