Case Study: An Elderly Hispanic Man with Depressive Disorder

Case Study: An Elderly Hispanic Man with Depressive Disorder

Decision 1

Start patient on (Effexor XR 37.5gm) po daily.

Reasons

Starting the client with a lower dose first gives the patient time for their body to adjust to a new medication and minimizes the side effects. The patient should be introduced to a low beginning dose first while monitoring for side effects before thinking of other options (Leahy et.al., 2012)

Expected results

The anticipated outcomes are a slight change or no change in symptoms compared to presenting symptoms.

Differences between original results and anticipated results

The results show that there were no significant changes on patient’s next visit after four weeks. The patient still showed depressive symptoms concluding the medication dose might have been too low to have any impact.

Decision 2

There is a need to increase the administered dose from 37.5 mg to 75 mg of Effexor XR po daily (Thomson, 2015). This decision to increase dose might be a better option since the lower dose had no effect

Reasons

The recommended starting dose of Effexor is 37.5 mg po daily and can be titrated up to 75mg po daily if no change in symptoms (Leahy et al., 2012). For some patient time can be allowed for them to adjust to the first dose to create an impact but in most cases a dose at 75mg is effective.

Expected Results

They might not be an improvement in symptoms right away but as the patient gets adjusted to the new dose increase and with time Effexor XR at dose 75 mg po will start working. Some patients can get up to 225mg of this medication per day if needed but most patients see good results at 75mg po daily (Leahy et al.,2012).

Difference between the anticipated results and the original results

There is an improvement or significant changes in the patient with Effexor XR 75 mg po daily than with the lower dose. The level of symptoms should reduce gradually on this patient. Thus, on patient’s next visit, there will be an improvement on the scale rate of the Montgomery-Asberg Depression Rating Scale (Thomson, 2015). Initially, the scale was 51 indicating severe depression level after examination as 51 score Leahy et al. (2012). I had estimated the score to reduce by 9 to 42. Conversely, there was a significant difference in the outcome after two consecutive visits. These results portrayed incredible improvement in the patient’s symptoms with a reduction of 26% in the Montgomery-Asberg Depression Rating Scale as per the American Psychiatric Association (2000).

Decision 3

The oral dose of Effexor XR 75gm recommended will be maintained while observing any changes.

Reasons

Medication can take weeks to reach it therapeutic level. In addition, the client is feeling better and no side effects noted. If the recommended dosage doesn’t show any improvement on the patient, then it needs to be changed. The oral Effexor XR will be modified from75 gm to 112.5 gm daily if the patient remains the same or changes and symptoms are getting worst. (Jamesburg, 2000).

Expected results

Continuous improvement in symptoms since on recommended dose. (American Psychiatric Association 2000). Depressive  symptoms will significantly reduce to a therapeutic level.

Difference between the anticipated results and the initial results

Slow improvement in depressive symptoms but can be more improved with another dose increase to Effexor XR 112.5 mg or maintain previous dose while counseling the client on what outcome to expect. (Thomson, 2015).

Ethical considerations in treatment plan and communication with patients

According to Leahy et al. (2012), while treating depressive disorder ethical consideration must be considered to assist providers in administering the correct recommendations. For example, issue such as severe, moderate, and mild require different doses of medication. Effexor XR 37.5mg will begin for the mild depression; 75gm for moderate and 225mg for the patients with severe depressive disorder.

Providers need to make sure that the patients take the right prescription of drugs and ensure they are following instructions provided (Romaine (1969). For example, patients should be encouraged to take medication with food or tapper doses when discontinuing a medication as directed.

The right dosage should be administered according to recommendations and providers must understand drug interaction and adverse effect to give the right advice or counseling to patient on what to expect. The provider must outline the possible side effects of the recommended treatment plan for the patients to predicts the outcome to facilitate management ((Thomson, 2015).

Some factor that influence the pharmacokinetic and pharmacodynamic in geriatric clients include slow metabolism of medications due to the aging process. This can lead to drug toxicity especially with the slow elimination process (American psychiatric Association, 2000). Providers need to also be aware of major adverse effects such as confusion and delirium in the elderly while on antidepressants. The risk of overdose is high in elderly due to pharmacokinetics of drugs in the elderly.

REFERENCES

American Psychiatric Association. (2000).  Major depressive disorder: A patient and family guide. Washington, D.C: American Psychiatric Association.

Leahy, R. L., Holland, S. J., & McGinn, L. K. (2012).  Treatment plans and interventions for depression and anxiety disorders. New York: Guilford Press.

Thomson PDR. (2005).  Physicians’ desk reference. Montvale, NJ: Thomson PDR.

Preventive medicine in managed care. (2000). Jamesburg, NJ: American Medical Pub.

Resident & staff physician. (1969). Port Washington, NY, etc.: Romaine Pierson Publishers, etc.