Advanced Psychopharmacology and Health Promotion
Unit 5 Medications for Depression and Anxiety Related Disorders 800W. APA. 4 references due 9-29-23.
A 24-year-old female presents to your office stating that she is troubled by headaches and fatigue. She says that she always feels tired and can’t sleep well, often waking up early if she gets to sleep at all. She describes her headaches as dull, aching, and generalized. These symptoms began about three weeks ago and have been getting worse. She reports a lack of interest in her usual activities, even the ones that she used to enjoy. She also reports that she is missing work due to fatigue and inability to concentrate. Although both her children are in school, she is concerned that she is “losing them”. She is worried that she might have “something bad” because she has difficulty concentrating and is having frequent crying spells. She reports a loss of appetite, with a weight loss of 10 pounds in the last month.
The patient has no significant past medical or psychiatric history and takes no regular medications. However, she takes ibuprofen for headaches. She denies using alcohol or drugs. The patient is married, with two elementary school-age children.
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- What diagnosis do you believe may apply to this individual?
- What classifications of medications can be used to treat this disorder? Which medication do you recommend and why?
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Please review the rubric to ensure that your response meets the criteria.
Based on the presented symptoms, it is possible that the 24-year-old female may be suffering from Major Depressive Disorder (MDD). To confirm this diagnosis, it is crucial to conduct a comprehensive psychiatric evaluation, including a detailed medical and psychiatric history, a physical examination, and potentially some laboratory tests to rule out any underlying medical conditions that could be contributing to her symptoms. A validated clinical assessment tool such as the Hamilton Depression Rating Scale (HAM-D) or the Patient Health Questionnaire-9 (PHQ-9) should be administered to assess the severity of her depressive symptoms.
- Diagnosis: Major Depressive Disorder (MDD)
The patient presents with several hallmark symptoms of MDD, including:
- Persistent low mood and anhedonia (loss of interest in previously enjoyed activities).
- Fatigue, poor concentration, and difficulty making decisions.
- Sleep disturbances, such as early morning awakenings and difficulty falling asleep.
- Appetite changes and significant weight loss.
- Frequent crying spells.
- Feelings of worthlessness and guilt.
To confirm the diagnosis, these symptoms must persist for at least two weeks and significantly impair the patient’s daily functioning. Additionally, it’s essential to rule out medical conditions and other psychiatric disorders that may mimic these symptoms, such as thyroid disorders or bipolar disorder.
- Classification of Medications for MDD:
Medications for the treatment of MDD fall into several classes, including:
a. Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are often considered the first-line treatment for MDD. They include medications such as fluoxetine, sertraline, and escitalopram. SSRIs work by increasing the availability of serotonin in the brain, which can help alleviate depressive symptoms. They are generally well-tolerated and have a lower risk of side effects compared to older antidepressant classes.
b. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): SNRIs like venlafaxine and duloxetine also play a significant role in the treatment of MDD. They work on both serotonin and norepinephrine systems, potentially providing better relief for certain symptoms such as fatigue and concentration difficulties.
c. Atypical Antidepressants: Bupropion is an example of an atypical antidepressant that primarily affects the dopamine and norepinephrine systems. It may be considered in cases with prominent fatigue or when sexual side effects from SSRIs are a concern.
d. Tricyclic Antidepressants (TCAs) and Monoamine Oxidase Inhibitors (MAOIs): These are typically reserved for cases where other treatments have failed due to their side effect profiles and potential for drug interactions.
In this case, given the patient’s young age and the preference for medications with a favorable side effect profile, an SSRI or SNRI would likely be the first choice. Escitalopram or sertraline could be considered due to their efficacy, tolerability, and safety profiles. However, the choice of medication should be made in consultation with a psychiatrist, as individual responses to antidepressants can vary, and the patient’s specific symptoms and medical history should be taken into account.
References:
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
- Qaseem, A., Barry, M. J., Kansagara, D., & Clinical Guidelines Committee of the American College of Physicians. (2016). Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 164(5), 350-359.
- Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., … & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391(10128), 1357-1366.