The Depressed Hispanic Man With

The Depressed Hispanic Man Wit

My client is a 32-year-old Hispanic American male presenting with symptoms of depression, including persistent sadness, loss of interest in activities, difficulty sleeping, increased weight, and concentration problems. His history reveals childhood loss of his mother in Mexico, upbringing by his father among many siblings, and social isolation during high school due to racial teasing. He reports physical pains from his labor-intensive job and recent worsening of mood symptoms over six months. Despite no hallucinations or suicidal thoughts, his Montgomery Depression Rating Scale score is 51, indicating severe depression.

The initial treatment decision was to start him on 25 mg of Zoloft (sertraline) daily. This choice was influenced by the prevalence of depression globally and the efficacy of SSRIs such as Zoloft, which are considered first-line treatments. SSRIs work by increasing serotonin levels in the brain, thus improving mood, sleep, and energy (Stahl & Stahl, 2013). The goal was to alleviate depressive symptoms, re-engage the client in daily activities, and improve concentration.

After four weeks, the client demonstrated a 25% reduction in symptoms, but he experienced a new side effect: erectile dysfunction. This side effect is linked to the action of Zoloft which reduces dopamine and norepinephrine activity and blocks nitric oxide pathways, impairing blood flow necessary for an erection (WHO, 2009). The occurrence of sexual dysfunction necessitated patient education and ongoing counseling about side effects and medication adherence.

Given the partial response, the decision was made to continue the same dose of Zoloft and reinforce adherence counseling. The rationale was that at 25 mg, the medication needs at least six weeks to produce full therapeutic effects, and the client had already shown some improvement. The focus was on ensuring medication compliance, expecting further symptom reduction, and observing for side effects like weight gain, as he had gained 15 pounds in two months.

However, the client reported worsening sexual side effects and stopped medication, highlighting adherence challenges often associated with side effects. Recognizing the importance of combination therapy, psychotherapy was suggested as adjunctive treatment. Psychotherapy, particularly cognitive-behavioral therapy (CBT), has demonstrated efficacy in conjunction with antidepressants by helping clients develop coping skills and modify maladaptive thoughts (Schimelpfening, 2020).

The third decision was to reintroduce Zoloft at a reduced dose of 12.5 mg daily, aiming to mitigate side effects such as erectile dysfunction. This dose reduction serves as a cautious approach to evaluate whether lower serotonergic activity improves tolerability. Patient education about the importance of gradual dose adjustments and avoiding abrupt discontinuation was emphasized, as sudden stoppage can precipitate relapse (Stahl & Stahl, 2013).

If this reduced dose fails to produce adequate symptom control or side effects persist, switching to alternative antidepressants such as bupropion (Wellbutrin XL) was considered. Bupropion tends to have less sexual side effects and can even enhance libido (Escobar, 2020). It acts by increasing dopaminergic and noradrenergic activity and usually takes four to six weeks to reach full effect. Comparing Bupropion and SSRIs like Zoloft, the former is often preferred when sexual dysfunction is a primary concern.

This treatment plan integrates pharmacological adjustments with psychoeducation and psychotherapy, aiming to optimize the client's response while minimizing side effects. Ethical considerations, such as beneficence and non-maleficence, guide the clinician to prioritize patient safety, informed consent, and adherence support (Kadivar et al., 2017). Personalizing treatment through client engagement and comprehensive care improves outcomes and promotes sustained recovery.

References

  • Escobar, A. (2020). Wellbutrin Addiction. Retrieved from https://www.medicalnewstoday.com/articles/324093
  • Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient's safety: a clinical case report. Journal of Medical Ethics and History of Medicine, 10, 15.
  • Schimelpfening, N. (2020). Types of Psychotherapy for depression. Retrieved from https://www.depressionhelp.me/psychotherapy/types
  • Schmaal, L., Veltman, D. J., van Erp, T. G., et al. (2016). Subcortical brain alterations in major depressive disorder: findings from the ENIGMA Major Depressive Disorder working group. Molecular Psychiatry, 21(6), 806–812.
  • Stahl, S. M., & Stahl, S. M. (2013). Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. Cambridge University Press.
  • Voineskos, D., Daskalakis, Z. J., & Blumberger, D. M. (2020). Management of Treatment Resistant Depression: Challenges and Strategies. Neuropsychiatric Disease and Treatment, 16, 221–230.
  • World Health Organization (WHO). (2009). Basic principles of prescribing. Retrieved from https://www.who.int/medicines/publications/Prescription_2009.pdf
  • Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder. Baltimore, MD: Author.
  • Schmaal, L., Veltman, D. J., van Erp, T. G., et al. (2016). Subcortical brain alterations in major depressive disorder. Molecular Psychiatry, 21(6), 806–812.
  • Voineskos, D., Daskalakis, Z. J., & Blumberger, D. M. (2020). Management of Treatment Resistant Depression: Challenges and Strategies. Neuropsychiatric Disease and Treatment, 16, 221–230.

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