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Reply to each post with 1 well-developed paragraph including references Post question: Linda is a 49-year-old female with a history of depression. She reports that she is suffering from fatigue, tearfulness, and difficulty sleeping. She has been taking fluoxetine 20mg for the past six months. What changes, if any, would you make to her plan of care and why?Post#1- JARRODFirst thing that I would do is gather more information. When did the symptoms of fatigue, tearfulness, and difficulty sleeping start? Are there any recent changes in her life such as life stressors or change in sleeping pattern due to something like a new job? I would assess to see if the medication is effective with treating her depression but, perhaps she is not tolerating the medication due to its side effects. I would also explore the possibility that the lack of sleep may be contributing to her fatigue and tearfulness. I would make sure that she is taking the medication in the morning to help reduce the side effect of insomnia and fatigue. I would also see how long she has been on fluoxetine and when was her last medications dose adjustment. Some common side effects of fluoxetine are insomnia along with sedation (Stahl, 2020). If she was started on fluoxetine 20 mg there is an option to reduce the dose to 10 mg to see if the medication is better tolerated and while still being effective at treating her depression. If the medication is not effective at 10 mg increase the dose back to 20 mg or more since the maximum dose is 80 mg a day there is room for increase (Stahl, 2020). If there is no improvement in a few weeks, consider switching or adding other drugs such as trazodone to help with her sleep as well with her depression. If the medication has not been effective for the last six months, consider that she may be a non-responder or treatment-resistant to fluoxetine and may require another medication along with fluoxetine (Stahl, 2020). Fluoxetine has been specifically studied in combination with olanzapine in a olanzapine/fluoxetine combination medication with promising results for treatment-resistant unipolar depression, and psychotic depression (Stahl, 2020).Post#2- Linda There are multiple factors to consider fo Linda, including her history of depression, current prescribed medication, complaints of insomnia, fatigue, and tearfulness. Fluoxetine is an antidepressant know as a selective serotonin reuptake inhibitor or SSRI. Fluoxetine is used to treat major depressive disorder, obsessive-compulsive disorder, panic disorder, bulimia, binge eating disorder, premenstrual dysphoric disorder, and bipolar depression (Sohel, 2022). SSRI popularity is due in part to their relatively few side effects and this characteristic leads to fewer complaints from patients. Fluoxetine exerts its effects by blocking the re-uptake of serotonin into presynaptic serotonin neurons by blocking the re-uptake transporter protein located in the presynaptic terminal (Sohel, 2022). Fluoxetine advantages include a long half-life, which is good for poor compliance and low risk of withdrawn syndrome. Disadvantages include a slower onset of action, higher risk for drug interactions, and more likely to cause insomnia than other SSRIs. For Linda I would increase her fluoxetine to 40 mg po daily as this is considered the normal therapeutic daily dose (Phelps, 2015). To address Linda’s insomnia I would begin with Trazodone 25 mg po at HS. Trazodone is an antidepressant medication that is FDA approved to treat depression, but it’s more often used off-label to insomnia (McAdoo, 2023). When taken 30 minutes before bedtime, a low-dose, between 25 mg and 100 mg can be effective for sleep problems. It has been shown to increase the quality and duration of sleep, and to improve daytime functioning, such as the tearfulness Linda is experiencing. Trazodone is considered an effective non-addictive alternative to benzodiazepines for patients with refractory co-morbid anxiety symptoms (Gibbs, 2016). Daytime sedation can be a concern, so dosing with be at hours of sleep (HS). Fatigue will likely improve with the addition of a sleep aid like trazodone. Linda, with the help of her healthcare provider should develop and keep a fatigue activity diary, as this provides a crucial information gathering tool. This is used for activity monitoring, symptom monitoring, and correlating activity with symptoms during therapy (Beck, 2024). Patients record their activity in one hour increments throughout the day and record their associated level of fatigue for each time period. Activities should be scheduled in advance and patients should record whether the scheduled activities were completed, as well as their associated level of fatigue.
