Depression Scenarios
Week 6 Discussion 1: Depression Scenarios
Done: Make forum posts: 1
Value: 100 points
Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7.
Grading Category: Discussion Forums
Initial Post
- For this discussion, you will build on your treatment plan from Week 5: Assignment 1: Depression Case Study. You will be seeing your patient at the six-week follow-up.
- Describe your treatment plan for your patient in each of these four scenarios. This means that you will have a treatment plan for each separate scenario.
- Your initial post should be in APA format with evidence-based references to support your statements.
Scenarios
- Patient reports that there is no response to the medication.
- Patient reports that there is a partial response to the medication. Mood has lifted, but energy and motivation are still poor.
- Patient reports that mood is improved but sexual side effects are interfering with quality of life.
- Patient reports that mood has improved, but they now have an extreme increase in energy and can’t slow down, are not sleeping, and feel like they can get four days work completed in only a few hours.
Reply Posts
Compare your response to two of your peers’ posts. What are the pros and cons of their choices? What other suggestions might you offer?
Your response should include evidence of your review of the course material through the inclusion of proper citations using APA format.
Please refer to the Grading Rubric for details on how this activity will be graded.
The described expectations meet the passing level of 80 percent. Students are directed to review the Discussion Grading Rubric for criteria that exceed expectations.
This is my peer’s post. I am replying to her post
Re: Week 6 Discussion 1: Depression Scenarios
by Trisha Antoine – Wednesday, 8 February 2023, 1:15 AM
During the six week follow up, if the patient states there is no response to Escitalopram, an important question to ask is about medication compliance. Another question to ask is if the patient has engaged in psychotherapy and aerobic exercises as recommended. Zamani et al. (2022) states that “….aerobic exercise is a non-pharmacological strategy for improving various brain functions, such as cognition and mood†(p. 1460). Other things to consider is that the patient may be known as nonresponders, sometimes called treatment-resistant or treatment-refractory. According to Stahl (2021), “some patients may experience apparent lack of consistent efficacy due to activation of latent or underlying bipolar disorder, and require antidepressant discontinuation and a switch to a mood stabilizer†(p. 251). Some considerations may include switching patient to a different class of antidepressants, other than SSRIs, or adding another SSRI agent.During the six week follow up, if the patient states there is partial response to Escitalopram, mood has improved but energy and motivation has not, then medication compliance is still an important question to ask. Another question to ask is if the patient has engaged in psychotherapy and aerobic exercises as recommended. It’s important to assess her energy and motivation with follow up questions during the visit.It’s also important to assess if the patient had experienced postpartum depression after having her two children, even though they are grown. Fluoxetine can be a good medication to augment with Escitalopram. According to Shafia et al. (2023), “It has been shown that a combination of fluoxetine and exercise, but not fluoxetine alone, increases neurogenesis in postpartum depression†(p. 2).During the six week follow up, if the patient states that her mood has improved while taking Escitalopram but she is experiencing sexual dysfunction, she can be offered one of the these augmenting medications: Bupropion, sildenafil, vardenafil, or tadalafil (Stahl et al., 202, p. 252). I would recommend bupropion due to its positive effects on improving poor concentration and fatigue which was initially reported by the patient. It is important to assess sexual dysfunction and to recommend treatment because it will not only impact a person’s quality of life, relationships, mental health, and recovery but it will also lead to medication noncompliance. Esteves-Sousa et al. (2020) states that “ Sexual dysfunction is frequently cited as a reason for nonadherence or discontinuation of treatment for depression†(p. 1).During the six week follow up, if the patient states that her mood has improved while taking Escitalopram but now experiencing an extreme increase in energy and can’t slow down, are not sleeping, and feel like they can get four days work completed in only a few hours; there should be an in depth evaluation of these symptoms. During the evaluation, one of the differential diagnoses could be bipolar 1 disorder. According to American Psychiatric Association Publishing, 2022, Diagnostic and statistical manual of mental disorders V; criteria of bipolar 1 disorder, manic episode includes the following: “A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). Bipolar 1 disorder, hypomanic episode refers to “A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day†(p. 124). For treatment plan, psychotherapy would be recommended as well as patient continuing Escitalopram, max dose in addition to adding low doses of lithium or quetiapine if no psychotic features.ReferenceAmerican Psychiatric Association Publishing. (2022). Diagnostic and statistical manual of mental disorders: Dsm-5-Tr.Esteves-Sousa, D., Moura, N., Albuquerque, M., Facucho-Oliveira, J., Espada-Santos, P., Mendonça, L., & Tropa, J. (2020). Managing antidepressant-associated sexual dysfunction. European Psychiatry, 63, S663.Shafia, S., Nikkhah, F., & Akhoundzadeh, K. (2023). Effect of combination fluoxetine and exercise on prefrontal BDNF, anxiety-like behavior and fear extinction in a female rat model of post-traumatic stress disorder (PTSD): a comparison with male animals. Behavioral & Brain Functions, 19(1), 1–12. https://doi.org/10.1186/s12993-023-00204-zStahl, S. M., Grady, M. M., & Muntner, N. (2021). Stahl’s essentialpsychopharmacology: Prescriber’s Guide. Cambridge University Press.Zamani, M., Radahmadi, M., & Reisi, P. (2022). Therapeutic effects ofexercise-accompanied escitalopram on synaptic potency and long-term plasticity in the hippocampal CA1 area in rats under chronic restraint stress. Iranian Journal of Basic Medical Sciences, 25(12), 1460–1467. https://doi.org/10.22038/IJBMS.2022.66718.14629*Hanging indentation not retained for references*
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