nursing project and need support to help me learn.
You should respond to at two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
1 reference per reply
Requirements: 300 words
Reply to Silvia week 2
St. Thomas University
Dr. Linda Mays
May 23, 2023
Clinical Case Summary and DSM-5TR Diagnosis
In this case study, a 41-year-old man presents to his primary care physician complaining of depressive symptoms. The patient felt hopeless, depressed, and helpless; had trouble sleeping; cried for no apparent reason; drank more alcohol than usual; and considered suicide. He also stopped going to work, which indicates severe deficits in both social and occupational functioning. Major Depressive Disorder (MDD) with the specifier “severe with psychotic features” due to the patient’s suicidal ideation would be the DSM-5TR diagnosis based on the available data.
Antidepressants are the standard method of treatment for MDD. Since they cause fewer side effects than traditional antidepressants, selective serotonin reuptake inhibitors (SSRIs) are widely used. If I were treating this patient, I would likely recommend an SSRI like sertraline (Belmaker & Agam, 2008). Sertraline is usually started at 50 mg once daily and raised to 200 mg daily if necessary. Take this drug exactly as prescribed, usually first thing in the morning, with or without a meal.
Sertraline has shown efficacy in treating depression and is generally well-tolerated. Thus, it makes sense to use it. Positive effects on mood, hopelessness, and suicidal thoughts have been shown with sertraline treatment (Otte et al., 2006). Sertraline’s modest sedative qualities may also help the patient, who has reported having trouble sleeping. However, keeping a close eye on the patient for signs of side effects such as nausea, vomiting, and dizziness is crucial.
Patients with MDD should also be offered non-pharmacological therapy (Otte et al., 2006) and pharmaceutical options. Antidepressant effects, better sleep, and less anxiety are just a few benefits of exercise. I would advise the patient to start a regular fitness program. The American Heart Association recommends at least 30 minutes of moderate exercise daily.
Due to its low cost, minimal risk, and proven effectiveness in alleviating depressive symptoms, exercise is a good fit for this patient. It has been shown that exercise can enhance the effects of medicine. Therefore, it may be useful in addressing the patient’s increased alcohol usage (McHugh & Weiss, 2019). The patient has reported a lack of drive and energy, which may make it difficult to stick to an exercise routine. However, creating momentum and boosting adherence over time may be possible by setting small, manageable goals at the outset. Physical activity is a low-cost intervention since it does not require expensive machinery or dedicated space. However, if the patient still needs to get them, they may need to purchase suitable apparel and footwear.
A 30-day supply of sertraline 50 mg pills costs between $10 and $20 at my drugstore, though this varies by pharmacy and region (Otte et al., 2006). As a result, it is in the patient’s best interest for the prescription to be filled at the cheapest pharmacy possible. Further savings could be had by looking into drugstore discount programs or manufacturer coupons.
Conclusively, as this case study has shown, the patient exhibits MDD symptoms and necessitates a multifaceted approach to therapy that incorporates both pharmaceutical and non-pharmaceutical methods. Major Depressive Disorder with Severe Features is the DSM-5TR diagnosis. Sertraline, at a starting dose of 50 mg once daily, is the suggested pharmaceutical treatment, while exercise is the preferred nonpharmaceutical treatment. The most cost-effective medicine option should be chosen, and the patient’s side effects and response to therapy should be continuously evaluated. The ultimate objective is to raise the patient’s mood, decrease suicidal thoughts, and enhance their capacity to live independently.
Belmaker, R. H., & Agam, G. (2008). Major depressive disorder. New England Journal of Medicine, 358(1), 55-68.
McHugh, R. K., & Weiss, R. D. (2019). Alcohol use disorder and depressive disorders. Alcohol research: current reviews, 40(1).
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., … & Schatzberg, A. F. (2016). Major depressive disorder. Nature reviews Disease primers, 2(1), 1-20
Reply to Carlos De Leon
Summary of the Clinical Case
The individual, aged 41 years, is currently exhibiting indications of despair, melancholy, powerlessness, and sleeplessness. These symptoms have been present for approximately six weeks and have significantly impacted his daily activities. The individual in question has exhibited an escalation in alcohol intake and has been noticeably absent from his place of work. The patient additionally reveals experiencing suicidal ideation, specifically ramming his vehicle into a canal nearby.
Major Depressive Disorder (MDD) with melancholic symptoms is the most appropriate DSM-5-TR diagnosis based on the given summary. Persistent depressive symptoms, including insomnia, sadness, helplessness and hopelessness, in addition to major impairments in interpersonal and occupational domains, are diagnostic criteria for Major Depressive Disorder (MDD) (Bains & Abdijadid, 2022).
Selective serotonin reuptake inhibitors (SSRIs) like Sertraline are recommended as an effective pharmacological strategy for Major Depressive Disorder (MDD) according to the current clinical recommendations. The typical starting dose of Sertraline for treating depression is 50 mg taken once day (Singh & Saadabadi, 2023). Depending on how well the drug works and how well the patient embraces it, the daily dose can be increased to a maximum of 200 milligrams (Singh & Saadabadi, 2023). In the treatment of depression, sertraline is often considered first-line. Major depressive disorder (MDD) patients have shown significant improvement in their mental state, decreased suicide ideation, and regained ability to engage in everyday activities after receiving this specific intervention.
In addition to administering Sertraline, this case may utilize exercise therapy as a non-pharmacological alternative for treatment in this specific case. Indeed, consistent physical activity has demonstrated favorable outcomes on psychological well-being, such as alleviating indications of depression (Gerber et al, 2016). Studies have shown that exercise therapy provides various advantages. For instance, it offers a comprehensive and organic methodology for addressing symptoms of depression. Additionally, consistent participation in physical activity has beneficial effects on sleep regulation, self-esteem enhancement, and social interaction promotion, all of which have the potential to influence an individual’s mood positively (Gerber et al, 2016). Furthermore, establishing and attaining exercise objectives can augment self-efficacy and cultivate a feeling of fulfillment, thereby mitigating the emotions of despair and powerlessness frequently linked with depression. Through prioritizing engagement in physical activity, individuals can redirect their focus from depressive symptoms, resulting in a decrease in distress and enhancement of their general state of well-being.
Assessment of Treatment Appropriateness, Cost, Effectiveness, Safety, and Adherence
As seen in the analysis of this case’s pharmacological and non-pharmacological options, the treatment plan involving sertraline and exercise therapy offers an appropriate and complementary approach to managing Major Depressive Disorder. The next point of assessment consists of evaluating the cost of this treatment option which must involve the consultation of local pharmacies for sertraline pricing because exercise therapy generally incurs no additional cost. Additionally, since Sertraline reduces depressive symptoms and exercise therapy improves mood and overall well-being, combining the two options can be deemed effective. Also worth noting in this assessment is that Sertraline is generally safe with potential side effects, while exercise therapy is safe with proper guidance. Finally, it is worth noting that clear instructions and support enhance adherence to both sertraline and exercise therapy. Overall, the combination of Sertraline and exercise therapy is a remarkable intervention in treating Major Depressive Disorder, as highlighted in the case above.
Bains, N., & Abdijadid, S. (2022). Major Depressive Disorder. PubMed; StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK559078/
Singh, H. K., & Saadabadi, A. (2020). Sertraline. PubMed; StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547689/
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