Psychopharmacology Week Assignment Paper

The client in this assignment is a 32-year-old man who presented with complaints about depression. The client reported reduced interest in engaging in normal activities, weight gain, insomnia, and poor concentration. The mental status exam indicated constricted affect, while insight and judgment were grossly intact. The client scored 51 in the “Montgomery- Asberg Depression Rating Scale (MADRS)”, showing severe depression. This paper will thus discuss three treatment choices for this client and conclude by discussing ethical issues that may impact his treatment plan.

Decision Point One

The selected decision point one is for the patient to start Effexor XR 37.5mg orally. This medication was selected due to its efficacy in treating and improving depressive symptoms. Effexor works by elevating the amount of serotonin and norepinephrine within the brain; the two neurotransmitters are responsible for improving mood and controlling aspects such as sleep, appetite, sleep, and perceptions (Gitlin, 2018). Effexor was also chosen because it has a good safety profile (Gitlin, 2018). The other two options were not chosen because these two medications have more side effects when compared to Effexor. Psychopharmacology Week Assignment Paper.

Selecting Effexor expected that the client would manifest notable symptom improvement because of the medication’s efficacy in treating and improving depressive symptoms. Secondly, it is hoped that the client would tolerate the drug and thus he would not report any side effect due to the medication’s good safety profile (Lyndon et al., 2019).

However, the outcome was not as it was expected because after four weeks the client did not manifest or report any symptom improvement. This can be explained with the small start dose of 37. 5 mg which was not adequately effective to improve the depressive symptoms. The client however did not report any side effects.

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Decision Point Two

The second decision appropriate for this client is to increase the dose of Effexor from 37.5 mg to 75 mg. The rationale for choosing this decision is because increased doses of Effexor have been demonstrated to be more effective, safe, and well-tolerated in people with depression (Skånland & Cieślar-Pobuda, 2019). The other decisions were not selected the maximum dose of the first treatment choice should be reached before changing the medication or augmenting the medication. Psychopharmacology Week Assignment Paper.

By increasing the dose to 75 mg, it was expected that the client would tolerate the increased dose at the same time exhibit symptom improvement. This is because higher doses of Effexor acts as both serotonin and norepinephrine uptake inhibitor and thus increases the efficacy of the medication (Skånland & Cieślar-Pobuda, 2019). Secondly, it is expected that the client would not experience any side effects even after increasing the dose.

As expected, the client manifested significant symptom improvement since the MADRS indicated a 25% symptom reduction after four weeks. Symptom improvement is attributable to the increased efficacy of Effexor with an increased dose (Skånland & Cieślar-Pobuda, 2019). Moreover, he did not report any side effects and therefore this indicates he was able to tolerate the increased dose.

Decision Point Three

The third decision selected is to increase the Effexor dose from 75 mg to 112.5 mg. This decision was selected because higher doses of Effexor have higher efficacy due to the increased action of the drug to inhibit the reuptake of both serotonin and norepinephrine (Li., 2017). The PMHNP should educate the client about the possible side effects with the increased dose. The other two choices were not chosen because it is advisable to reach the maximum dose with the first-line treatment before changing or augmenting the medication.

By increasing the dose to 112.5 mg, it was expected that the client would continue exhibiting symptom improvement and eventually achieve complete symptom remission. Increased doses of Effexor are associated with increased efficacy (Cipriani et al., 2016). Secondly, it was hoped that he would tolerate the increased dose and thus experience no side effects.

Ethical Considerations

Treatment normally involves various ethical issues that should be addressed to ensure ethical treatment. For this patient, it would be important for the nurse to seek informed consent from the client before starting any treatment (Stark et al, 2018). Psychopharmacology Week Assignment Paper. This should involve the nurse explaining to the client about all the available treatments, the associated side effects, administration route, and their efficacy. This will inform the client and facilitate in making an informed treatment choice. Secondly, mental illnesses are normally associated with stigma, and as a result majority of symptoms prefer their diagnosis and other health information to remain private (Stark et al, 2018). Therefore, it is important for the nurse to ensure the confidentiality and privacy of the patient’s information are maintained and protected. Moreover, the ability to make treatment decisions is another issue of concern for patients with mental disorders. Accordingly, the nurse should equip the client will all information that makes him understand the treatment process and make an independent treatment decision. The client should be actively involved when making decisions about his treatment (Stark et al, 2018).

Conclusion

The first decision is for the client to begin Effexor 37 mg. The rationale for choosing this decision is because if the medication’s efficacy in improving depressive symptoms and also because the safety of the medication is well established. However, the client tolerated the medication well without any side effects, he did not report any improvement. Therefore, the second decision was to increase the dose to 75 mg in order to increase its efficacy. The client showed 25% symptom improvement, without any side effects. The third decision was thus to increase the dose to 112.5 mg to ensure further symptom improvement due to increased efficacy. The ethical considerations pertinent when treating this client include confidentiality and privacy, informed consent, and decision-making capacity. Psychopharmacology Week Assignment Paper.

References

Cipriani, A., Zhou, X., Del Giovane, C., Hetrick, S. E., Qin, B., Whittington, C., … & Cuijpers, P. (2016). Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. The Lancet, 388(10047), 881-890.

Gitlin M. (2018). Antidepressants in bipolar depression: an enduring controversy. Int J Bipolar Discord. 6(25).

Li X. (2017). Short-term efficacy and tolerability of venlafaxine extended-release in adults with generalized anxiety disorder without depression: A meta-analysis. PLoS One. 12(10), e0185865.

Lyndon, G. J., Prieto, R., Wajsbrot, D. B., Allgulander, C., & Bandelow, B. (2019). Efficacy of venlafaxine extended-release in major depressive disorder patients: effect of baseline anxiety symptom severity. International clinical psychopharmacology, 34(3), 110–118.

Stark A, Hanna K, Stein J, Maier W, Heser K, Wiese B, Mamone S, Hans K, Bock J, Steffi G & Martin S. (2018). A qualitative study on older primary care patients’ perspectives on depression and its treatments – potential barriers to and opportunities for managing depression. BMC Fam Pract. 19(2). Psychopharmacology Week Assignment Paper.

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Skånland, S. S., & Cieślar-Pobuda, A. (2019). Off-label uses of drugs for depression. European Journal of Pharmacology, 865, 172732.

NURS_6630_Week3_Assignment_Rubric

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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. Psychopharmacology Week Assignment Paper.