Patient Medication Guide for Treatment of Depressive Disorders Essay

Introduction

In current practice, there are still serious gaps in the diagnosis and treatment of mental health disorders including depression. This is especially true for vulnerable populations. These populations include patients who are at high risk for severe illness like children, adolescents, pregnant women, and patients with dementia (Kaser & Sahakian, 2019). In patients with special conditions like dementia, the depression will not only affect their mood but it also affects their treatment response and may exacerbate the symptoms of dementia. In this paper, the author gives the medication guide for the treatment of depressive disorder in older patients with dementia by highlighting the diagnosis, medication considerations, and treatment monitoring. Patient Medication Guide for Treatment of Depressive Disorders Essay

Depressive Disorder Causes and Symptoms

According to WHO, major depressive disorder is the third cause of the burden of disease worldwide. Depressive disorder patients experience low or depressed mood, decreased interest in activities, lack of energy, poor concentration, and lack of sleep among others. The etiology of depressive disorder is multifactorial, meaning many factors contribute to its development. These include biological, genetic, environmental, and psychosocial factors (Kaser & Sahakian, 2019). Biological factors are associated with abnormalities in the neurotransmitters serotonin, norepinephrine, and dopamine. Various studies show that people with low serotonin levels have a higher risk of developing depressive disorder.

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Psychosocial and environmental factors such as stressful or traumatic events like sexual abuse, loss of a loved one, or financial issues are also major contributing causes of depressive disorder. Genetics also contributes to depression with people who have blood relatives with a history of depression or mental illnesses being at a higher risk of developing depression. Patient Medication Guide for Treatment of Depressive Disorders Essay

The symptoms of depressive disorder according to DSM-5 diagnostic criteria include persistent feelings of sadness, hopelessness, loss of interest in activities previously enjoyed, loss of energy, poor concentration in tasks, feelings of worthlessness, and recurrent thoughts of death and suicidal ideation (Kaser & Sahakian, 2019). Others may also present with physical symptoms without physical causes such as digestive problems, headaches, and pain.

Diagnosis of Depression in People with Dementia

The diagnosis of depression depends mainly on clinical evaluation through history taking and the use of screening tools. The DSM-5 diagnostic criteria outline the diagnosis of major depressive disorder as an individual having five or more of the above symptoms every day, nearly all day for two consecutive weeks (Burke et al., 2019). Depression is common in people with dementia and often the symptoms may overlap making it difficult to identify.

Diagnosing depression in dementia also requires a thorough evaluation of the medical history, physical and mental examination, and interviews with the primary caregiver and family members who know the patient well. The National Institute of Mental Health guidelines for the diagnosis of depression in Alzheimer’s dementia include depressed mood, decreased pleasure in activities together with two or more of the symptoms of withdrawal, disruption in appetite and sleep, agitation, irritability, fatigue, hopelessness, and recurrent thoughts of death for two weeks or more (Burke et al., 2019). Patient Medication Guide for Treatment of Depressive Disorders Essay

Why Dementia is a vulnerable population

Dementia refers to disease processes that affect memory, thinking, and the ability to perform daily activities. People with dementia are usually older individuals above the age of 65 and may have other co-existing health conditions like hypertension. As such, people with dementia are vulnerable because their symptoms may affect their cognitive, reasoning, and communication ability thus they may not be able to take care of themselves (Aggarwal et al., 2022). This will affect their treatment and prognosis. People with dementia also have long-term physical, mental, and intellectual impairments and thus will not be able to perform their daily activities or interact in society. This complicates the diagnosis of depression in this population and influences treatment options, outcomes, and quality of life.

Medication Treatment Options for Individuals with Dementia

The pharmacological treatment of depression in patients includes the use of antidepressants for symptom control. Long-term use of antidepressants can also cause upregulation of neurotrophic factors to increase hippocampal neurogenesis. The most prescribed drugs for the treatment of depression in Alzheimer’s dementia (AD) patients are selective serotonin reuptake inhibitors (SSRIs) like Fluoxetine, Sertraline, and Citalopram (Costello et al., 2023). SSRIs inhibit the reuptake of serotonin to increase the levels of serotonin at the neuromuscular junctions for mood regulation. SSRIs are preferred for depression in older patients because they have fewer side effects as compared to other antidepressants like tricyclic antidepressants such as Amitriptyline. Patient Medication Guide for Treatment of Depressive Disorders Essay

The use of antidepressants in AD may help reduce agitation and improve mood. However, their efficacy and safety are still inconclusive and therefore are not FDA-approved. Some of the side effects of SSRIs use include indigestion, dizziness, dry mouth, weight loss, and diarrhea or constipation (Burke et al., 2019). Adverse effects of amitriptyline also include constipation, headaches, dizziness, dry mouth, and weight gain. SSRIs also have a lower risk of interactions with other medications like other antidepressants.

Medication Considerations and Proper Prescription

The use of antidepressants for depression in older patients with dementia should consider finding a balance between the drug efficacy and tolerability, the type of depression and presentation, patient preference, and patient safety (Costello et al., 2023). Patient safety in this group should address the risk of overdose and drug interactions with other medications. Drugs such as tramadol and monoamine oxidase inhibitors like Selegiline increase serotonin toxicity when combined with SSRIs. Patient Medication Guide for Treatment of Depressive Disorders Essay

Prescription Examples:

• Patient Name- D.O Date of Birth- 16/04/1955     Dx- Depression in dementia

Sertraline 50 mg 1 tab PO OD, Disp #30 (thirty) refills 6.

Prescriber Signature……

• Patient Name- D.O Date of birth-16/04/1955   Indication- Depressive disorder

Fluoxetine 20 mg 1 tab PO OD  Disp #30 Refills 11.

Prescriber signature…

• Patient Name- D.O Date of Birth- 16/04/1955    Indication- Depressive Disorder

Citalopram 20mg 1 tab PO OD Disp #30 Refills 6.

Signature…..

Medication Monitoring

When treating depression in patients with dementia using SSRIs, it is important to monitor the patient for drug toxicity and efficacy. Initially, a thorough evaluation of the depression and suicide risk is required to determine the correct dose. For elderly patients on fluoxetine, it is important to monitor blood glucose and liver functions (Stutzman, 2021). This is because fluoxetine reduces blood glucose and may be hepatotoxic thus causing liver failure. Those with liver disease may need dose adjustments or alternative medications. Sertraline can induce hyponatremia and therefore require monitoring of the electrolytes and mental status. All patients on SSRIs require ECG monitoring for QT prolongation to rule out heart problems. Patient Medication Guide for Treatment of Depressive Disorders Essay

Special Considerations for the Patient Population

Several considerations are necessary when treating depression in patients with dementia to ensure good outcomes. A multidisciplinary approach should be used and treatment options should include a combination of medications and psychotherapy. Other factors that influence treatment include ethical considerations, legal considerations, cultural considerations, and social determinants of health. The legal aspects of mental health require the involvement of patients’ caregivers in treatment decisions (Bipeta, 2019). Patients should also be protected against unethical acts like discrimination and patient-physician confidentiality be maintained.

Cultural beliefs have a great impact on the treatment of depression as it influences health-seeking behaviors and medication compliance. Physicians should understand and respect the patient’s cultural beliefs and educate against mental health stigma (Murphy & Hankerson, 2017). Social determinants of health like level of education, access to healthcare, and environment also have an impact on one’s health and quality of life (Martin et al., 2021). Having a higher level of education and good social support will have a positive impact on the treatment of a patient with dementia.

Patient follow-up

Patient follow-up for depression treatment should be done to assess medication compliance, and patient progress, and monitor side effects. They can be conducted at the local hospital clinic or other peripheral facilities. The physician should discuss with the patient and their caregivers to decide on healthcare facilities convenient for them. Patient Medication Guide for Treatment of Depressive Disorders Essay

References

Aggarwal, H., Chaware, S., & Aggarwal, H. (2022). A critical study on the impact of dementia on older people undergoing treatment in care homes. Cureus. https://doi.org/10.7759/cureus.30056

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological Medicine, 41(2), 108-112. https://doi.org/10.4103/ijpsym.ijpsym_59_19

Burke, A. D., Goldfarb, D., Bollam, P., & Khokher, S. (2019). Diagnosing and treating depression in patients with Alzheimer’s disease. Neurology and Therapy, 8(2), 325-350. https://doi.org/10.1007/s40120-019-00148-5

Costello, H., Roiser, J. P., & Howard, R. (2023). Antidepressant medications in dementia: Evidence and potential mechanisms of treatment-resistance. Psychological Medicine, 53(3), 654-667. https://doi.org/10.1017/s003329172200397x

Kaser, M., & Sahakian, B. J. (2019). Major depressive disorder is a disorder of cognition. Cognitive Dimensions of Major Depressive Disorder, 23-34. https://doi.org/10.1093/med/9780198810940.003.0003

Martin, R., Shan, L., Geldmacher, D., Pilonieta, G., Kennedy, R., Oates, G., & Pisu, M. (2021). Social determinants of Alzheimer’s disease and related dementias: Racial and regional variations. Innovation in Aging, 5(Supplement_1), 101-101. https://doi.org/10.1093/geroni/igab046.382

Murphy, E., & Hankerson, S. (2017). Beliefs about causes of major depression: Clinical and treatment correlates among African Americans in an urban community. Journal of Clinical Psychology, 74(4), 594-607. https://doi.org/10.1002/jclp.22523

Stutzman, D. L. (2021). Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing. Mental Health Clinician, 11(6), 320-333. https://doi.org/10.9740/mhc.2021.11.320 Patient Medication Guide for Treatment of Depressive Disorders Essay

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. Patient Medication Guide for Treatment of Depressive Disorders Essay

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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. Patient Medication Guide for Treatment of Depressive Disorders Essay