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ASSESSING AND TREATING VULNERABLE POPULATIONS
FOR DEPRESSIVE DISORDERS
Mood disorders can impact every facet of a human being’s life, making the most basic
activities difficult for patients and their families. This was the case for 13-year-old
Jeanette, who was struggling at home and at school. For more than 8 years, Jeanette
suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in
judgment, and sleep issues.
As a Psychiatric Nurse Practitioner (PNP) working with pediatric patients, you must be
able to assess whether these symptoms are caused by psychological, social, or
underlying growth and development issues. You must then be able to recommend
appropriate therapies.
Assignment- develop a patient medication guide for 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
your course provided resources.
In your patient guide, include discussion on the following:
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•
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Depressive disorder causes and symptoms.
How depression is 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)
•
•
•
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What is important to monitor in terms of labs, comorbid medical issues with
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
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.
LEARNING RESOURCES
Required Readings
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Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis
and practical applications (5th Ed.) Cambridge University Press.
o Chapter 6, “Mood Disorders and the Neurotransmitter Networks
Norepinephrine and y-Aminobutyric Acid (GABA)” (pp. 244-282)
o Chapter 7, “Treatments for Mood Disorders: So-Called
“Antidepressants” and “Mood Stabilizers” (pp. 283-338)
American Psychiatric Association. (2022). Diagnostic and statistical manual of
mental disordersLinks to an external site. (5th ed., text
rev.). https://go.openathens.net/redirector/waldenu.edu?u…
Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve
Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and
Mental Health ServicesLinks to an external site., 46(9), 21–
24. https://doi.org/10.3928/02793695-20080901-06
Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve
Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing
and Mental Health ServicesLinks to an external site., 46(10), 21–
24. https://doi.org/10.3928/02793695-20081001-05
Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in
using psychotropic medication in children and adolescents. In J. M. Rey & A.
Martin (Eds.), IACAPAP e-textbook of child and adolescent mental healthLinks to
an external site.. https://iacapap.org/_Resources/Persistent/45bdffb2…
Magellan Health. (2013). Appropriate use of psychotropic drugs in children and
adolescents: A clinical monographLinks to an external
site.. http://www.magellanhealth.com/media/445492/magella…
•
•
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Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale—
RevisedLinks to an external site.. Western Psychological Services.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & AnxietyLinks
to an external site., 30(9), 787–791. https://doi.org/10.1002/da.22171
Yasuda, S. U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in
variability in response to drugs: Focus on clinical pharmacology
studies. Clinical Pharmacology & TherapeuticsLinks to an external site., 84(3),
417–423. https://web.archive.org/web/20170809004704/https:/…
MEDICATION RESOURCES
• U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugsLinks to an
external site.. https://www.accessdata.fda.gov/scripts/cder/daf/in…
Note: To access the following medications, use the Drugs@FDA resource. Type the
name of each medication in the keyword search bar. Select the hyperlink related to the
medication name you searched. Review the supplements provided and select the
package label resource file associated with the medication you searched. If a label is
not available, you may need to conduct a general search outside of this resource
provided. Be sure to review the label information for each medication as this information
will be helpful for your review in preparation for your Assignments.
Review the following medications:
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amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
•
•
•
•
•
•
•
•
•
•
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imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
REQUIRED MEDIA
• Doc Snipes. (2022, April 13). Major depressive disorders in the DSM 5 TRLinks to an
external site. [Video]. YouTube. Note: The approximate length of this media piece is 59
minutes.
•
Psych Hub. (2020, October 5). Social determinants of healthLinks to an external
site. [Video]. YouTube. Note: The approximate length of this media piece is 4 minutes.
1
Depression in Older Adults: A Medication Guide
Name
Institution
Course
Professor
Date
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Depression in Older Adults: A Medication Guide
Depression is a mood disorder affecting more people in the community today. Feeling
down or lowly is normal every once in a while is normal for everyone. However, if this feeling
persists for weeks or months accompanied by other symptoms, one may have depression. The
mood disorder can significantly affect a person’s quality of life and health outcomes hence the
need to address the symptoms and treat depressive disorder. The treatment of the disorder varies
with the people being treated due to different considerations including causes and symptoms,
response to medications, and special cases in vulnerable population. This paper is patient
medication guide for depression in older adults.
Depressive Disorder Causes and Symptoms
Depression is a treatable medical condition that may affect just about anyone although
some people are at an increased risk. People experience depression differently. However, most
people have a combination of the symptoms shown in figure 1 below.
Figure 1: Symptoms of depression
3
Many factors can cause depressive symptoms. These are referred to as risk factors.
The most common risk factors include life stressors of all sorts, genes (having a close family
member with depression), serious medical conditions such as cancer, sleep problems, loneliness
and social isolation (Avasthi & Grover, 2018). Using drugs such as alcohol can also increase risk
of depression. In older adults, especially, limitations in activities of daily living such as ability to
walk, feed, clothe, and bath increase risk of depression.
Diagnosis in Older Adults
Older adults are a vulnerable population in medical terms for several reasons. They
experience a decline in health and independence and most of them continually become
dependent on other. Most chronic conditions affect this population, they are also more likely to
have financial instability, and are more prone to abuse (Serani, 2016). They are, therefore,
vulnerable. When diagnosing depression in the population, the doctor will review present
symptoms and history. According to the American Psychiatric Association (2013), a person
should have low mood, loss of pleasure in enjoyable activities, or loss of interest. Symptoms
must have persisted for the same 2 week period and not attributed to other conditions such as
drugs, and causing significant challenge in day to day life. In addition, they must have 5 or more
of the following symptoms: sleep problems, worthlessness, inappropriate guilt, appetite changes,
concentration problems, agitation, fatigue or lack of energy, and suicidal thoughts.
Medication Treatment Options
Table 1: FDA-approved depression medications
Medication Options
1. Selective serotonin reuptake
inhibitors (SSRIs)
Sertraline, citalopram,
escitalopram
Risk/Benefit
• Fewer side
effects & well
tolerated
• Increased risk
of GI bleeding
Side Effects
Abdominal distress, nausea, weight
loss/gain, sleep disruptions, sexual
dysfunction
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2. Serotonin norepinephrine
reuptake inhibitors (SNRIs)
Venlafaxine, duloxetine,
levomilnacipran
3. Tricyclic antidepressants
Desipramine, Nortriptyline
4. Atypical antidepressants
Trazodone, nefazodone
Well tolerated but
increased risk of
hypertension
Abdominal distress, might increase blood
pressure, drowsiness
Lower tolerability
than SSRIs &
SNRIs
Risk of hepatic
failure &
arrhythmias
Sexual dysfunction, drowsiness, weight
gain, abdominal distress, anticholinergic
effects
Abdominal distress, weight gain,
drowsiness, severe hepatotoxicity,
anticholinergic effects (Robertson et al.,
2019; Baba et al., 2022; Kok & Reynolds,
2017)
Medication Considerations and Monitoring
Older adults are more likely to have certain health conditions and hence considerations
and monitoring are necessary with depressive medications. The table below lists the issues to
consider and monitor when using medications for depression among older adults.
Table 2: Medications monitoring and considerations
Issue
Considerations/Monitoring
Liver function
SSRIs, SNRIs, & tricyclic antidepressants are metabolized in the liver. Monitor for
hepatic function and clearance especially in patients with liver conditions
Kidney
function
fluoxetine, amitriptyline, and doxepin may cause kidney damage
Heart
conditions
tricyclic antidepressants have high risks for arrhythmias and sudden cardiac death, not
recommended for patients with history of cardiovascular diseases
Change in
consciousness
Some medications cause drowsiness and may cause impairment and injury in older
adults
Dementia
Efficacy of antidepressants may be limited in patients with dementia
Drug toxicity &
Averse events
With all antidepressants in older adults, patient should be closely monitored especially
in first 72 hours for any adverse effects (Serani, 2016; Kok & Reynolds, 2017)
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Special Considerations
Every vulnerable population has several issues to consider when treating them for
depression. Older adults present ethical, legal, cultural, and social determinants of health to be
considered as shown below:
Figure 2: Special considerations when treating depression in older adults
Where to Follow-Up in the Community
If an older adult has depression, they may get help and follow-up in treatment in the community
with the following resources:
•
Community health centers
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National Institute on Aging
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Crisis text line: Text HOME to 741741.
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Suicide prevention line: Call 1-800-273-TALK (8255)
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Examples of Prescriptions
Patient Name: Adan Ahmed
Patient Name: Adan Ahmed
Patient Name: Adan Ahmed
Age: 66
Age: 66
Age: 66
Date: 6/22/2023
Date: 6/22/2023
Date: 6/22/2023
Rx: Zoloft 25 mg, thirty (30)
tablets
Rx: Cipralex 5 mg, thirty
(30) tablets
Rx: Celexa 10mg, thirty (30)
tablets
Take one tablet by mouth
once daily
Take one tablet by mouth
once daily
Take one tablet by mouth once
daily
Refills: #1
No refills
No refills
Provider Name:
_______________________
Provider Name:
_______________________
Provider Name:
_______________________
Signature: ______________
Signature: ______________
Signature: ______________
Conclusion
Mental health is a crucial issue during aging and older adults should be screened and
treated for depression. Depression is not a normal process in aging and it can be caused by
numerous factors such as stress, social isolation, chronic conditions, and genetic predisposition.
Diagnosis can be done using APA guidelines and psychosocial assessment also completed. The
treatment options commonly used are SSRIs and SNRIs although tricyclic and atypical
antidepressants are also used. This medication guide outlines the key issues to consider in
depression treatment among older adults.
7
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders: DSM-5 (5th Ed.). Washington, DC: American Psychiatric Association.
Avasthi, A., & Grover, S. (2018). Clinical practice guidelines for management of depression in
elderly. Indian Journal of Psychiatry, 60(Suppl 3), S341. https://doi.org/10.4103/00195545.224474
Baba, H., Kito, S., Nukariya, K., Takeshima, M., Fujise, N., Iga, J., & Committee for Treatment
Guidelines of Mood Disorders, Japanese Society of Mood Disorders. (2022). Guidelines
for diagnosis and treatment of depression in older adults: A report from the Japanese
Society of mood disorders. Psychiatry and Clinical Neurosciences, 76(6), 222-234.
https://doi.org/10.1111/pcn.13349
Kok, R. M., & Reynolds, C. F. (2017). Management of depression in older adults: A review.
Jama, 317(20), 2114-2122. https://doi.org/10.1001/jama.2017.5706
Robertson, L., Bertolini, F., Meader, N., Davies, S. J., Barbui, C., Gilbody, S., & Churchill, R.
(2019). Antidepressants for major depression disorder in older people: A network
meta‐analysis. The Cochrane Database of Systematic Reviews, 2019(9).
https://doi.org/10.1002/14651858.CD013394
Serani, D. (2016). Depression in later life: An essential guidebook. Rowman & Littlefield
Publishers.
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