Hispanic Male Case Study

Introduction

A depressive disorder is a common medical condition with negative effects on how a person feels, thinks and acts. The condition leads to feelings of sadness and loss of interest in particular activities that one once enjoyed. It may also cause various physical and emotional problems, which would decrease the ability of a person to function well. Older adults always have an increased risk of depression and depressive disorders (Rytwinski et al., 2014). When one is diagnosed with a depressive disorder, antidepressants would be prescribed to treat them and reduce the symptoms of the condition. This paper focuses on a 32-year old Hispanic American male who reports severe depression as indicated by the Montgomery-Asberg Depression Rating Scale.

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Decision 1

In this first decision, the selected medication was Zoloft 25mg orally on a daily basis. Zoloft is used to treat and manage the major depressive disorder, which the 32-year old Hispanic American male has been diagnosed with. It can also treat other conditions like anxiety and panic disorders, post-traumatic stress and obsessive-compulsive disorder (Rytwinski et al., 2014). The major reason for the selection of Zoloft is because it is more effective in the treatment of severe depression among adults as compared to Phenelzine. The mechanism of action of Zoloft is that it works by blocking pumping of the serotonin reuptake and dopamine reuptake. As such, the amount of serotonin will increase in the brain hence maintaining mental health balance (Stahl, 2017). Ideally, Phenelzine was one of the medications that were not selected since it would only be recommended in situations where other drugs fail to produce the expected outcomes. Effexor XR has harsh side effects like the increased risk of suicidal thoughts hence would not be recommended for treatment of severe depression. The main reason for the decision was to reduce the symptoms of depression and improve the quality of life of the patient. However, after four weeks, the patient returns to the clinic with a 25% decrease in the symptoms but reports erectile dysfunction hence has to be concerned about the new condition (Stahl, 2013).

Decision 2

The second decision involved three medications to choose from. One of them is decreasing the Zoloft dose to 12.5mg orally daily. The other one is continuing with the same dose, as well as adding an augmenting agent like Wellbutrin IR 150mg when taking the drug in the morning. The decision selected was the one involving the addition of an augmenting agent. Since Zoloft had caused erectile dysfunction, Wellbutrin is the most efficient augmenting agent for the side effect brought forth. In essence, by using the two drugs, the patient would be expected to report good results as the symptoms of depression are reduced substantially (Yasuda, Zhang & Huang, 2008). When Wellbutrin and Zoloft are combined, the problem of erectile dysfunction will be corrected. Wellbutrin works by boosting serotonin levels in the brain. The decision was made to help reduce the symptoms of severe depression, and correct erectile dysfunction. Importantly, when the patient returns to the clinic after four weeks, there is a more significant decrease in the depressive symptoms. It is also reported that erectile dysfunction has abated. Nevertheless, the patient tends to be feeling nervous. The expectation from the decision was some jittery and nervous feeling (Wassertheil-Smoller et al., 2014).

Decision 3

In the third decisions, various medications are available to choose from, which comprise of discontinuing Zoloft and continuing Wellbutrin, changing the dose of Wellbutrin to 150mg orally daily, or adding Ativan 0.5mg orally for anxiety. The decision selected in this case was to change the dosage of Wellbutrin to XL 150mg orally daily in the morning. The decision was the most efficient since the SR leads to the effects of nervousness and jittery hence the need to change from Wellbutrin SR to Wellbutrin XL. Discontinuing Zoloft would not be an appropriate decision since the two drugs have worked together to decrease the depressive symptoms of the patient and consequently abating erectile dysfunction (Howland, 2008). Ativan 0.5mg oral TID/PRN would not reduce the effects of nervousness and jittery since the drugs have different side effects hence it might lead to more harm than good to the patient. The expected outcome of changing to Wellbutrin XL was to decrease the symptoms of severe depression and abate the effect of erectile dysfunction (Rytwinski et al., 2014). Concisely, Wellbutrin and Zoloft drugs caused jitteriness, which is always a temporary feeling with the selective serotonin-reuptake inhibitors. The feeling would be most associated with the immediate release of Wellbutrin (Rush et al., 2004). Consequently, the most relevant decision for the patient involves a change of the Wellbutrin to the XL dosage. Ativan does not add the required medication for reduction of the depressive symptoms and other side effects experienced. Therefore, the need would be to modify or change the proper medication for doing away with the adverse side effects.

Conclusion

For the treatment process to be effective and produce appropriate results, the health care professional needs to understand ethical considerations such as being culturally sensitive to the Hispanic American patient. Since the ethnic group is different and may be treated differently in society, the depressive disorder would not be handled in the same manner as patients from other ethnic groups. The practitioner needs to guide the patient on the appropriate dosage of the drugs prescribed.

References

Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression (STAR* D)--Part 2: Study Outcomes. Journal of psychosocial nursing and mental health services, 46(10), 21-24. Retrieved from https://doi.org/10.3928/02793695-20081001-05

Rush, A. J., Fava, M., Wisniewski, S. R., Lavori, P. W., Trivedi, M. H., Sackeim, H. A., ... & Kupfer, D. J. (2004). Sequenced treatment alternatives to relieve depression (STAR* D): rationale and design. Controlled clinical trials, 25(1), 119-142. Retrieved from https://doi.org/10.1016/S0197-2456(03)00112-0

Rytwinski, N. K., Rosoff, C. B., Feeny, N. C., & Zoellner, L. A. (2014). Are PTSD treatment choices and treatment beliefs related to depression symptoms and depression-relevant treatment rationales?. Behaviour research and therapy, 61, 96-104. Retrieved from https://doi.org/10.1016/j.brat.2014.07.013

Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2017). The prescriber's guide (6th ed.). New York, NY: Cambridge University Press.

Wassertheil-Smoller, S., Arredondo, E. M., Cai, J., Castaneda, S. F., Choca, J. P., Gallo, L. C., ... & Penedo, F. J. (2014). Depression, anxiety, antidepressant use, and cardiovascular disease among Hispanic men and women of different national backgrounds: results from the Hispanic Community Health Study/Study of Latinos. Annals of epidemiology, 24(11), 822-830. Retrieved from https://doi.org/10.1016/j.annepidem.2014.09.003

Yasuda, S. U., Zhang, L., & Huang, S. M. (2008). The role of ethnicity in variability in response to drugs: focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417-423. Retrieved from https://doi.org/10.1038/clpt.2008.141