Assessing And Treating Adult Clients With Mood Disorders

Assessing And Treating Adult Clients With Mood Disordersa Mood Disorde

Assessing and Treating Adult Clients with Mood Disorders: A Mood Disorder Overview and Case Analysis

Paper For Above instruction

Mood disorders constitute a significant segment of mental health conditions characterized by fluctuations in mood, including major depressive disorder (MDD) and bipolar disorder. These disorders considerably affect individuals' daily functioning, quality of life, and overall well-being. According to the United States Department of Health and Human Services (MentalHealth.gov, 2017), approximately 20 million Americans suffer from depression, presenting symptoms such as persistent sadness, anhedonia, weight fluctuations, fatigue, feelings of hopelessness, and suicidal ideation. Furthermore, current research indicates that depression onset often occurs in adulthood, with about 30% of adults experiencing a major depressive episode in their lifetime, typically around the median age of 32.5 years (Park & Zarate, 2019).

Effective assessment and treatment strategies are crucial for managing mood disorders. Screening tools, comprehensive evaluations, and ongoing monitoring are fundamental components ensuring patient safety and well-being (Park & Zarate, 2019). Pharmacotherapy, especially with antidepressants, combined with psychotherapy, is often regarded as first-line treatment approaches, owing to their proven efficacy and safety profiles (Park & Zarate, 2019). This paper reviews a clinical case involving a 32-year-old Hispanic male presenting with major depressive disorder symptoms, discusses appropriate pharmaceutical interventions based on research evidence, and considers key ethical issues within psychiatric mental health care.

The case involves a client reporting initial feelings of social alienation, minimal social support, and a recent decline in daily functioning. The client exhibits classic depressive symptoms, including significant weight gain (15 pounds over two months), sleep disturbances, concentration difficulties, and diminished interest in activities. Notably, the depression screening score of 51 indicates severe depression (Montgomery & Asberg, 1979). The treatment options include pharmacological choices such as sertraline (Zoloft), venlafaxine (Effexor), and phenelzine, a monoamine oxidase inhibitor (MAOI). Given the safety profiles, side effect considerations, and the patient's symptomatology, Zoloft emerges as the preferred initial medication (Stahl, 2013; NAMI, 2018b).

Sertraline, an SSRI, enhances serotonergic activity by blocking serotonin reabsorption into presynaptic neurons, thereby increasing neuroavailability to promote mood stabilization (Stahl, 2013). SSRIs are favored as first-line agents because of their efficacy, tolerability, favorable side effect profiles, and cost-effectiveness (Masuda et al., 2017). Starting at 25 mg daily and titrating up based on tolerability aligns with standard clinical practices to minimize adverse effects (National Alliance on Mental Illness [NAMI], 2018b). The initial low dose allows monitoring for side effects such as gastrointestinal disturbances, sexual dysfunction, or sleep issues.

Venlafaxine, an SNRI, acts on both serotonin and norepinephrine reuptake sites. It is effective but carries risks like antidepressant discontinuation syndrome (ADS), characterized by dizziness, electric shock-like sensations, and mood instability upon abrupt cessation (Bhat & Kennedy, 2017). Given the client's current clinical stability, Effexor's discontinuation risk may outweigh benefits. Phenelzine's profile as an MAOI entails dietary restrictions and a high risk for hypertensive crises, making it generally unsuitable unless previous treatments fail and close monitoring is feasible (Stahl, 2017).

As the client progresses, his response indicates partial symptom reduction. The emergence of erectile dysfunction, a common SSRI side effect, warrants treatment reevaluation. To address sexual side effects and weight concerns, augmenting therapy with bupropion (Wellbutrin) is appropriate. Bupropion, a norepinephrine-dopamine reuptake inhibitor, not only alleviates depression but also has stimulating properties that can promote weight loss and counter SSRI-induced sexual dysfunction (Stahl, 2017; NAMI, 2018a). Initiating bupropion at 150 mg once daily in extended-release form minimizes side effects increasing adherence (U.S. Food and Drug Administration [FDA], 2011a).

The subsequent clinical outcomes show significant improvement. The patient reports a 25% reduction in depressive symptoms after four weeks. However, he experiences mild jitteriness and nervousness, typical early side effects with bupropion (Stahl, 2017). This underscores the importance of close monitoring during medication initiation and titration. In subsequent decision-making, increasing bupropion to a 150 mg extended-release dose may enhance tolerability and adherence. Switching from immediate-release to extended-release formulations provides smoother absorption kinetics, reducing peak-related side effects (FDA, 2011b; Guzman, n.d.).

Regarding adjunctive therapy for anxiety symptoms, the choice of adding benzodiazepines like lorazepam (Ativan) carries concerns due to dependence potential. While short-term use may provide benefit, routine addition to mood disorder management is discouraged without thorough assessment (Stahl, 2017). The current stability suggests that escalating medication management or non-pharmacological strategies, such as cognitive-behavioral therapy (CBT), should be prioritized. CBT has demonstrated robust efficacy in treatment-resistant depression and can help address residual symptoms, improve coping skills, and prevent relapse (Li et al., 2018).

Ethical considerations play a vital role in managing mood disorders. Respecting patient autonomy, especially regarding medication adherence, involves clear communication about treatment benefits, risks, and costs (Barker & Guzman, 2015). Cultural competence is essential, particularly with Hispanic clients, to address language barriers, cultural beliefs about mental illness, and expectations about treatment (Guzman, n.d.). Financial constraints influence medication accessibility; thus, prescribing cost-effective generics or facilitating pharmacy assistance programs can enhance adherence and outcomes. Additionally, safeguarding confidentiality and providing patient education about side effects empower clients to participate actively in their treatment plan.

In conclusion, managing adult mood disorders requires a comprehensive, individualized approach integrating evidence-based pharmacotherapy, psychotherapy, and ethical clinical practice. Careful medication selection, monitoring for side effects, cultural sensitivity, and patient engagement are crucial for achieving remission and enhancing quality of life. As evident from this case, starting with SSRIs like sertraline, considering augmentation with agents like bupropion, and addressing side effects through formulation adjustments can optimize outcomes. Ongoing assessment and ethical considerations ensure holistic, patient-centered care that respects individual preferences and circumstances.

References

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