NRNP 6675 Week 9 Prescribing for Older Adults and Pregnant Women

 

Older adults often suffer from depressive disorders; severe depression is prevalent in this age group at 4% and dysthymia at 0.9% (Shang et al., 2020). Antidepressant medication and psychotherapy are the primary forms of treatment. Long-term antidepressant use may preserve well-being, lessen the risk of death, and decrease recurrence rates. However, prolonged usage may raise the risk of cardiovascular disease and osteopenia. This paper intends to propose one FDA-approved medication, one non-FDA-approved “off-label” medication, and one nonpharmacological intervention for the treatment of older persons with major depressive disorder.

Medication Recommendations

Depression in older persons is treated with pharmaceutical and non-pharmacological therapies. An FDA-approved drug called sertraline is often used to treat elderly patients with severe mental illness. Although it is usually well accepted, it should only be used under a practitioner’s supervision (Borhannejad et al., 2020). Because of its relaxing properties and appetite stimulation, mirtazapine is also used “off-label” to treat depression in older persons, which helps with insomnia and weight control (Kato et al., 2023). Lastly, a nonpharmacological method called cognitive behavioral therapy works well for treating depression by helping patients recognize and change negative thought patterns and behaviors, addressing age-related issues, and avoiding the adverse effects associated with medication (Shang et al., 2020).

Risk Assessment

A comprehensive risk assessment is crucial for administering drugs such as Sertraline (Zoloft) and Mirtazapine (Remeron) for the treatment of depression in older persons. Sertraline has advantages, including effectiveness, a favorable safety profile, and support for concomitant anxiety; nonetheless, it poses dangers such as gastrointestinal complications, hyponatremia, and potential medication interactions (Jha et al., 2022). Mirtazapine induces relaxation and stimulates hunger while presenting a reduced risk of sexual dysfunction, yet it has potential dangers of sedation, weight gain, orthostatic hypotension, and anticholinergic effects (Kato et al., 2023). CBT is a secure and practical alternative; nevertheless, it may be inaccessible and requires active patient participation (Shang et al., 2020). Clinicians must assess patient history, current medicines, and side effect profiles and include patients and families in decision-making, starting treatment with modest dosages to reduce side effects.

Clinical Practice Guidelines

Professional organizations produce clinical practice guidelines for the treatment of depression in older individuals, including evidence-based suggestions for healthcare professionals. Essential guidelines encompass those from the American Psychiatric Association, which stresses personalized treatment based on age and comorbidities; NICE, promoting a stepped-care model; and CANMAT, providing explicit recommendations for antidepressants and psychotherapy (Srifuengfung et al., 2023). Sertraline is preferred for its safety profile. However, Mirtazapine is used off-label for specific symptoms. CBT is advocated for its efficacy, especially for patients who choose non-pharmacological alternatives. These recommendations provide customized, evidence-informed treatment for elderly individuals suffering from depression.

Conclusion

Sertraline and Mirtazapine are efficacious interventions for depression in older persons. Sertraline is FDA-approved and generally well-tolerated. CBT and other nonpharmacological interventions are advantageous as well. Risk assessments are essential, and clinical guidelines stress the need for personalized, evidence-based strategies that consider patient history and preferences for optimum treatment.

References

Borhannejad, F., Shariati, B., Naderi, S., Shalbafan, M., Mortezaei, A., Sahebolzamani, E., Saeb, A., Mortazavi, S. H., Kamalzadeh, L., Aqamolaei, A., Noorbala, A. A., Namazi‐Shabestari, A., & Akhondzadeh, S. (2020). Comparison of vortioxetine and sertraline for the treatment of major depressive disorder in elderly patients: A double‐blind, randomized trial. Journal of Clinical Pharmacy and Therapeutics, 45(4), 804–811. https://doi.org/10.1111/jcpt.13177

Jha, M. K., Fatt, C. C., Minhajuddin, A., Mayes, T. L., & Trivedi, M. H. (2022). Accelerated brain aging in adults with major depressive disorder predicts poorer outcome with sertraline: findings from the EMBARC study. Biological Psychiatry Cognitive Neuroscience and Neuroimaging, 8(4), 462–470.