The case study depicts Laura, a 55-year-old White female accompanied by her daughter for her annual exam. The daughter expresses concerns about Laura being sleepy all the time and significant weight loss of 25 lb over the past two months with no dieting. Laura reports having increased fatigue and low energy levels. Besides, she has diminished interest in her hobbies because she frequently feels sad. She is diagnosed with Major Depression. Her medical history is positive for hypothyroidism, hyperlipidemia, and newly-diagnosed hypertension. The purpose of this assignment is to answer questions regarding the patient’s treatment approaches.
The specific treatment goals for Laura include improving her overall mood and interest/pleasure in activities she previously found enjoyable. Treatment will also seek to alleviate symptoms of depression such as hypersomnia, low energy levels, and fatigue.
The drug therapy for Laura will include Fluoxetine (Prozac) 20 mg orally once daily.
Prozac would be prescribed because it is an antidepressant under selective serotonin reuptake inhibitors (SSRIs). SSRIs are the recommended first-line antidepressants for mild to moderate depression due to their minimal anticholinergic effects (Clevenger et al., 2018). Besides, Prozac was selected because it has a modest adverse-effect profile which promotes better treatment compliance.
The success of Prozac therapy will be monitored by re-evaluating the severity of depressive symptoms in the patient after 4-6 weeks of treatment. A depression screening tool such as the Patient Health Questionnaire-9 (PHQ-9) can be used to assess the severity of depressive symptoms and monitor if the therapy has been effective in alleviating depression (Clevenger et al., 2018).
The patient education based on prescribed Prozac therapy will include the potential side effects of the drug such as nausea, diarrhea, insomnia, dry mouth, anorexia, headache, drowsiness, nervousness, and decreased sexual arousal (Edinoff et al., 2021). However, the patient will be informed that most of these side effects are immediate and abate with time. Therefore, it will be ideal to wait for the side effects to abate before changing treatment. Besides, the patient will be educated that most side effects are dose-dependent and time-dependent and thus will abate with time.
Prozac may cause induction of mania or activation of suicidal ideations and behavior in patients (Edinoff et al., 2021). If the two adverse reactions were to occur in Laura, the drug would be changed to another SSRI or antidepressant.
The second-line drug of choice will be Duloxetine (Cymbalta) 30 mg orally once daily. Duloxetine is an antidepressant under Serotonin/norepinephrine reuptake inhibitors (SNRIs). It was selected because it is recommended as a second-line agent in individuals who do not exhibit an adequate response to SSRIs (Gautam et al., 2017). Besides, its safety, side-effect, and tolerability profiles are comparable to SSRIs.
Amitriptyline is an alternative medication appropriate for Laura. It is a Trycyclic antidepressant indicated for major depressive disorder. Amitriptyline would be appropriate since it has established efficacy in treating depression (Gautam et al., 2017). However, the drug is associated with side effects, such as sedation, weight gain, and anticholinergic effects, which might lower the compliance rate.
Lifestyle modifications to be recommended to Laura based on her current major depression and history of hypothyroidism, hypercholesterolemia, and hypertension include dietary changes. The patient would be recommended on diets like the Dietary Approaches to Stop Hypertension (DASH) diet (Lassale et al., 2019). The DASH diet is a low-sodium diet established to promote healthy weight loss, lower hypertension, and reduce the risk of stroke. The diet is high in whole grains, vegetables, fruits, and low-fat dairy foods, which lower caloric dietary int
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