Adult/Geriatric Depression

Introduction 

According to Mace et al. (2017), geriatric depression disorder is a health condition that affects adult people with the main symptoms see for a patient with the condition being the frequent change in moods and the sadness. The condition is as well common among younger people although this is not a common health issue. As a result of the impact of the condition, there is a need for getting an understanding of the condition and the best medical process that is to be followed. With the treatment of the patients there is a need for understanding the fact that if one medication does not succeed, there is a need for implementation of a new medication or change of the prescription for the patient. This paper focuses on the options chosen for managing the conditions for a patient. 

Symptoms of adult/geriatric depression disorder

A patient with geriatric depression disorder will be seen to have issues of mood swings as the main symptoms of the condition. The other symptoms that will be evident will include issues of the feeling of despair and sad and the patient will have issues of pain and aches in all parts of the body. Laird et al. (2019) allude that a patient with the health condition will have risks of loss of appetite and lack of hope or lacking any willingness to get help. There are risks of the patient as well as lacking any morale in improving their condition. 

Causes

Vlasova et al. (2019) allude that one of the main risk factors that increased the chance of a patient getting geriatric depression is old age. As such, a patient who is old will be at high risk of being affected by the health condition. The other risk factor is that women are at higher risk of suffering from the health issue as compared to their male counterparts. The people who have a low-level education as well as those that have physical illnesses and influencing the standard of thinking of the person.

Thus, there is a need for healthcare providers to help in the education of the patients who are at risk of suffering from the health condition. The patients who are found to be making use of various drugs and that have psychological stressors are at high risk of being affected by the health concern. The patients as well may lead to affecting the patients who have white matter changes.

Patient case

This is a case of 32-year-old patients of Hispanic origin and who came to the US for his education. The patient has his mother passing on while he was in school and ended up being admitted to the healthcare facility as a result of depression issues. On having an assessment, it is found that the patient does not suffer from any other health issue and the patient has presented that he has had pain and stiff parts of the body.

There are various signs and symptoms expressed by the patient with the main issue faced by the patient being undermined as a result of the color of his skin. There is evidence of the patient having little socialization since he has not been seen to be having any friends. The patient has had a reduction in the morale to interact with the other people living in the community and has had a detachment and does not have the evidence of being with the others. 

The indication is that he has had an issue of lack of sleep for most of the days for the last 6 months and the patient claims that the condition has become worse each day. The patient as well presents that he does not have enough exposure and does not present his best at work. On the Montgomery Asberg depression rating scale, the patient is found to score 51 and this shows that he has a severe case of depression. 

Decision #1

Which decision did you select?

Begin Effexor XR 37.5 mg orally daily

Why did you select this decision?

The selection of this medication is to help in the reduction of the issue of depression and is fundamental for patients as a way of therapy. The selection of this medication is attributed to the fact that the medication has fewer side effects as compared to the use of medications such as Zoloft or phenelzine (Crocco et al., 2017).

What were you hoping to achieve by making this decision?

The expected results for the use of this medication is that the patient will have a change in his condition and that he would be found to have a reduction in cases of depression. Thus, the use of the medication is expected to help in the enhancement of the social skills of the patient hence he may be able to interact with more people as depicted by Beyer and Johnson (2018).

Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

The use of the medication is expected to help in the improvement of the depressive condition of the patient and that the patient will have had improved symptoms. After the use of the medication and the follow up being made after four weeks, it is found that there were no changes in the symptoms expressed by the patient. As a result of the lack of changes in the depressive symptoms of the patient, there has been a need for having another decision to help in healing the patient.

Decision #2

Why did you select this decision?

The second decision is to increase Effexor XR to 75 mg orally daily. The medication that is focused on in this case is to help in the enhancement of the quality of health of the patient. The patient is expected to have an increase in the dosage for the change in the symptoms and the medication does not have excessive side effects. 

What were you hoping to achieve by making this decision?

The decision, in this case, is made with the expectation of an improvement in the quality of health. The patient can learn of the improvement in the quality of health and that there is the ease in the development of the standard of care with the symptoms that the patient has including issues of depression being improved. This is of importance in ensuring that one can have a better living standard and that the skills of socialization are eliminated (Vlasova et al., 2019).

Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

The use of the medication is expected to help in ensuring that there is the ease in the advancement of the standard of health for the development of the quality of health. The patient’s condition is expected to ensure that one can manage the condition of depression. The patient comes after four weeks to the healthcare facility and indicates that there is an improvement in the depressive symptoms. As such, the patient has had an improvement in the quality of health. At this time, the patient has been able to do the exam on the rating MADRS scoring 38 out of the initial 51 which shows that the patient has had a reduction in the quality of health.

Decision #3

Why did you select this decision?

The third choice that is to be made is to increase the dose to 112.5 mg orally daily. This is an indication that the patient should be in a position to have changes in the standard of health. The selection of the medication is expected to help in the development of the quality of health. The issue of patient care facing health concern is that one is supposed to learn of the changes in the kind of medication being used. The process is expected to help in improving the chances of depressive disorder as pointed out by Crocco et al. (2017).

What were you hoping to achieve by making this decision?

The use of this medication is expected to help in that it allows for the development of the improved standard of patient care. There will be an improvement in the standard of health of patients and that the healthcare quality of the patients as well as the improvement in the health standard of patients. 

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

The use of the medication is of importance in that there will be ease in increasing the dosage allowing for the patient to have a better standard of health. This is as well an important process in that it ensures that the patient can have an improvement in the quality of life. There is a need for taking into account the fact that patient care standards are taken into account at the time of making use of this medication. The change in dosage is expected to help in making the healing process to be faster.

Ethical considerations

In the process of provision of medication for patients, there is a need for ensuring that there is ethics taken into account. The ethical standards that should be taken into account, in this case, is that the patient’s health should not be misunderstood and that there should not be a challenge in the advancement of the quality of health of the patients. The decision making should not be seen to influence the health of patients and that the doses that are given to the patient should not affect the health of the patient.

Summary

The patient taken into account, in this case, is one with depressive concerns. The start of the condition is seen to be from the time of death of his mother. The selection medication that is expected to be used is Effexor XR. The initial dose during the first one moths is 37.5 mg orally daily, this is followed by Effexor XR 75 mg orally daily and 112.5 mg after 4 consecutive weeks.

References

Beyer, J. L., & Johnson, K. G. (2018). Advances in pharmacotherapy of late-life depression. Current psychiatry reports, 20(5), 34.

Crocco, E. A., Jaramillo, S., Cruz-Ortiz, C., & Camfield, K. (2017). Pharmacological management of anxiety disorders in the elderly. Current treatment options in psychiatry, 4(1), 33-46.

Laird, K. T., Lavretsky, H., Paholpak, P., Vlasova, R. M., Roman, M., Cyr, N. S., & Siddarth, P. (2019). Clinical correlates of resilience factors in geriatric depression. International psychogeriatrics, 31(2), 193-202.

Mace, R. A., Gansler, D. A., Suvak, M. K., Gabris, C. M., Areán, P. A., Raue, P. J., & Alexopoulos, G. S. (2017). Therapeutic relationship in the treatment of geriatric depression with executive dysfunction. Journal of affective disorders, 214, 130-137.

Vlasova, R. M., Siddarth, P., Krause, B., Leaver, A. M., Laird, K. T., St Cyr, N., … & Lavretsky, H. (2018). Resilience and white matter integrity in geriatric depression. The American Journal of Geriatric Psychiatry, 26(8), 874-883.