Adult/Geriatric Depression Hispanic Male With MDD
Decision # 1
For this case, I chose to start the patient with Effexor XR 37.5 mg orally daily. I recommended him to take a single dose after eating one time a day. Either in the morning or the evening. However, he was to ensure that the time is approximately the same each day (Slowiczek, 2020). The patient was to swallow the capsule with a fluid such as water. Therefore, after meals, he was to take the drug immediately with water. The client was to ensure they swallow it whole to take all the pellets or spheroids.
The reason for selecting this decision was to allow the new patient to adjust to the medication before increasing the dose to 75 mg per day. The 32-year-old client was undergoing this kind of treatment for the first time (Song et al., 2011). Therefore, starting with a lesser dosage will enable the body to adequately adjust to the treatment without resulting in adverse side effects.
By making this decision, I intended to achieve two objectives. First, I hoped that the client would adjust to this type of medication since they had never had another treatment of a similar kind before. Second, I thought that the client would at least show some improvement, indicating that they are responding to the medications. Don't use plagiarised sources.Get your custom essay just from $11/page
The client came back to the hospital after several weeks and stated that he did not experience any change in the depressive symptoms at all. The existence of such a difference indicated that the MDD ranged between moderate to severe. His real-life experiences can explain this scenario. The client started experiencing depression while still in due to the death of her mother. During the clinical interview, he confirmed to be a victim of racism in high school because he was Hispanic. Besides, he acknowledged reduced participation in activities that would trigger more exercise. Hence, resulting in a considerable weight gain. He has insomnia that gradually worsens. These incidents show that indeed his depressive disorder lies between moderate to severe.
Decision #2
The second decision was to increase Effexor to 75 mg orally daily. Since the starting dosage proved that the patient is not suffering from a minor depressive disorder, it was appropriate to prescribe the 75 mg once a day, either during the morning or evening (Drugs.com, 2019). Just like Effexor XR 37.5 mg, he was to swallow the capsule whole with a glass of water without chewing or tearing to increase its effectiveness.
I hoped that the dose would eliminate depressive symptoms and that after some time, the patient will come back and report that they do not experience any of the signs anymore. These included insomnia as well as depression feelings. Also, I expected to witness a significant reduction in the Montgomery- Asberg Depression Rating Scale (MADRS).
However, there existed a considerable difference between what I expected to achieve by making this decision and the results obtained. The patient came back after four weeks and reported an improvement in depressive symptoms. Insomnia and feelings of depression continued to decrease daily. Although there was notable progress with the medication, the expectation was that he would fully recover from the disorder. Besides, the MADRS decreased by 25%. Hence, the score indicated a substantial decline in the severity of the depression.
Decision #3
For this scenario, I had two options. One, discussing with the patient whether they can maintain the current dose if they are feeling better. Besides, he had no complaints of experiencing side effects. The second choice is to increase the treatment, but I must counsel the client about the likelihood of encountering side effects (Avasthi & Grover, 2018). The most appropriate decision was to increase the Effexor to 112. 5 mg orally daily. However, its potential side effects included dizziness, loss of appetite, nausea, and general weakness. Therefore, I advised the patient to take rest and avoid operating machines such as driving after taking the medication.
By making this decision, I expected that the patient would respond quickly. Since he exhibited some improvement, increasing the dose would contribute significantly to the recovering process. The use of the augmenting agent was still not appropriate because we had not reached the maximum dose with Effexor (Song et al., 2011). The client was on outpatient services because although his condition was severe, the symptoms were not equivalent to those of severely depressed inpatients.
Although the medication was enough at this point, the recovery rate was slower than I expected. I hoped that the client would recover in less than two weeks, but he took almost a month to eliminate the symptoms. The reason for this difference was because the dose was still relatively small for severe depressive symptoms. However, the patient reported a positive change and that he completed the medication without experiencing any severity of the side effects.
Impacts of Ethical Considerations
Some ethical considerations hindered an adequate diagnosis of the severity of the MDD. For instance, while assessing the client, sometimes he tended to underreport his depressive symptoms. He did not provide clear information, whether he encounters hallucinations or paranoid thoughts. Besides, he denied that he has never had any suicidal or homicidal feelings in his entire life. Perhaps, this ethical consideration was a significant contributor to the underestimation of his condition. Another potential hindrance to accurate diagnosis was the fear of stigma, which acted as a barrier to accurate reporting of the symptoms. Basing the relationship on trust, respect, and honesty with the client can contribute significantly to overcoming these barriers (Pattanayak et al., 2017). Besides, a practitioner should assure the patient that the information they provide is confidential.
References
Avasthi, A., & Grover, S. (2018). Clinical practice guidelines for the management of depression in the elderly. Indian Journal of Psychiatry, 60(3), S341–S362. https://doi.org/10.4103/0019-5545.224474
Drugs.com. (2019, November 19). Effexor XR Dosage. https://www.drugs.com/dosage/effexor-xr.html
Pattanayak, R., Jain, S., Kuppili, P., & Sagar, R. (2017). Ethics in psychiatric research: Issues and recommendations. Indian Journal of Psychological Medicine, 39(5), 558. https://doi.org/10.4103/ijpsym.ijpsym_131_17
Slowiczek, L. (2020). Effexor XR: Dosage, side effects, uses, and more. Health News – Medical News Today. https://www.medicalnewstoday.com/articles/326678#for-professionals
Song, J., Yu, B., Lee, D., Yoon, S. C., & Jeon, H. J. (2011). Uncontrolled self-medication with venlafaxine in a patient with major depressive disorder. Psychiatry Investigation, 8(1), 74. https://doi.org/10.4306/pi.2011.8.1.74