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.

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 this link provided.

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 6, “Mood Disorders”

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
• doxepin
• 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.

Howland, R. H. (2008). 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:02793695-20081001-0510.3928/02793695-20080901-06

Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21-24. doi:02793695-20081001-0510.3928/02793695-20080901-06

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

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.

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