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. The Impact of Ethnicity on Antidepressant Therapy Essay
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 The Impact of Ethnicity on Antidepressant Therapy Essay
The Impact of Ethnicity on Antidepressant Therapy
Case 2: Volume 1, Case #7: The case of physician does not heal thyself
- Within the last two weeks, how often have experienced sadness, feeling depressed or worthless and hopeless?
The rationale for asking this question is that sadness and feeling worthless and hopeless nearly daily and all day for two weeks or more is an indication of depression (Wang et al, 2017)
- Have you been having any suicidal thoughts?
The rationale for asking this question is that the client’s answer to the question will enable the mental healthcare practitioner to rate the severity of the client’s depression (Mark et al, 2016)
- How is your sleep? Are you able to sleep well?
The rationale for asking this question is that sleep disturbance is a symptom of depression and also indicates a higher for depression (Wang et al, 2017)
People in the Patient’s Life to Ask Questions
- Do you know of life events that seem to be stressing the client?
The rationale for this question is to determine factors that contribute to the resistant depression in the client.
- Does the client have reliable friends and family members?
The reason for asking this question is to get information about whether the client has any support system in his life. A reliable support system is very important for effective treatment of depression (Wang et al, 2017)
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Appropriate Physical Exams and Diagnostic Tests
The physical and diagnostic examples appropriate for this client include blood tests and CT scan. The blood tests can reveal if the client has any health conditions that may be causing the depressive symptoms (Mark et al, 2016). The tests can test if the client is anemic, or has thyroid disorders; these conditions are associated with depressive symptoms. A CT scan can be used to rule out any brain condition such as a tumor that could be causing the depressive symptoms (Mark et al, 2016).
- Treatment-resistant depression
- Schizoaffective disorder
- Bipolar disorder
The most probable diagnosis for this client is treatment-resistant depression. The client’s experiences manic and hypomanic symptoms are compatible with symptoms of major depressive disorder. Moreover, the client has used more than two antidepressants of the required period and dose, but there has been no total symptom remission. The Impact of Ethnicity on Antidepressant Therapy Essay
Pharmacologic Agents and Dosing
Venlafaxine XR 450 mg: The mechanism of action of this medication is facilitating the activity of neurotransmitters within the CNS by hindering the reuptake of dopamine, norepinephrine, and serotonin. These neurotransmitters are associated with promoting mood improvement. The elimination half-life of venlafaxine is about 72 hours (Ahmed et al, 2019).
Sertraline 250 mg: The mechanism of this medication is through inhibition of SERT transporter and reuptake of dopamine. The elimination half-life of sertraline is between 26-32 hours (Howie et al, 2018).
The recommended medication for this client is Venlafaxine XR 450 mg. The rationale for choosing venlafaxine over sertraline is because venlafaxine acts through many mechanisms (hindering the reuptake of dopamine, norepinephrine, and serotonin) (Ahmed et al, 2019), whereas on the other hand sertraline’s mechanism of action is only by inhibiting reuptake of dopamine. The Impact of Ethnicity on Antidepressant Therapy Essay
Contraindications of Venlafaxine
Venlafaxine is contraindicated for individuals with high cholesterol level, cardiovascular conditions, liver problems and hypertension (Ahmed et al, 2019). Some ethnicities have a higher risk of cardiovascular conditions which is a contraindication to using venlafaxine. Ethnicity may also impact the response of a person to treatment.
Ahmed A, Jenkins G, Rush J, Rung S, Bobo W, Wang R & Mark F. (2019). Pharmacokinetic-Pharmacodynamic interaction associated with venlafaxine-XR remission in patients with major depressive disorder with a history of citalopram/escitalopram treatment failure. J Affect Disord. 1(246). 62–68.
Howie N, Herberg S, Durham E, Grey Z, Hill W, Cray J et al. (2018). Selective serotonin reuptake inhibitor sertraline inhibits bone healing in a calvarial defect model. Int J Oral Sci. 10(3), 25.
Mark C, How C & Ping Y. (2016). Major depression in primary care: making the diagnosis. Singapore Med J. 57(11), 591–597.
Wang J, Wu X, Lai W, et al. (2017). Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open.7(1). The Impact of Ethnicity on Antidepressant Therapy Essay