discussion

      Read the discussion below :

 Doyou agree with their decision making? What are the pros and cons of theirchoices? What other suggestions might you offer?

Your response should include evidence ofreview of the course material through proper citations using APA format.      
 This discussion post, the main points of focus will look at the six weeks follow up from the depression case study addressed before Mrs. Lane. Before giving the steps that would be taken following the three scenarios, it would be essential to provide details surrounding the patients case. Mrs. Lane reported to the clinic detailing that she was sad and could not stop crying. Her primary caregiver advised her to seek help. Her history showed that she had been diagnosed and treated for major depressive disorder and generalized anxiety disorder. Her current symptoms also pointed towards the same conditions. These were changes in sleep patterns where she experienced trouble falling and staying asleep, depressed mood, loss of interest in activities such as cooking for her family not forgetting difficulty concentrating. The patient was put on antidepressants in the treatment plan, specifically selective serotonin reuptake inhibitors sertraline 50 mg a day. The given discussion will follow up on the step that will be taken depending on the scenarios of the patients response to the medication.
         1. There is no response to the medication.
             If there is no response to the medication given, the medication she is using will be switched to another. Since she is on SSRIs, the switch will not be on another class of drugs but rather another SSRI. Research details that switching antidepressants s an option of treatment and follow when a patient shows inadequate or no response at all to medication given after a specified duration and the correct dosage is administered (Rafeyan et al., 2020). The patient can be taken off sertraline and put on citalopram or escitalopram. Typically, antidepressants take around four weeks to start indicating efficacy in treating depression. Therefore, if the patient reports no response to her six weeks follow-up, it is possible that sertraline is not for her, thus the need to change to another drug. It is important to remember that switching cannot be applied just like that due to the severe withdrawal symptoms patients experience from being discontinued on antidepressants (Horowitz & Taylor, 2019). Therefore, tapering will be applied in this situation. Research suggests tapering by giving minimum or half doses over two or four weeks before discontinuing altogether (Horowitz & Taylor, 2019).
 
          2. There is a partial response to the medication. Mood has lifted, but energy and motivation are still poor.
              In the above scenario, it is clear that the patient experiences partial response in that there is some improvement in some areas. Therefore, the step that will be taken will be to add her dosage or add another antidepressant to the one she is currently using. Research mentions that when there is a partial response, physicians should consider increasing dosages or adding other drugs, for example combining SSRIs or adding another class of antidepressants (Vazquez et al., 2021). since she is on sertraline 10mg a day, the dosage will be cranked up to around 20mg a day to be gradually increased or decreased depending on the response on the effectiveness, increase in her energy and motivation levels and the side effects. If the dosage is not increased, a combination of SSRIs will be prescribed instead. The patient will be put on sertraline and escitalopram as these have a good effectiveness, acceptability and efficacy level.
         3. Mood is improved, but the patient has sexual side effects that interfere with quality of life.
              Antidepressants, for example, SSRIs, are associated with side effects, with one of them being sexual side effects. Research mentions that one of the main issues facing the treatment of major depressive disorder is adherence and compliance to treatment from patients (DellOsso et al., 2020). One factor that promotes non-adherence is the side effects of medication, which is a patient-related factor (DellOsso et al., 2020). Therefore, the patient will go through education to educate them on the importance of adhering to medication regardless of the side effects considering the benefits outweigh the risks. Education will also look to inform the patient of the other side effects that she will experience and the practices she can input to mitigate the impact of these side effects on her quality of life

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