Medication Guide for the Management of Depressive Disorders

Medication Guide for the Management of Depressive Disorders

Depression is a mental health illness characterized by a persistent feeling of low mood, sadness, and loss of interest in pleasurable activities. It is a leading cause of morbidity and mortality globally. While these disorders are prominent across populations, older adults are disproportionately affected by these illnesses (Park & Zarate, 2019). This paper details a patient medication guide for managing depressive disorders among the elderly.

Managing Depression among Older Adults

Comprehensive management of depression among the elderly utilizes pharmacological and non-pharmacological approaches. Pharmacotherapy in depressive disorders utilizes antidepressant medications. The available antidepressant medications include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), serotonin dopamine activity modulators (SDAMs), and monoamine oxidase inhibitors (MAOIs).

Patient Medication Guide to Managing Depression among Older Adults

Option#1: Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the first line in the management of depressive disorders. These medications maintain effectiveness in alleviating depressive symptoms. They are also tolerable due to their low toxicity profile and ease of dosing (Edinoff et al., 2021). Examples of SSRIs include sertraline, citalopram, escitalopram, fluoxetine, paroxetine, fluvoxamine, and vilazodone.

Pharmacological Particulars

SSRIs are a group of medications widely used as antidepressants. They Act by inhibiting the reuptake of serotonin, consequently increasing serotonin activity in the brain (Edinoff et al., 2021). These medications have a lower toxicity profile compared to TCAs and SNRIs because of their minimal histaminergic, adrenergic, and cholinergic effects. SSRIs are available in oral formulations, typically taken once daily, preferably at night.

Indications

SSRIs are FDA-approved for pediatric and adult management of depressive disorders. They can safely be used by older adults with depressive symptoms. They can also be used in the management of generalized anxiety disorders, bulimia nervosa, panic disorder, post-traumatic stress disorder, and social anxiety disorder. These medications are also used off-label in the management of binge eating disorder, premature ejaculation, fibromyalgia, Raynaud phenomenon, and autism.

Side Effects and Monitoring Considerations

Sedation, headache, xerostomia, gastrointestinal disturbances, sleep disturbances, anxiety, and weight changes are common side effects of SSRIs. Older adults taking SSRIs should be monitored for arrhythmias and QT prolongation due to the potential of these medications to worsen these conditions. Additionally, they should be monitored for weight changes to ascertain the presence of any metabolic derangements.

Option#2: Serotonin Norepinephrine Reuptake Inhibitors

These medications are also effective in the management of depressive disorders and can be used where SSRIs are contraindicated. Examples of SNRIs include venlafaxine, duloxetine, milnacipran, levomilnaciparin, and desvenlafaxine.

Pharmacological Particulars

SNRIs maintain effectiveness in alleviating depressive symptoms. They act by blocking the reuptake of serotonin and norepinephrine, increasing their activity postsynaptically (Shelton, 2018). They are available in oral formulations. Venlafaxine is available in immediate-release and extended-release formulations, with the extended-release formulation administered every 24 hours and the immediate-release formulation every 12 hours. Duloxetine, desvenlafaxine, and levomilnaciparin are administered every 24 hours, while milnaciparin every 12 hours.

Indications

SNRIs are indicated for depressive disorders. Venlafaxine and duloxetine are also FDA-approved in the management of anxiety disorders, social phobias, and panic disorders. Duloxetine can also be used in managing neuropathic pain.

Adverse Effects and Monitoring Considerations

Elevation of blood pressure, bone resorption, headache, GI disturbances, and diaphoresis are common side effects of SNRIs. Before initiating these medications, patients should be monitored for blood pressure. Subsequently, blood pressure tracking should be monitored for hypertension. Anxiety, agitation, mood alteration, and nervousness should also be monitored to ascertain the patient’s response to these medications.

Option#3: Tricyclic Antidepressants (TCAs)

TCAs are medications predominantly used in managing major depressive disorders. They are used where SSRIs are inappropriate. They include amitriptyline, nortriptyline, clomipramine, doxepin, imipramine, desipramine, amoxapine, and protriptyline.

Pharmacological Particulars

TCAs are typical antidepressants effective in alleviating depressive episodes. They act by inhibiting the reuptake of serotonin and norepinephrine in the synaptic terminal, resulting in increased serotonin and norepinephrine activity (Vos et al., 2021). They are available in oral formulations. Clomipramine is available for IV administration. They are predominantly metabolized by CYP450, primarily by CYP2C10 and CYP2D6, and can, therefore, interact with other medications metabolized by similar mechanisms.

Indications

TCAs are FDA-approved in the management of depression. They can also be used off-label in the prophylaxis of migraine, managing neuropathic pain, OCD, and insomnia.

Adverse Effects and Monitoring Considerations

Constipation, xerostomia, dizziness, headache, and GI disturbances are the common side effects of TCAs. They can also induce orthostatic hypotension, blurred vision, weight gain, QT prolongation, and ventricular fibrillation. Patients on these medications should be monitored for cardiovascular changes. Weight tracking is also necessitated due to the potential for weight gain. Due to their narrow therapeutic index, close monitoring for toxicity manifestations such as muscle rigidity, coma, and tremors is necessary.

Other Medications

Other medications effective in the management of depressive disorders include MAOIs such as selegiline, serotonin modulators such as aripiprazole, and atypical antidepressants such as bupropion. These medications are all effective in alleviating depressive episodes.

These medications are available in oral formulations and are typically administered every 24 hours. Serotonin modulators prevent the reuptake of serotonin, MAOIs prevent the metabolism of serotonin, norepinephrine, and dopamine, thus increasing their activity, while bupropion, an atypical agent, prevents the reuptake of serotonin and norepinephrine. Buproprione has the potential to cause seizures, serotonin modulators, particularly trazodone, can cause sedation and priapism, while selegiline can cause serotonin syndrome. When taking these medications, it is important to monitor for these side effects as well as the depressive symptoms to ascertain response to therapy.

Antidepressant medications maintain effectiveness in the management of depressive disorders. The choice of an antidepressant is often dependent on symptom severity and pattern, as well as patient factors such as age. Notwithstanding, SSRIs are the first line in the management of depression among older patients. These medications are highly tolerable due to their ease of use and low toxicity profile. Additionally, they are highly effective, with a success rate of over 60%  (Edinoff et al., 2021). The once-dosing regime for SSRIs is particularly beneficial to older patients who may have been under other medications to manage underlying conditions. SNRIs can be considered where the response to SSRIs is suboptimal or where contraindications are apparent. These medications are equally efficacious and have safety profiles comparable to those of SSRIs. The side effects of hypertension and panic attacks that may occur upon using these medications dispute their application as first-line medications. Other medications such as TCAs, serotonin modulators, and atypical agents can always be considered whenever SSRIs fail due to their comparable efficacy in alleviating depressive episodes.

References

Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., Viswanath, O., Urits, I., Boyer, A. G., Cornett, E. M., & Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: A narrative review. Neurology International, 13(3), 387–401. https://doi.org/10.3390/neurolint13030038

Park, L. T., & Zarate, C. A. (2019). Depression in the primary care setting. New England Journal of Medicine, 380(6), 559–568. https://doi.org/10.1056/nejmcp1712493

Shelton, R. C. (2018). Serotonin and norepinephrine reuptake inhibitors. Antidepressants, 145–180. https://doi.org/10.1007/164_2018_164

Vos, C. F., Aarnoutse, R. E., Op de Coul, M. J., Spijker, J., Groothedde-Kuyvenhoven, M. M., Mihaescu, R., Wessels-Basten, S. J., Rovers, J. J., ter Hark, S. E., Schene, A. H., Hulscher, M. E., & Janzing, J. G. (2021). Tricyclic antidepressants for major depressive disorder: A comprehensive evaluation of current practice in the Netherlands. BMC Psychiatry, 21(1). https://doi.org/10.1186/s12888-021-03490-x

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

Assignment-

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.

It is important that you describe the pharmacology of the medications that you choose. It is vital that a practitioner understand the pharmacology, indications, side effects and monitoring considerations for all medications in order to make an informed decision on the most appropriate therapy.