Depressive Disorder Discussion Paper

This week, you will become “captain of the ship” as you take full responsibility for a client with a depressive disorder. You will recommend psychopharmacologic treatment and psychotherapy, identify medical management needs and community support, and recommend follow-up plans. You will also explore how to obtain a DEA license and the responsibilities for safe prescribing and prescription monitoring.
Students will:
.Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with depression disorders
.Recommend psychotherapy based on therapeutic endpoints for clients with depression disorders
.Identify medical management needs for clients with depression disorders
.Identify community support resources for clients with depression disorders
.Recommend follow-up plans for clients with depression disorders
To prepare for this Assignment:
Select an adult or older adult client with a depressive disorder you have seen in your practicum. Depressive Disorder Discussion Paper
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QUESTION:
In 3–4 pages, write a treatment plan for your client in which you do the following:
.Describe the HPI and clinical impression for the client.
.Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your .psychopharmacologic agent. (This should relate to HPI and clinical impression.)
.Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
.Identify medical management needs, including primary care needs, specific to this client.
.Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
.Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
Introduction

Depressive disorder refers to a syndrome typified by sad and irritable mood. Sadness in depression normally lasts for a long period with high intensity which impairs normal functioning. Symptoms of depressive disorder consist of: negative thoughts and negative moods, impaired behaviors, low energy, eating problems, sleep disturbances, among other symptoms (Iqbal & Awan, 2016). This paper presents a client with major depressive disorder. The HPI for the client will be discussed and the psychopharmacologic treatments and psychotherapy choices recommended. The patient’s medical management needs and the community support resources will be identified. Finally, a follow-up plan will be recommended and how a DEA license can be obtained.

Client Presentation

The client was 36 year old woman who presented with depressive symptoms. She reported of having frequent crying spells, insomnia, binge eating, over-thinking, and spent most of the time worrying about her family for the last 3 years. During the first assessment she said that she was always felt down and empty. The client denied suicidal ideations. However, she acknowledged that her symptoms had affected her life in various ways. For example, she felt that her relationship with her husband and children had been affected. In addition, had withdrawn from her friends and stopped attending social events such as family gatherings. Finally, the client reported that there are various days she did not report for work because of feeling down and lack of energy and that she had received a warning letter due to work absenteeism. Depressive Disorder Discussion Paper

HPI & Client’s Clinical Impression

The client reported that she developed post-partum depression 12 months ago after giving birth to her fourth child. She said that on discovering her pregnancy, she became depressed because she did not want another child and her depression worsened after giving birth. Throughout her pregnancy she would feel sad, fatigued, and crying often without any reason. She would also have difficulties in falling asleep and felt total lack of control in her life. She confirmed that these feelings persisted even after giving birth. During pregnancy her prescription was Paxil 20 mgs which she took for five months but discontinued because she did not feel any improvement. She did not report any other depression event in her lifetime.

The client manifests symptoms of major depression such as fatigue, eating problems, sleep disturbances, frequent crying, anxiety and sadness, social withdrawal and impaired relationships.

Psychopharmacologic Treatments

Mirtazapine: This is a multifunctional antidepressant medication as it improves both the release of norepinephrine and serotonin in order to affect the anti-depression effect. Evidence shows that mirtazapine effective and good tolerability in treating patients with major depression (Stahl et al, 2015). This medication is also effective in improving anxiety and sleep disturbance in patients with depression comorbid anxiety and sleep disturbances as evident in the patient (Stahl et al, 2015). The recommended daily dose range for the client is 15 to 30 mg.

Bupropion: This medication has shown efficacy in treating major depressive disorder (Patel et al, 2016). The medication works by improving monoaminergic neurotransmission. Additionally, this medication had few side effects and does not produce weight gain nor interfere with sexual functioning (Patel et al, 2016). The recommended dose for the client is 100 mg BID.

Psychotherapy Choices

Cognitive behavior therapy (CBT): Evidence shows the efficacy of CBT in treating depression symptoms in patients with major depression. CBT offers long-term benefits because patients learn skills that they continue practicing even after stopping treatment (Renn & Arean, 2017). Depressive Disorder Discussion Paper

Problem-solving therapy (PST): In PST, patients are taught about how to address problems and at the same time maximize their well-being through effective problem solving. PST decreases depression psychopathology and improves quality of life by improving competency in problem-solving that ensures effective coping (Renn & Arean, 2017). Accordingly, PST will improve the client’s problem solving and at the same time help her to cope with many life events. Medical Management Needs

The patient needs to start her medications at a sub-therapeutic dose in order to evaluate antidepressants’ tolerability and then increase the dose gradually to a point of achieving minimally effective dose (Mark et al, 2017). In addition, it is necessary to manage the client’s stressors in order to eradicate stress triggers, engage social support, address any stigma concerns, as well as manage any concomitant comorbidity for the client (Mark et al, 2017). Moreover, it is important to maintain a good therapeutic relationship with the client and be an active and empathic listener throughout treatment period.

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Community Support Resources

The nearest support group for people with depression will be identified and the patient will be referred to the support group. This will enable the patient to interact and engage with individuals having depression as well and hence she will get moral and peer support. Additionally, a social worker will be assigned to the client in order to ensure the client adheres to the treatment regimen. Moreover, the client will be referred to online support materials such as websites and journal articles addressing management of depression.

Follow-up Plan

The patient will be going for review after every 2 weeks. A social worker will be assigned to the patient in order to provide any necessary support and at the same time monitor the client’s adherence to medication and help in developing coping strategies for the client. On the same breadth, an outreach worker will also facilitate the follow-up plan and ensure that the client is adhering to the treatment regimen. The client’s husband will also be educated to always support the client, to avoid any stress triggers, and remind her to always take her medication (Torres-González et al, 2014).

Obtaining DEA License

When it comes to administration, prescription and dispensation of the controlled substances, a healthcare provider is supposed to register with DEA. DEA license can be obtained online through www.deadiversion.usdoj.gov. The registration number should be noted. During the application, the healthcare provider should meet the licensing prerequisites (Gadbois et al, 2015).

Conclusion

The paper presents a client with major depressive disorder with symptoms such as frequent crying spells, insomnia, binge eating, over-thinking, social withdrawal and impaired relationships etc. The recommended psychopharmacologic treatments include mirtazapine and bupropion, because the efficacy of these medications has been shown. The suggested psychotherapy choices include CBT and PST. The medical management needs for the client are eradicating stressors, offering support to the client, medication adherence, as well as examining the patient tolerability to the medications. Community support resources include support groups, social worker, and online resources. Finally, a follow up plan has been discussed as well as the process of obtaining a DEA license. Depressive Disorder Discussion Paper

References

Gadbois E, Miller E, Tyler D & Intrator O. (2015). Trends in State Regulation of Nurse Practitioners and Physician Assistants, 2001 to 2010. Med Care Res Rev. 72(2), 200–219.

Iqbal M & Awan N. (2016) Case Study of Major Depression. J Med Diagn Meth. 5(214).

Mark C, Choon H & Ping Y. (2017). Managing depression in primary care. Singapore Med J. 58(8): 459–466.

Patel K, Allen S, Hague M, Ilinca A, David B & Tracy D. (2016). Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Ther Adv Psychopharmacology. 6(2), 99–144.

Renn B & Arean P. (2017). Psychosocial Treatment Options for Major Depressive Disorder in Older Adults. Curr Treat Options Psychiatry. 4(1): 1–12.

Stahl M, Culpepper L & Muskin P. (2015). Major Depressive Disorder: Understanding the Significance of Residual Symptoms and Balancing Efficacy with Tolerability. The American Journal of Medicine. (2015) 128, S1-S15.

Torres-González F, Ibanez-Casas I, Saldiva S, Ballester D, Grandon P, Xavier M & Manuel G. (2014). Unmet needs in the management of schizophrenia. Neuropsychiatr Dis Treat. 1(10), pp: 97–110.

Van Krugten FCW, Kaddouri M, Goorden M, van Balkom AJLM, Bockting CLH, Peeters FPML, et al. (2017) Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review. PLoS ONE. 12(2): e0171659.

Depressive Disorder Discussion Paper

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