by Shannon Schaal – Tuesday, 1 October 2019, 5:00 PM
Week 5 Discussion: Depression Case Study
Medication Choice 1
5. List one medication that would be appropriate for this case. Include the name and starting dose
· Zoloft 50mg PO daily
6. Describe your clinical decision making. What is your rationale for choosing this medication? Also, include the mechanism of action for this medication choice, and the neurotransmitters and areas of the brain in which the medication is proposed to act on.
I chose to prescribe this patient Zoloft for several reasons. Zoloft is classified as a selective serotonin reuptake inhibitor (SSRI). Knorr, Madsen, and Kessing (2019) report that SSRIs are the first line drug of treatment for major depression. Since suicide risk is always a consideration when dealing with depressed patients, it is important to note that death due to overdose with drugs in this class is rare (Lichtblau, 2011). SSRIs are clearly less toxic and better tolerated by patients than other antidepressants (Lichtblau, 2011). If a provider chooses to prescribe an SSRI, Lexapro and Zoloft are good options because they have minimal side effects and minimal drug-drug interactions (Puzantian & Carlat, 2018).
Zoloft is an antidepressant with selective inhibitory effects on presynaptic serotonin (5-HT) reuptake and very weak effects on norepinephrine and dopamine neuronal uptake (Lexicomp, 2018). Zoloft boosts the neurotransmitter serotonin, blocks the serotonin reuptake pump, and desensitizes serotonin receptors (Stahl, 2013). Zoloft also has mild ability to block the dopamine reuptake pump which can increase dopamine transmission and contribute to the therapeutic actions (Stahl, 2013).
7. What laboratory testing/monitoring is needed for safely prescribing this medication?
Zoloft does not require any routine lab testing or monitoring for healthy individuals (Stahl, 2013).
8. Are there any contraindications or safety concerns associated with this medication?
A black box warning regarding an increased risk of suicidal ideation in children, adolescents, and young adults up to age 24 was added to the labeling on all medication approved for the treatment of depression (Puzantian & Carlat, 2018). Serotonin syndrome is a potentially life threatening condition associated with the use of multiple or high dose serotonergic agents (Puzantian & Carlat, 2018). Serotonin syndrome is characterized by hallucinations, agitation, variable blood pressure, hyperthermia, hyperreflexia, tachycardia, myoclonus, nausea, vomiting, and diarrhea (Puzantian & Carlat, 2018). Abrupt discontinuation of SSRIs can result in discontinuation syndrome. While this is not medically dangerous, it can be uncomfortable for many patients and result in headache, irritability, nausea, diarrhea, and insomnia (Puzantian & Carlat, 2018). Contraindications of Zoloft include allergy to Zoloft or any component of the formulation, use of MAOIs, concurrent use of pimozide, thioridizine, or disulfiram.
13. What non-pharmacologic interventions do you recommend? Do you recommend including psychotherapy, complimentary, or holistic therapies?
Providers must not solely rely on medication for treatment of mental health conditions. Psychotherapy would be significantly beneficial for this patient. Psychotherapy has proven to be notably effective in the treatment of psychiatric conditions; and, when coupled with medication management, offers positive patient outcomes. Cuijpers et al. (2012) report that it is well established that psychiatric medication, as well as psychotherapies, have significant effects on mental health disorders, that both are about equally effective, and that combined treatments are significantly more effective than either psychotherapy or medication management alone.
Follow the steps to complete this discussion
1. Watch the Video
2. Using readings and references, complete the worksheet, Case Study Questions (PDF).
3. Review the Instructions for Depression Case Study to view the grading criteria for this assignment.
4. Post your responses to questions 5-8 and 13 to this discussion board.
5. Submit your completed worksheet for grading to the Week 5 Assignment 2: Depression Case Study.
Critique the decision making of two of your peers in your response post.
1. Do you agree/disagree with their medication choice? Why?
2. Is there anything else you recommend including?
3. Compare peer’s decision making to yours—what are the advantages and disadvantages of each?
Your response should include evidence of review of the course material through proper citations using APA format.