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Week 3: Adult and Geriatric Antidepressant Therapy The National Institute of Mental Health estimates that approximately 15.7 million adults in the United States have depression (NIMH, 2014), making depression one of the most common disorders you will treat in practice. Although this disorder is so prevalent, antidepressant therapy must be as unique as each individual you treat. There are dozens of antidepressant medications on the market, and you must be able to identify which medication or combinations of medications will result in the best outcomes for your clients 2 Week 3: Adult and Geriatric Antidepressant Therapy The National Institute of Mental Health estimates that approximately 15.7 million adults in the United States have depression (NIMH, 2014), making depression one of the most common disorders you will treat in practice. Although this disorder is so prevalent, antidepressant therapy must be as unique as each individual you treat. There are dozens of antidepressant medications on the market, and you must be able to identify which medication or combinations of medications will result in the best outcomes for your clients. This week, as you study antidepressant therapies, you examine the assessment and treatment of clients with mood disorders. You also explore ethical and legal implications of these therapies. Photo Credit: Comstock Images/Getty Images Discussion: The Impact of Ethnicity on Antidepressant Therapy Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture. Learning Objectives Students will: · Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients · Analyze factors that influence pharmacokinetic and pharmacodynamic processes in adult and geriatric clients requiring antidepressant therapy · Analyze the impact of ethnicity on antidepressant therapy · Evaluate efficacy of treatment plans · Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy Learning Resources Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. Required Readings Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.   Note: To access the following chapters, click on the  Essential Psychopharmacology, 4th ed  tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter. · Chapter 7, “Antidepressants” Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.   Note: To access the following medications, click on the  The Prescriber’s Guide, 5th ed  tab on the Stahl Online website and select the appropriate medication.   Review the following medications: · amitriptyline · bupropion · citalopram · clomipramine · desipramine · desvenlafaxine · Order Nursing papers · duloxetine · escitalopram · fluoxetine · fluvoxamine · imipramine · ketamine · mirtazapine · nortriptyline · paroxetine · selegiline · sertraline · trazodone · venlafaxine · vilazodone · vortioxetine American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Note: Retrieved from Walden Library databases. Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06 Note: Retrieved from Walden Library databases. Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05 Note: Retrieved from Walden Library databases. Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf To prepare for this Discussion: Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number. Case 1: Volume 1, Case #1: The man whose antidepressants stopped working Case 2: Volume 1, Case #7: The case of physician do not heal thyself Case 3 : Volume 1, Case #29: The depressed man who thought he was out of options · Review this week’s Learning Resources and reflect on the insights they provide. · Go to the Stahl Online website and examine the case study you were assigned. · Take the pretest for the case study. · Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office. · Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.). · Consider whether any additional physical exams or diagnostic testing may be necessary for the patient. · Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance. · Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient. · Review the posttest for the case study. Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! By Day 3 Post a response to the following: · Provide the case number in the subject line of the Discussion thread. · List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions. · Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why. · Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used. · List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why. · List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other. · For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities? · If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided. · Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations Read a selection of your colleagues’ responses. By Day 6 Respond to at least two of your colleagues who were assigned to a different case than you. For example, if you were assigned to Case Study 1, respond to one colleague assigned to Case Study 2 and one colleague assigned to Case Study 3. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings. · If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained. · If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective. The Impact of Ethnicity on Antidepressant Therapy Discussion