Depression Scenario

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Running head: DEPRESSION CASE STUDY 1

DEPRESSION CASE STUDY 3

Depression Case Study

Roseanna Melle-Green

Regis College

Depression Case Study

Medication Choice 1

1. List 1 medication that would be appropriate for this case. Include name, starting dose.

The case study involves Alison, a 38-year-old female, divorced, and a mother of two children complaining of low mood. I would recommend escitalopram (Lexapro) for the patient in the depression case study. The starting dose of escitalopram is 10 mg taken once daily but it can be titrated to 20 mg a day after about three weeks (MedlinePlus, 2016).

2. Describe your clinical decision making. What is your rationale for choosing this medication? Also, include the mechanism of action for this medication choice, and the neurotransmitters and areas of the brain in which the medication is proposed to act on.

The main reasons for selecting escitalopram are its high efficacy and tolerability. According to Sanchez, Reines, and Montgomery (2014), escitalopram is more effective and tolerable in the treatment of depression as compared to other SSRIs including sertraline and paroxetine, as well as other antidepressants. Therefore, most patients achieve remission when using escitalopram and they experience only a few and mild side effects. Escitalopram is an SSRI (selective serotonin reuptake inhibitor) hence; its mechanism of action involves binding to SERT and raising serotonin levels in the brain without affecting other neurotransmitters Li, G., (Shen, Luo, & Li, 2017). Escitalopram inhibits neurons from reabsorbing serotonin thus enabling more serotonin to transfer messages between neurons in the brain. Notably, escitalopram binds to allosteric and orthosteric binding sites to block uptake of 5-HT, increase its extracellular levels and raise the speed of auto receptor desensitization of 5-HT1A (Sanchez, Reines, & Montgomery, 2014). Therefore, escitalopram is a unique medication because it has chiral and allosteric advantages and it is an ASRI apart from being an SSRI citalopram (Sanchez, Reines, & Montgomery, 2014).

3. What laboratory testing/monitoring is needed for safely prescribing this medication?

Laboratory testing including electrocardiography, a thyroid-stimulating hormone level, a complete blood cell count, and metabolic panel tests are necessary to safely prescribe antidepressants including escitalopram (Shultz & Malone, 2013). Laboratory testing is important to ensure the patient does not have underlying medical conditions that might be causing the depression or prevent the use of escitalopram. Some of the conditions that should be checked before prescribing escitalopram are epilepsy, allergic reactions, pregnancy, heart problems, low heart rate, diabetes, and glaucoma (MedlinePlus, 2016). Close monitoring is also crucial to ensure the patient is responding appropriately to the medication and to prevent the development of severe side effects when using escitalopram (Shultz & Malone, 2013). After about 4 week, the dosage will be increased or the medication might be replaced with another agent if there is little response. For instance, the patient is suicidal and antidepressants increase suicide risk hence the need for close monitoring.

4. Are there any contraindications or safety issues associated with this medication?

The major contraindications associated with escitalopram are drug-to-drug interactions; escitalopram is an SSRI that goes through CYP450 metabolism in the liver (Shultz & Malone, 2013). Therefore, some agents might cause adverse events if prescribed together with escitalopram and P450 inhibition alters the metabolism of such agents. For example, serotonin syndrome occurs when MAOIs are prescribed together with escitalopram and Pimozide should not be used together with the medication (U.S. Food and Drug Administration, 2017). Safety issues can also arise when prescribing the medication and the patient is pregnant.

Non-pharmacologic Interventions

13. What non-pharmacologic interventions do you recommend? Do you recommend including but not limited to psychotherapy, complimentary and holistic therapies?

I would also recommend psychotherapy especially CBT conducted through individual and group counseling formats. CBT will equip Alison with skills to determine negative thoughts and replace them with healthy ones. Complimentary and holistic therapies such as acupuncture, exercises, yoga, meditation, massage, folate, Omega-3 fatty acids, as well as guided imagery and relaxation are effective for controlling depression (Nahas & Sheikh, 2011). Using the recommended non-pharmacologic interventions along with escitalopram will enhance management of depression.

References

Li, G., Shen, Y., Luo, J., & Li, H. (2017). Efficacy of escitalopram monotherapy in the treatment of major depressive disorder. A pooled analysis of 4 Chinese clinical trials. Medicine, 96 (39), p e8142. doi: 10.1097/MD.0000000000008142

MedlinePlus. (2016, February 15). Escitalopram. Retrieved from https://medlineplus.gov/druginfo/meds/a603005.html

Nahas, R., & Sheikh, O. (2011). Complementary and alternative medicine for the treatment of major depressive disorder. Canadian Family Physician Medecin de Famille Canadien, 57(6), 659–663. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114664/

Sanchez, C., Reines, E. H., & Montgomery, S. A. (2014). A comparative review of escitalopram, paroxetine, and sertraline: Are they all alike? International Clinical Psychopharmacology, 29(4), 185–196. doi:10.1097/YIC.0000000000000023

Shultz, E., & Malone, D.A. (2013). A practical approach to prescribing antidepressants. Cleveland Clinic Journal of Medicine, 80(10), 625-631. Retrieved from https://www.mdedge.com/ccjm/article/95887/drug-therapy/practical-approach-prescribing-antidepressants

U.S. Food and Drug Administration. (2017, January). Lexapro (escitalopram oxalate). Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021323s047lbl.pdf

 
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