Impacts of Ethnicity on Antidepressant Therapy Essay

Complications of both depression and substance use are some of the most prevalent and debilitating mental conditions affecting individuals worldwide. Nevertheless, the effects of these mental illnesses are distributed unevenly. Disparities in mental health services refer to the difference in care provided to individuals of various ethnic or perhaps racial communities that have not been accepted by the patients’ basic health conditions or care choices (Arcangelo, et al, 2017). For example, ethnic minority members of the American society, the Black Americans are at higher risk of suffering from under-determined or even under-treated depressive complications compared to the white ethnic community. Black Americans are less likely to follow the antidepressant directions as compared to whites with depression. Impacts of Ethnicity on Antidepressant Therapy Essay.

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Three Questions for the Patient
1. How did your medication make you feel?
Through bringing this up, I let the patient explain any adverse effects that have been encountered. This will enable a clinician to determine whether to change the drug, titrate the dose or prescribe alternative treatment options, such as psychotherapy.
2. What made you stop taking your depression medication?
Recognizing why the client decided to stop taking his medication brings up the chance to fix some problems, such as how the medication functions, as well as the anticipated results. For instance, a patient may lack adequate information on how the medicine functions, anticipated timelines, and clinical effects of prolonged utilization.
3. Do you take alcohol?
Asking this question will help consider why the patient is switching medicine for alcohol. According to his history, it is noted that there is no abuse of alcohol, but the client may not have accepted the drinking as abuse. Bringing this up might also help practitioners to determine the duration and type of drug to administer.
Feedback from Individuals in the Patient’s Life
As history clearly shows that the patient has been married for 33 years, interviewing the patient’s wife would be essential because she has lived with this patient for a long period. It is necessary to ask these questions to exclude any other potential disorders like schizophrenia and dementia. Verifying clinical manifestations from the wife may also enable the health professional to ascertain if the client is safe at all times and utilizes these details for additional assessment. I will ask the patient’s wife the following questions:
1. Does the patient take medications as agreed?
2. What do you believe causes the patients’ deterioration?
3. What habits are the most concern to you?
4. Have you observed some changes in cognition?
Physical Exams and Diagnostic Tests
An essential element of diagnostic assessment involves knowing general health through a physical assessment. The reason behind this is that the outcomes of a physical assessment can help to eliminate other disorders that may have common symptoms, based on the occurrence (Patten et al., 2018). For instance, patients’ severe health problems, particularly those largely defined by pain and inflammation, have demonstrated a significant pervasiveness of MDD. Moreover, the utilization of screening devices like the Beck Depression Inventory-II (BDI-II), is necessary. Impacts of Ethnicity on Antidepressant Therapy Essay.  When patients are perceived to have symptoms of depression, the 21-item self-reporting questionnaire is utilized. The device analyses a person’s attitude, despondency, and feeling of hopelessness, self-dissatisfaction, self-accusation, self-dislike, despair, anger, suicidal thoughts, appetite changes, fatigue, insomnia, sadness, irritability, frustration, social isolation, lack of direction, job problems, and lack of interest in intimate relations (Strunk & Lane, 2017). Another means of assisting with the diagnosis of depression is by using Electroencephalograph (EEG) which is a non – destructive procedure, widely used to evaluate different brain problems. It produces signals that signify neurological diseases related to brain damage (Bairy et al., 2017). A brain CT scan can also be used to evaluate brain function with a normal brain during a depressive period (Bairy et al., 2017).
Differential Diagnosis
1. Major Depressive Disorder (MDD)
2. Bipolar Disorder
3. Posttraumatic Stress Disorder (PTSD)
MDD is the most probable diagnosis for this client since, historically speaking, he encountered at least five manifestations for two weeks and at least one of the manifestations was a depressive mood. Additionally, the client’s functioning was tampered with by these symptoms (Zimmerman et al., 2015). According to Rosenthal & Burchum (2018), MDD is also linked to a neurotransmitter functional deficit and that is why antidepressant treatments are mentioned.
Pharmacological Agents
It would be necessary to administer a selective serotonin reuptake inhibitor (SSRI), like Zoloft because they are the primary treatment for MDD and anxiety conditions. SSRIs function by raising and reinforcing neurotransmitter levels within the nervous system (Stahl, 2017). Studies show that most SSRI agents portray a similar potency, but efficacy with fewer complications and previous reaction to the drug is driven by a treatment option. As a result of clients’ encounters with sexual dysfunction with Zoloft previously, Wellbutrin an unusual antidepressant will be introduced to resolve this problem.
Monoamine oxidase inhibitors (MAOIs), like transdermal selegiline, can be used when SSRIs are unable to address symptoms of depression. This kind of medication acts by preventing the breaking down of dopamine, serotonin, and noradrenaline leading to neurotransmission that is more easily accessible. In order to prevent lethal drug interactions like serotonin syndrome, it is vitally important that the client moves from SSRIs to MAOIs under physician guidance. I would pick transdermal Selegiline at this moment since it is efficient, and no adverse effects have been mentioned. Impacts of Ethnicity on Antidepressant Therapy Essay.
Contraindications
This case study did not mention the ethnicity of the patient, but in general ethnicity, culture, and history taking, can decide patient compliance with the treatment plan and most importantly the cultural patterns that might influence the functionality of particular drugs (Rosenthal & Burchum, 2018). For instance, in cultural groups in which food intake involves diet high in tyramine, it might significantly impact the bioavailability of the medication.
Therapeutic Changes
According to the history of the patient’s termination of medication and persistent instances of regression for more than thirteen years, he would need to be educated about potential drug resistance, the likelihood of withdrawal symptoms when antidepressant medications are suddenly discontinued and the probability of initiating maintenance care permanently. A combination of psychotherapy services may also consist of counseling to overcome symptoms and improve ways of coping.
Lessons Learned
There are several lessons that I have learned from this case study. First, I have discovered that depression is a reoccurring condition and that regular reassessment of medication is essential to a better result. I have also learned that the treatment of a patient might have been effective before but that does not guarantee it will always function. Additionally, I will recommend informing the client about the value of scheduled follow-up visits to ensure adherence to medication and the progression of the illness. I have gotten an idea that three or more regression incidents need indefinite antidepressant medication. Lastly, I have learned that prolonged depression periods can trigger brain changes.

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References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Bairy, G. M., Lih, O. S., Hagiwara, Y., Puthankattil, S. D., Faust, O., Niranjan, U. C., & Acharya, U. R. (2017). Automated diagnosis of depression electroencephalograph signals using linear prediction coding and higher-order spectra features. Journal of Medical Imaging and Health Informatics, 7(8), 1857-1862.
Patten, S. B., Williams, J. V. A., Lavorato, D. H., Wang, J. L., Jetté, N., Sajobi, T. T., … & Bulloch, A. G. M. (2018). Patterns of association of chronic medical conditions and major depression. Epidemiology and psychiatric sciences, 27(1), 42-50.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehn’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Stahl, S. M. (2017). Prescriber’s Guide: Antidepressants: Stahl’s Essential Psychopharmacology. Cambridge University Press.
Zimmerman, M., Ellison, W., Young, D., Chelminski, I., & Dalrymple, K. (2015). How many different ways do patients meet the diagnostic criteria for major depressive disorder?. Comprehensive psychiatry, 56, 29-34. Impacts of Ethnicity on Antidepressant Therapy Essay.

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

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. Impacts of Ethnicity on Antidepressant Therapy Essay.