Assessing And Treating Vulnerable Populations For Depressive Disorders

Assessing And Treating Vulnerable Populations For Depressive Disorders

The ballooning prevalence of mental health illnesses across the globe remains a point of concern for healthcare systems worldwide. The resolve to address these illnesses has gained considerable attention in many countries. Their impact on community health has created a discourse among healthcare professionals, health groups, and governments on the need to manage these disorders comprehensively. Notwithstanding, managing mental health illnesses remains a challenge. This is attributable to their poor understanding of these illnesses in some communities, their invisible nature, and differences in societal perceptions of their presentations. This paper details a patient management guide for treating a depressive disorder.

Depressive Disorder Causes and Symptoms

Depressive disorder is one of the most common mental health illnesses. It is a life-threatening mental health illness affecting children and adults. Pasman et al. (2023) report that the global prevalence of depression stands at 12%. Previously perceived as a disorder of the older population, recent surveys have revealed the increasing incidence of the disease in younger populations (Pasman et al., 2023). This has been correlated with the high alcohol abuse among members of this group (Beirão et al., 2020). This highlights the need to address this disorder.

Depression is a chronic mental health illness. It is characterized by persistently low mood, lowered interest in activities, feelings of worthlessness and guilt, lack of concentration, poor appetite, suicidal ideations and tendencies, and sleep disturbances. These manifestations may last a few hours of the day, most of the days, days, and even a few weeks.

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Depression has a multi-factorial cause. A combination of genetics, biological, psychosocial, and environmental factors interplay to cause this disorder. The pathogenic components of the disease revealed neurological abnormalities consistent with the disease. De Menezes Galvão et al. (2021) note that GABA, glutamate, and glycine play a role in the development of the disease. Persons with depression are likely to have lower GABA levels. Genetic imprints of the disorders are also evident. The propensity to develop depression is up to twice as high in persons whose close relatives have depression. These factors, along with other psychosocial factors such as drug and substance abuse, marital status, culture, and educational levels, may interplay in the development of depressive disorders. Several environmental factors contribute to the development of depression. Death of a loved one, childhood violence and bullying, poor access to sunlight, maternal depression during pregnancy, and natural disasters all have a bearing on the development of depressive disorders.

How Depression is Diagnosed for the Vulnerable Population

Teen depression is a major health concern today. It affects adolescents’ behaviour, feelings, or thinking processes and may also cause physical, functional, and emotional problems. A combination of the client’s history, subjective and objective assessments, and symptomatic manifestations are required to make a definitive diagnosis of depression. The Diagnostic and Statistical Manual (DSM) is a valuable guide in the diagnosis of depressive disorders. As per DSM-V, a positive diagnosis of depression is made in the presence of a depressed mood, resulting in social impairment and any other of the four symptoms outlined above, along with supportive assessment findings (Karrouri et al., 2021). The client’s psychiatric, medical, and medication histories should thus be taken to exclude manic or hypomanic manifestations.

Adolescence is a unique developmental phase with specific particularities that predispose individuals in this group to depression and other mental health illnesses. Physical, social, and emotional alterations that characterize adolescents also make them vulnerable to depressive disorders. Beirão et al. (2020) note that changes in the teenage phase, such as exposure to violence, abuse, or poverty, may also predispose them to mental health problems such as depression. Personality traits such as being overcritical about self and low self-esteem, in the presence of other predisposing factors, may also make teenagers vulnerable to depression. Therefore, understanding these factors gives insight into how to manage and prevent morbidity attributable to depression in members of this group.

Medication Treatment Options

Depression pharmacotherapy maintains effectiveness in alleviating depressive symptoms and improving the quality of life of the affected individuals. The FDA-approved antidepressant medications can be categorized into selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), atypical antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs) serotonin modulators, and monoamine oxidase inhibitors (MAOIs) (Karrouri et al., 2021). Other medication classes with antidepressant effects include antipsychotic medications and mood stabilizers. However, the choice of which medication to use is often arrived at after a risk versus benefit analysis.

SSRIs maintain the first line in depression pharmacotherapy. These medications are effective in managing depressive symptoms and are well tolerated in adolescents and other population groups. Despite their effectiveness and high tolerability profile, their use isn’t without risks. The common side effects of SSRIs include agitation, restlessness, and dizziness. Examples of medications under this class include fluoxetine, sertraline, fluvoxamine, citalopram, and escitalopram.

TCAs also maintain effectiveness in managing depressive symptoms. Their use has, however, been associated with weight gain. Weight gain may not be favourable in adolescence, where other self-image problems and low self-esteem are common. Additionally, TCAs have been associated with cardiovascular problems, blurry vision, and dry mouth. Examples of TCAs include imipramine, amitriptyline, doxepin, and nortriptyline. Atypical antidepressants include bupropion and mirtazapine. These medications are effective in managing teenage depression. They have, however, been associated with dizziness and dryness of the mouth. SNRIs such as venlafaxine, milnacipran, and duloxetine also present the side effects of dizziness and dryness.

Medication Considerations

Despite their effectiveness in managing depressive symptoms, several considerations have to be made when using antidepressants. These medications can react unpredictably with other medications, including over-the-counter medications, resulting in deleterious effects. Most antidepressant medications cause dizziness, blurred vision, and drowsiness. Therefore, people who take these medications should refrain from using heavy machinery and driving. Concomitant use of antidepressants or other medications may also result in profound side effects. Concurrent use of SSRIs and linezolid, MAOIs, and other agents that cause serotonin levels to rise is contraindicated because of the potential for a life-threatening serotonin syndrome.

Why is it Important to Monitor Labs

Antidepressant medications have a narrow therapeutic index. This warrants their monitoring upon administration and use. Several lab works may be necessitated in this regard. Electrocardiographic monitoring is necessary with TCAs due to their potential to cause cardiovascular complications. Drug-specific level monitoring may also be necessary when taking antidepressants to ascertain the likelihood of toxicity. Drug level monitoring may particularly be useful when more than one medication is involved. Antidepressants should also be taken cautiously in the presence of comorbidity. SSRIs should also be taken with precautions in patients with bipolar disorder as they may exacerbate the manic phase of the disorder with resultant compounded manifestations.

Special Considerations

Legal considerations in antidepressant use often border states or federal malpractice claims. Breaches in the informed consent provisions and civil negligence resulting in compromises in the standard of practice are legal considerations of concern to caregivers. Due to their potential to cause harm to their users, criminal liabilities of intoxication may be invoked in case caregivers do not take keen consideration of the dosing instructions, interactions, and side effects profiles of these medications (Giorgi-Guarnieri, 2019). This liability may stretch to behaviours influenced by these medications, such as violence with SSRI use. Thus, caregivers must maintain knowledge of the properties of these medications.

Ethical concerns when taking antidepressants border the provisions of beneficence and non-maleficence. Caregivers must protect the welfare of their clients and prevent harm from befalling them. In this regard, they should play their role in disclosing the potentially harmful effects of these medications. Additionally, prescribers should maintain rationality when prescribing these medications to prevent any unwanted effects on the clients.

Cultural consideration in antidepressant pharmacotherapy borders often borders medication adherence and compliance with therapeutic regimens. In mental health illnesses management, it is imperative to acknowledge societal differences in interpreting and recognizing these illnesses. This will guide the choice of therapeutic interventions to start with the patients. Medication adherence may be low in communities that widely disregard mental health illnesses as a disease. Maintaining cultural humility may guide caregivers towards noticing such differences and working with clients to manage their disease.

Conclusively, depression remains a global health concern. This disorder has a multi-factorial aetiology and has significant health effects. Understanding its presentations and the available management options is thus key. Pharmacotherapy with antidepressant medications maintains effectiveness in managing depressive symptoms. Their use has, however, been associated with several unwanted effects. Educating clients on these effects and the likely benefits is crucial when selecting the medication of choice.

 References

Beirão, D., Monte, H., Amaral, M., Longras, A., Matos, C., & Villas-Boas, F. (2020). Depression in Adolescence: A Review. Middle East Current Psychiatry, 27(1). https://doi.org/10.1186/s43045-020-00050-z

de Menezes Galvão, A. C., Almeida, R. N., de Sousa, G. M., Leocadio-Miguel, M. A., Palhano-Fontes, F., de Araujo, D. B., Lobão-Soares, B., Maia-de-Oliveira, J. P., Nunes, E. A., Hallak, J. E., Schuch, F. B., Sarris, J., & Galvão-Coelho, N. L. (2021). Pathophysiology of major depression by clinical stages. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.641779

Giorgi-Guarnieri, D. (2019). Clinician liability in prescribing antidepressants. FOCUS, 17(4), 372–379. https://doi.org/10.1176/appi.focus.20190024

Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges. World Journal of Clinical Cases, 9(31), 9350–9367. https://doi.org/10.12998/wjcc.v9.i31.9350

Pasman, J. A., Meijsen, J. J., Haram, M., Kowalec, K., Harder, A., Xiong, Y., Nguyen, T.-D., Jangmo, A., Shorter, J. R., Bergstedt, J., Das, U., Zetterberg, R., Tate, A., Lichtenstein, P., Larsson, H., Odsbu, I., Werge, T., Reichborn-Kjennerud, T., Andreassen, O. A., … Lu, Y. (2023). Epidemiological overview of major depressive disorder in Scandinavia using nationwide registers. The Lancet Regional Health – Europe, 29, 100621. https://doi.org/10.1016/

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For this assignment, you will develop a patient medication guide for the treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of the resources provided by your course.

Assessing And Treating Vulnerable Populations For Depressive Disorders

In your patient guide, include a discussion on the following:

Depressive disorder causes and symptoms

How is depression diagnosed for the vulnerable population of your choice, why is this population considered vulnerable?

Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice

Medication considerations of medication examples prescribed (see last bullet item)

What is important to monitor in terms of labs, comorbid medical issues and why important for monitoring

Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond the basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health

Where to follow up in your local community for further information

Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.