Assessing and Treating Vulnerable Populations for Depressive Disorders
Omolola Kilani-Bala
College of Nursing, Walden University
NURS 6630: Psychopharmacologic Approaches to Treatment of Psychopathology
Dr. Steve M St. Onge
March 26th, 2023
Assessing and Treating Vulnerable Populations for Depressive Disorders
Major depression is a mental disorder among most of the American population. Depression affects health, wellbeing and quality of life of the patients and their families. Psychiatric practitioners should be competent in the assessment, diagnosis, treatment, monitoring, and evaluation of depression. They should be able to select evidence-based treatments for vulnerable populations for their recovery and health. Therefore, this essay examines depression among the elderly populations. It focuses on topics such as causes and symptoms, diagnosis, medication treatment options, monitoring and special considerations.
Causes and Symptoms of Depression
Depression among the elderly is attributed to several causes. One of the causes is genetics. An elderly patient born to a family with a history of major depression is at a risk of developing the disorder because of the role of genetics. Chronic illnesses also contribute to the development of major depression. For example, the experiences with health issues such as cancer or chronic obstructive pulmonary disease predispose patients to major depression. The use of alcohol and other drugs can also cause depression. Substance use and abuse may produce side effects, which include major depression. Traumatic experiences in life also cause major depression. Patients with histories such as loss of a significant other, job, or undergoing challenges such as a divorce also increases the risk of developing major depression. Imbalances in the neurotransmitters and hormones in the brain also cause major depression. Imbalances in hormones such as acetylcholine and dopamine predispose individuals to major depression (Trenoweth, 2022). Similarly, any disruption in the levels of neurotransmitters such as serotonin and norepinephrine also cause major depression.
The elderly patients suffering from major depression experience several symptoms. One of them is feeling sad in most of the days, nearly every day. They also raise a significant decline in their interest or pleasure nearly every day. The patients also report weight gain from increased appetite or loss because of decline in appetite. They also experience slowed thought processes, fatigue, and feel worthless or guilty almost every day. The depressed mood makes it hard for them to concentrate or make decisions. In some cases, patients report recurrent suicidal thoughts, attempts, with or without a plan. A comprehensive history taking reveals that the symptoms are not because of a medical condition, medication use or substance abuse (Trenoweth, 2022). In addition, the symptoms affect the normal functioning of the patients in their environments.
Diagnosis
The diagnosis of major depression in the elderly patients require a detailed history taking and physical assessment. History taking provides subjective information about the disorder to the practitioner. The psychiatric nurse asks questions that quantify the existence and severity of a health problem. History taking provides insights into potential causes of major depression such as family history of the disease, substance abuse, a history of depression, and the patient experiencing a traumatic event. Physical examination provides subjective information about the disorder. The practitioner relies on methods such as inspection, palpation, percussion, and auscultation. There are also the use of diagnostic and laboratory investigations in physical assessment. The investigations help rule out other potential causes of major depression symptoms in this population (Alshawwa et al., 2019). Nurse practitioners use both subjective and objective assessments to develop accurate diagnoses of their clients’ problems.
The elderly are considered a vulnerable population when diagnosing and treating mental health problems. First, they are a vulnerable population because of their increased predisposition to multiple comorbidities. Besides major depression, the elderly people also have a high risk of developing chronic conditions such as hypertension, heart failure, and dementia. The elderly patients are also a vulnerable population because of their decline in productivity. Social and occupational productivity decline with aging. The elderly patients have limited involvement in most of the social and occupational roles. As a result, their access to healthcare and other social opportunities is low, making them a vulnerable population. Aging is also associated with decline in physiological functioning. Accordingly, the elderly patients have reduced functioning of the vital organs such as the liver and kidneys. The reduced functioning alters the normal processes such as drug metabolism and excretion (Saedi et al., 2019). The changes places them at a high risk of drug toxicity in disease management, hence, them being a vulnerable population.
Medication Treatment Options
Pharmacotherapy is the gold approach to depression treatment in the elderly patients. The treatment phases are three. They include acute, continuation, and maintenance phase. Prescription of drugs for this population should consider their environmental and social contexts. For example, the availability of adequate social support and socialization improves outcomes in the elderly patients suffering from major depression. Most of the elderly patients have pre-existing comorbid conditions such as diabetes and heart failure (Hoel et al., 2021). As a result, the treatment options for major depression should be considered for safety and quality outcomes.
Antidepressants are the primary drugs of choice in major depression among the elderly. Tricyclic antidepressants such as amitriptyline, desipramine, and nortriptyline are used in some patients. However, patients should be monitored for cardiac and cognition abnormalities. Selective serotonin reuptake inhibitors have a high preference rate for major depression in the elderly patients because of their safety and efficacy levels. Patients should be monitored closely for falls, insomnia, weight gain, and suicidal thoughts and attempts among patients (Li et al., 2021; Miller et al., 2020). The FDA approved antidepressants for use among the elderly patients with major depression include sertraline, citalopram, venlafaxine, mirtazapine, and bupropion.
Medication Considerations
Practitioners can consider several medications for treating major depression among the elderly patients. They include sertraline, citalopram, venlafaxine, mirtazapine, and bupropion. The other options for the disorder are venlafaxine, amitriptyline, desipramine, and nortriptyline (Li et al., 2021; Miller et al., 2020). Practitioners should always weigh the risks and benefits associated with the different classes of medications utilized for major depression.
Monitoring
Psychiatric mental health nurse practitioners should monitor patients for the side effects associated with the prescribed medications. The use of antidepressants have side effects such as dizziness, constipation, nausea, insomnia, headache, and sexual dysfunction. Patients should be informed that these side effects improve over time. It is important to monitor patients for any cognitive or cardiac abnormalities with the use of tricyclic antidepressants. The risk of falls is also high with the use of antidepressants. Fall risk assessment should be undertaken before prescribing antidepressants to mitigate the risk. Laboratory investigations for serum electrolytes should also be undertaken. Drugs such as selective serotonin reuptake inhibitors increase the risk of hyponatremia due to the development of syndrome of inappropriate antidiuretic hormone secretion. The risk of suicide with antidepressants is also elevated. Follow-up should seek to establish if the patient has developed suicidal thoughts, plans, or attempts (Krause et al., 2019; Perini et al., 2019). Weight changes should also be monitored with the use of antidepressants. Excessive weight gain may predispose the elderly to comorbidities such as diabetes, cardiovascular complications, and fractures.
Special Consideration and Follow-Up
Some special considerations influence the choice of treatment for major depression in the elderly patients. As identified initially, most of the elderly patients also suffer from comorbid conditions and decline in physiological processes. The risk of harm during the treatment is high. Psychiatric mental health nurse practitioners must ensure the use of evidence-based treatments that align with the patients’ needs. The focus should be on ensuring quality and safety of the treatment, hence, benevolence and non-maleficence. The treatment of major depression in this population may also demand care coordination. Care coordination requires sharing of information among the different healthcare providers involved in disorder management. As a result, practitioners must ensure data privacy and confidentiality. They should seek informed consent from the patients before sharing any information with the healthcare providers, hence, the protection of autonomy in the care process. Follow-up care is often after four weeks of the first and subsequent treatments (Kupfer, 2005; Pilotto et al., 2020). Patients can benefit from community resources such those by the American Psychological Association and the Centers for Disease Control and Prevention.
Example of Prescriptions
Po escitalopram 10 mg od
Po Sertraline 50 mg od
Po venlafaxine 37.5 mg bd
Conclusion
In conclusion, this paper has explored major depression among elderly populations. The elderly populations are considered vulnerable because of changes in their physiological and physical functioning. Safety should be considered when treating this population due to these changes and existence of multiple comorbidities. Antidepressants are largely used for major depression in the elderly patients. Ethical considerations should inform the selected treatments.
References
Alshawwa, I. A., Elkahlout, M., El-Mashharawi, H. Q., & Abu-Naser, S. S. (2019). An Expert System for Depression Diagnosis. http://dspace.alazhar.edu.ps/xmlui/handle/123456789/128
Hoel, R. W., Giddings Connolly, R. M., & Takahashi, P. Y. (2021). Polypharmacy Management in Older Patients. Mayo Clinic Proceedings, 96(1), 242–256. https://doi.org/10.1016/j.mayocp.2020.06.012
Krause, M., Gutsmiedl, K., Bighelli, I., Schneider-Thoma, J., Chaimani, A., & Leucht, S. (2019). Efficacy and tolerability of pharmacological and non-pharmacological interventions in older patients with major depressive disorder: A systematic review, pairwise and network meta-analysis. European Neuropsychopharmacology, 29(9), 1003–1022. https://doi.org/10.1016/j.euroneuro.2019.07.130
Kupfer, D. J. (2005). The pharmacological management of depression. Dialogues in Clinical Neuroscience, 7(3), 191–205. https://doi.org/10.31887/DCNS.2005.7.3/dkupfer
Li, Z., Ruan, M., Chen, J., & Fang, Y. (2021). Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications. Neuroscience Bulletin, 37(6), 863–880. https://doi.org/10.1007/s12264-021-00638-3
Miller, K. J., Gonçalves-Bradley, D. C., Areerob, P., Hennessy, D., Mesagno, C., & Grace, F. (2020). Comparative effectiveness of three exercise types to treat clinical depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. Ageing Research Reviews, 58, 100999. https://doi.org/10.1016/j.arr.2019.100999
Perini, G., Cotta Ramusino, M., Sinforiani, E., Bernini, S., Petrachi, R., & Costa, A. (2019). Cognitive impairment in depression: Recent advances and novel treatments. Neuropsychiatric Disease and Treatment, 15, 1249–1258. https://doi.org/10.2147/NDT.S199746
Pilotto, A., Custodero, C., Maggi, S., Polidori, M. C., Veronese, N., & Ferrucci, L. (2020). A multidimensional approach to frailty in older people. Ageing Research Reviews, 60, 101047. https://doi.org/10.1016/j.arr.2020.101047
Saedi, A. A., Feehan, J., Phu, S., & Duque, G. (2019). Current and emerging biomarkers of frailty in the elderly. Clinical Interventions in Aging, 14, 389–398. https://doi.org/10.2147/CIA.S168687
Trenoweth, S. (2022). Understanding Mental Health Practice for Adult Nursing Students. Learning Matters.
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