NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology
Week 3: Adult and Geriatric Antidepressant Therapy
The Impact of Ethnicity on
... [Show More] Antidepressant Therapy
Case 3: Volume 1, Case #29: The depressed man who thought he was out of options
Age: 69yo Gender: Male
SUBJECTIVE DATA:
Chief Complaint (CC):
unremitting, chronic depression
History of Present Illness:
The client was diagnosed with depression 40 years ago with a positive response to treatment up
until five years ago. The client’s depression relapsed while taking Effexor 225mg. 2 years ago;
the client had nine rounds of Electroconvulsive Therapy (ECT) with partial response. For the
past few years, he has tried every known antidepressant and augmentation combinations and has
seen numerous psychiatrists. The combinations have included five different SSRI’s, Cymbalta,
Remeron, 2 TCA’s, augmented with five different antipsychotics, and augmented with Lithium,
Thyroid, Buspar, and L-methylfolate. After ECT, took Nardil, which is an MAOI, and then tried
an MAOI with Phenelzine, which is a TCA along with Elavil (Nortriptyline).
Psychiatric Medications:
Phenelzine 90mg
Elavil 50mg
Ativan PRN.
Past Medical History (PMH):
Not contributory
1
This study source was downloaded by 100000852290574 from CourseHero.com on 12-05-2022 16:08:07 GMT -06:00
https://www.coursehero.com/file/57148425/Psychopharmacologic-Approaches-week3doc/
nursing
Other medications:
– Boniva for osteoporosis
– Avapro for hypertension
– Lipitor for hypercholesterolemia
– Flomax for enlarged prostate
– Melloxicam for arthritis
Patient Intake:
Severely depressed and demoralized. No joy or pleasure; sad, feeling helpless, hopeless,
worthless, problems concentrating. Past two years rates himself 9/10 in severity (10 worst). Wife
states he is letting go and giving up
Social History:
The client is a retired engineer, has three children, eight grandchildren, non-smoker, no history of
drug or alcohol abuse.
Family History:
Several first-degree relatives: depression. No family history of suicide.
List three questions you might ask the patient if he or she were in your office.
1.) Have you been taking your medications as prescribed? If not, can you explain why?
Assessing the compliance of medication should be determined. The clinician should not assume
the client is automatically compliant. Effective symptom management weighs significantly on
adherence to antidepressant therapy. Sansone and Sansone (2012), acknowledge that the reason
for non-adherence of antidepressants with clients includes hopelessness, medication-induced
sexual dysfunction, delayed onset of medication action, and fears of addiction.
2
This study source was downloaded by 100000852290574 from CourseHero.com on 12-05-2022 16:08:07 GMT -06:00
https://www.coursehero.com/file/57148425/Psychopharmacologic-Approaches-week3doc/
2.) Are you sleeping okay? Are you waking in the early hours of the morning and unable to fall
asleep again?
One of the screening tools that is considered the gold standard in screening for depression is the
Hamilton Depression Rating Scale (HDRS) (Vinbjerg et al., 2019). Screening the client for
insomnia can indicate depression. “Depressed individuals may suffer from a range of insomnia
symptoms, including difficulty falling asleep (sleep onset insomnia), difficulty staying asleep
(sleep maintenance insomnia), unrefreshing sleep, and daytime sleepiness” (National Sleep
Foundation, 2019, para. 3).
3.) Have you had any thoughts on suicide?
Part of the HDRS assessment tool evaluates the client’s thoughts on self-harm. If the client is
feeling hopeless, the clinician will need to rule out suicidal ideation. One of the significant
causes of suicide are feelings of isolation and disconnectedness. People who are suicidal are
hurting. Knowing that someone has cared enough to notice and ask the question can interrupt the
path towards suicide enough for the person to seek help.
Identify people in the patient’s life you would need to speak to or get feedback from to
further assess the patient’s situation.
The client’s spouse would be the ideal person to speak with to receive feedback on the client’s
situation. The spouse could attest for the clients sleep habits, mood, and compliance with
treatment.
Include specific questions you might ask these people and why.
1.) Why does she feel like he is letting go and giving up?
The spouse stated the client was letting go and giving up. A more detailed explanation of this
statement provides the clinician with the client’s actions.
3
This study source was downloaded by 100000852290574 from CourseHero.com on 12-05-2022 16:08:07 GMT -06:00
https://www.coursehero.com/file/57148425/Psychopharmacologic-Approaches-week3doc/
2.) Have the client’s symptoms worsened after he retired?
It is common for individuals that retire to lose a sense of purpose. Often it is our career that
defines us as who we are. If the depression relapse aligns with retirement, it may be
recommended that the client join a senior citizens group or volunteer in community activities.
3.) What would you consider a good day for your husband?
It is essential that the spouse can distinguish when the client is doing well compared to when he
is not doing well. Providing the clinician with a reflection of good days, we can set realistic
goals.
Explain what physical exams and diagnostic tests would be appropriate for the patient and
how the results would be used.
Thyroid Function Test: Clients with thyroid disorders could develop depressive symptoms, and
conversely depression may be accompanied by various subtle thyroid abnormalities.
Abnormality in thyroid hormone levels has been associated with depression. Also, various doses
of thyroid hormones have been used as enhancing agents to antidepressants, either to boost their
effectiveness in patients with inadequate response or to quicken their onset of action (Stahl,
2013). The most common thyroid abnormalities are elevated T4 levels, low T3, elevated rT3,
blunted TSH response to TRH, positive antithyroid antibodies, and high CSF TRH
concentrations (Hage & Azar, 2012). [Show Less]