Depression Case Study: Medication Choice ✓ Solved

Depression Case Study Medication Choice

List 1 medication that would be appropriate for this case. Include name, starting dose. The case study involves Alison, a 38-year-old female, divorced, and a mother of two children complaining of low mood. I would recommend escitalopram (Lexapro) for the patient in the depression case study. The starting dose of escitalopram is 10 mg taken once daily but it can be titrated to 20 mg a day after about three weeks (MedlinePlus, 2016).

2. Describe your clinical decision making. What is your rationale for choosing this medication? Also, include the mechanism of action for this medication choice, and the neurotransmitters and areas of the brain in which the medication is proposed to act on. The main reasons for selecting escitalopram are its high efficacy and tolerability. According to Sanchez, Reines, and Montgomery (2014), escitalopram is more effective and tolerable in the treatment of depression as compared to other SSRIs including sertraline and paroxetine, as well as other antidepressants. Therefore, most patients achieve remission when using escitalopram and they experience only a few and mild side effects. Escitalopram is an SSRI (selective serotonin reuptake inhibitor) hence; its mechanism of action involves binding to SERT and raising serotonin levels in the brain without affecting other neurotransmitters Li, G., (Shen, Luo, & Li, 2017). Escitalopram inhibits neurons from reabsorbing serotonin thus enabling more serotonin to transfer messages between neurons in the brain.

Notably, escitalopram binds to allosteric and orthosteric binding sites to block uptake of 5-HT, increase its extracellular levels and raise the speed of auto receptor desensitization of 5-HT1A (Sanchez, Reines, & Montgomery, 2014). Therefore, escitalopram is a unique medication because it has chiral and allosteric advantages and it is an ASRI apart from being an SSRI citalopram (Sanchez, Reines, & Montgomery, 2014). 3. What laboratory testing/monitoring is needed for safely prescribing this medication? Laboratory testing including electrocardiography, a thyroid-stimulating hormone level, a complete blood cell count, and metabolic panel tests are necessary to safely prescribe antidepressants including escitalopram (Shultz & Malone, 2013).

Laboratory testing is important to ensure the patient does not have underlying medical conditions that might be causing the depression or prevent the use of escitalopram. Some of the conditions that should be checked before prescribing escitalopram are epilepsy, allergic reactions, pregnancy, heart problems, low heart rate, diabetes, and glaucoma (MedlinePlus, 2016). Close monitoring is also crucial to ensure the patient is responding appropriately to the medication and to prevent the development of severe side effects when using escitalopram (Shultz & Malone, 2013). After about 4 week, the dosage will be increased or the medication might be replaced with another agent if there is little response. For instance, the patient is suicidal and antidepressants increase suicide risk hence the need for close monitoring. 4. Are there any contraindications or safety issues associated with this medication? The major contraindications associated with escitalopram are drug-to-drug interactions; escitalopram is an SSRI that goes through CYP450 metabolism in the liver (Shultz & Malone, 2013).

Therefore, some agents might cause adverse events if prescribed together with escitalopram and P450 inhibition alters the metabolism of such agents. For example, serotonin syndrome occurs when MAOIs are prescribed together with escitalopram and Pimozide should not be used together with the medication (U.S. Food and Drug Administration, 2017). Safety issues can also arise when prescribing the medication and the patient is pregnant. Non-pharmacologic Interventions 13. What non-pharmacologic interventions do you recommend? Do you recommend including but not limited to psychotherapy, complimentary and holistic therapies? I would also recommend psychotherapy especially CBT conducted through individual and group counseling formats. CBT will equip Alison with skills to determine negative thoughts and replace them with healthy ones. Complimentary and holistic therapies such as acupuncture, exercises, yoga, meditation, massage, folate, Omega-3 fatty acids, as well as guided imagery and relaxation are effective for controlling depression (Nahas & Sheikh, 2011). Using the recommended non-pharmacologic interventions along with escitalopram will enhance management of depression.

Paper For Above Instructions

Escitalopram, commonly known as Lexapro, is a selective serotonin reuptake inhibitor (SSRI) that is commonly prescribed for the treatment of major depressive disorder and generalized anxiety disorder. This paper discusses the selection of escitalopram as an appropriate medication for Alison, a 38-year-old female presenting with low mood, as well as the clinical reasoning behind this choice, its mechanism of action, necessary monitoring, contraindications, and recommended non-pharmacologic interventions that could be beneficial in her treatment plan.

The choice of escitalopram for Alison is primarily based on its efficacy and tolerability compared to other antidepressants. Research indicates that escitalopram has a higher success rate in achieving remission from depressive symptoms with minimal side effects (Sanchez, Reines, & Montgomery, 2014). Many patients report fewer adverse effects when treated with escitalopram in comparison to other SSRIs such as sertraline and paroxetine (Li, Shen, Luo, & Li, 2017). Therefore, the starting dose for Alison will be 10 mg once daily, which can be adjusted to 20 mg after three weeks depending on her response to the medication (MedlinePlus, 2016).

Escitalopram operates primarily by selectively inhibiting the serotonin reuptake transporter (SERT) which leads to increased levels of serotonin in the synaptic cleft (Sanchez et al., 2014). This increase in serotonin availability enhances neurotransmission and is believed to improve mood and alleviate depressive symptoms. The pharmacological effects of escitalopram are attributed to its chiral properties, making it a unique choice among SSRIs (Sanchez et al., 2014). The targeted increase in serotonin levels is associated with several regions of the brain, including the prefrontal cortex, amygdala, and hippocampus, which are critical areas involved in mood regulation and emotional responses.

Monitoring the patient’s response to escitalopram is crucial for ensuring safety and effectiveness. Routine laboratory tests including electrocardiograms, complete blood counts, thyroid-stimulating hormone levels, and metabolic panels are recommended prior to initiating treatment (Shultz & Malone, 2013). Specific health conditions such as history of seizures, heart problems, or other psychiatric disorders need to be evaluated to preemptively address any contraindications. Additionally, the patient should be regularly monitored for adverse effects and overall response to the medication (Shultz & Malone, 2013; U.S. Food and Drug Administration, 2017). If there is no improvement after four weeks, clinicians should consider adjusting the dosage or changing the medication depending on the clinical scenario.

In addition to pharmacologic interventions, non-pharmacologic therapies such as cognitive behavioral therapy (CBT) should be an integral part of Alison’s treatment plan. CBT is effective in helping individuals identify and modify negative thought patterns, promoting healthier behavior (Nahas & Sheikh, 2011). Complementary therapies, including mindfulness exercises, yoga, and meditation, can also provide valuable support for managing stress and improving quality of life (Nahas & Sheikh, 2011). These interventions should be discussed with Alison, taking into account her preferences and readiness to engage in therapy.

One major concern with escitalopram is the risk of drug interactions due to its metabolism via the cytochrome P450 system (Shultz & Malone, 2013). Concurrent use of monoamine oxidase inhibitors (MAOIs) can lead to potentially life-threatening serotonin syndrome. Pregnant women must also be carefully evaluated prior to initiation of escitalopram due to potential risks to the fetus (U.S. Food and Drug Administration, 2017).

In conclusion, escitalopram represents a justified first-line treatment option for Alison given its proven efficacy and tolerability in managing depressive symptoms. Ongoing monitoring of her response to the medication as well as consideration of non-pharmacologic interventions will form a comprehensive treatment approach aimed at improving her overall well-being.

References

• Li, G., Shen, Y., Luo, J., & Li, H. (2017). Efficacy of escitalopram monotherapy in the treatment of major depressive disorder. A pooled analysis of 4 Chinese clinical trials. Medicine, e8142. doi: 10.1097/MD.
• MedlinePlus. (2016, February 15). Escitalopram. Retrieved from https://medlineplus.gov/escitalopram.html
• Nahas, R., & Sheikh, O. (2011). Complementary and alternative medicine for the treatment of major depressive disorder. Canadian Family Physician, 57(6), 659–663.
• Sanchez, C., Reines, E. H., & Montgomery, S. A. (2014). A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike? International Clinical Psychopharmacology, 29(4), 185–196. doi:10.1097/YIC.
• Shultz, E., & Malone, D.A. (2013). A practical approach to prescribing antidepressants. Cleveland Clinic Journal of Medicine, 80(10), 1-9. Retrieved from https://www.ccjm.org/content/80/10/1
• U.S. Food and Drug Administration. (2017, January). Lexapro (escitalopram oxalate). Retrieved from https://www.fda.gov/media/84710/download