Discussion: Treatment for a Patient With a Common Condition

Discussion: Treatment for a Patient With a Common Condition

Respond to at least two of your colleagues on two different days in one of the following ways:

If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.

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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.

 

For this patient there are several questions that need to be asked still to determine the best course of action. They first question I would ask is: “Do you feel like the sertraline has helped your depression at all?” At this point I need to clarify if we should try going up to a higher dose of sertraline or if we need to switch to another antidepressant entirely. If she has felt some improvement, but not enough, I would be inclined to increase the dose to 150mg daily. If she has not felt any improvement at all I would be more inclined to taper off Sertraline and begin a new antidepressant.

The second question I would ask is “have you tried anything to help you sleep? Are you just having trouble falling asleep or also staying asleep?” This is important to determine what kind of therapy she needs. If she is simply having difficulty falling asleep and has not tried something as simple as melatonin, then this should be the first plan. At the age of 75 adding a sleeping medication could have significant side effects.

Lastly, I would be sure to ask, “who is there to support you in your life?” The reason for this question would be to identify a support system that this patient has. They may also be people to interview to help get a better idea of this patient’s needs. People that might be good to interview would be this patients children, close siblings, or if she lives in a retirement home or assisted living, then staff at that facility might be good to interview.

A possible different diagnosis for this patient is insomnia. By treating this patient’s insomnia, it may also resolve her depression. In addition to differential diagnosis, I would also explore issues such as hypothyroidism that could be causing the depression symptoms and so I would order a TSH test. Other medications to try if going up on the Sertraline is not an option include fluoxetine, another SSRI, and if that didn’t work, venlafaxine, an SNRIs. SSRIs tend to have the least amount of side effects so as a first option I would try a different SSRI, then I would move onto another mechanism of action such as an SNRI or tricyclic antidepressant (Marasine, et al., 2021).

When choosing a new medication to switch to it is important to review the patient’s history. If this patient has a history of falls, then both fluoxetine and venlafaxine should be avoided if possible (IBM Micromedex Drug Reference, 2021). With fluoxetine, due to her age, she would need to be monitored for hyponatremia and due to her diabetes her blood sugar would need to be monitored very closely. None of her current medications are contraindications to therapy with fluoxetine or venlafaxine.

 
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