Discontinuing Antidepressant due to Side Effects in 59-Year-Old

The patient is a 49-year-old female. She presented unwanted side effects of increased appetite with consequent weight gain and excess daytime sedation after five months of use of Paxil and wants the medication to be discontinued. The patient experienced two tremendous stressors three years ago and suffered a major depressive episode that was not treated then. Her past psychiatric history revealed that she had experienced two depressive episodes in her teenage years and postpartum depression and anxiety after the birth of each of her three children. Five months ago, she sought treatment for the first time after experiencing fatigue and could not get out of bed. Her past medical history revealed that she has had non-insulin-dependent diabetes for 10 years and has been managing it with anti-diabetic medications. She is married and has three grown children. Review of systems negative with exception of weight gain.

The patient is alert and seems oriented to space, time, event, and place. She responds immediately and appropriately to questions asked. She has a BP of 123.81, a respiratory rate of 18 breaths per minute, and a pulse rate of 78 beats per minute. The patient is overweight, as confirmed by a BMI reading of 31. The patient is at a high risk of developing diabetes-related complications. Paxil use among people with diabetes has been associated with poor glycemic control (Sun et al., 2021). The increase in HgA1c levels by a one percentile point seen in the patient may be a result of inadequate glycemic control.

Assessment findings revealed that the patient has depression and is currently on Paxil for the management of her disease. The patient developed unwanted side effects of increased appetite and consequent weight gain, and excess daytime sedation after Paxil use. The ICD code for adverse effects of selective serotonin reuptake inhibitors is 2023 ICD-10-CM Diagnosis Code T43. 225A. Paxil is a selective serotonin reuptake inhibitor used in managing major depressive disorders and anxiety disorders. Its use has been associated with weight gain and drowsiness (Kowalska et al., 2021). These side effects are common in higher doses.

Addressing adverse reactions to medication is a priority clinical concern in the comprehensive management of depressive disorders. Lowering the dose, substituting it with other antidepressants, and discontinuing the medication involved may effectively address adverse drug events (Buelt & Mcquaid, 2023). During management, the patient’s input is required to ascertain the extent of the unwanted side effects and to develop a nexus between the presenting side effects and the medication used. In the patient case above, the side effects were apparent after the initiation of Paxil use. Additionally, subjective and objective findings did not reveal any systemic defect that may have been causing the patient’s presentations.

The likely obstacles to treating the patient above may be bordered on her health-seeking behavior and compliance with medical provisions. The patient’s history is suggestive of poor health-seeking behavior. She only sought treatment when she developed profound fatigue and could not get out of bed. Additionally, the patient was reluctant to start medications. Her unwillingness to seek healthcare and adopt care practices recommended to her may impede her treatment process.

The patient, in this case, will benefit from discontinuing the Paxil medication and replacing it with escitalopram. The patient will initially be weaned off the Paxil medication. This will involve a gradual and definite reduction in the dose every two to six weeks. The patient will then be started on low-dose escitalopram of 10mg every 24 hours. This may be titrated upwards to a maximum dose of 20mg every 24 hours.

A comprehensive history of the patient is required before initiating escitalopram. Patients with a history of cardiovascular illnesses and suicidal tendencies should be monitored closely upon initiating this medication (Buelt & Mcquaid, 2023). Referral to psychiatry may be warranted where an increase in suicidal ideation and tendencies are reported after initiating this medication. Referral to a cardiologist may also be necessary when the patient develops cardiac arrhythmia.

Compliance with medication is vital with escitalopram use. Taking medication as prescribed may enhance the effectiveness of the medication in relieving depressive symptoms. Patients should thus be advised to comply with dosing instructions and take their medications without fail. Pharmacotherapy with escitalopram can also be complemented with cognitive behavioral therapy for optimal outcomes. Adjunctive management of depression with pharmacotherapeutic and non-pharmacotherapeutic modalities is superior to either agent used alone in the management of depression (Clevenger et al., 2019). Upon initiating therapy, the patient should return to the clinic after two weeks for monitoring of apparent side effects and compliance with treatment.