Walden University
NURS 6630N
Adult and Geriatric Clients with Mood Disorders
Introduction
Mood disorders significantly impact the quality of life for adult and geriatric patients. Individuals with these conditions often experience a decreased interest in daily activities, leading to social withdrawal and reduced peer interactions. Elderly patients, in particular, may suffer from poor appetite, disrupted sleep patterns, frequent panic attacks, and difficulty concentrating (Gordon & Melvin, 2015). Recent studies have highlighted the complex interplay between mood disorders and cognitive function in older adults, emphasizing the need for tailored treatment approaches (Srifuengfung et al., 2023). Zoloft (sertraline) stands out as an effective and widely prescribed medication for treating mood disorders, having received FDA approval for improving patients’ quality of life. In the case study under discussion, an elderly patient was initially prescribed Zoloft 25mg orally daily. When this dosage proved insufficient, it was increased to 50mg orally daily, resulting in enhanced therapeutic efficacy. By the conclusion of the treatment period, the patient exhibited significant improvements in their overall quality of life. Zoloft has demonstrated effectiveness in treating mood disorders across various age groups, including pediatric and elderly patients. The medication’s ability to modulate serotonin levels in the brain plays a crucial role in alleviating depressive symptoms and improving overall mood regulation.
Decision #1
The case study focuses on an elderly Hispanic patient diagnosed with Major Depressive Disorder, necessitating the introduction of either Zoloft or Effexor. The initial decision was to prescribe Zoloft 25mg orally daily. Zoloft is recognized as an effective medication for treating depression in both elderly and adult patients, specifically targeting symptoms associated with Major Depressive Disorder. Recent research has underscored the importance of careful dosing in geriatric populations, considering factors such as altered drug metabolism and increased sensitivity to side effects (Singh et al., 2023). While Effexor was considered as an alternative option for treating depressive disorders, concurrent use of both medications was ruled out due to the potential for severe side effects, including confusion, seizures, hallucinations, and hypertension (Stahl, 2013). The selection of Zoloft over Effexor was further supported by its widespread use and FDA approval for depression treatment. Additionally, Zoloft’s initial low dosage aligns with FDA guidelines aimed at minimizing adverse effects, particularly the risk of suicidal ideation (Gordon & Melvin, 2015). The patient’s advanced age was a crucial factor in the decision-making process, as higher drug doses can significantly impact drug metabolism, distribution, absorption, and excretion in older individuals.
The primary objective in prescribing Zoloft was to alleviate depression symptoms. Expected outcomes included enhanced social interaction, reduced withdrawal symptoms, and improved appetite. Depression often leads to diminished appetite, potentially resulting in malnutrition (Crocco et al., 2017). During these challenging periods, patients require adequate nutrition to cope with depression-related conditions. Zoloft’s mechanism of action involves increasing serotonin levels in the brain, which plays a vital role in regulating sleep, mood, and memory (Crocco et al., 2017). Therefore, the prescription aimed to improve sleeping patterns, enhance memory function, and stabilize mood. Recent studies have also indicated that sertraline may have positive effects on cognitive function in older adults with depression, highlighting its potential benefits beyond mood regulation (Srifuengfung et al., 2023).
Upon the patient’s return to the clinic after two weeks, it became apparent that the expected outcomes had not been achieved, despite adherence to the medication regimen. The patient showed no significant improvements in appetite, sleep patterns, or social interactions. This discrepancy between expected and actual outcomes can be attributed to the initial dosage (Crocco et al., 2017). Research indicates that Zoloft may require a higher dosage, typically 50mg, to achieve the desired therapeutic effects in many patients. The importance of individualized dosing strategies in geriatric populations has been emphasized in recent literature, suggesting that careful titration and close monitoring are essential for optimizing treatment outcomes (Singh et al., 2023).
Decision #2
Based on the patient’s response to the initial treatment, the second decision involved increasing the Zoloft dosage to 50mg orally daily. This decision is supported by numerous research studies and evidence-based practices, which indicate that a higher dosage often leads to more favorable outcomes. Specifically, Zoloft 50mg orally daily has been shown to effectively promote better sleep patterns, enhance appetite, improve mood, and reduce anxiety levels (Potter, 2019). A key expected outcome was to facilitate improved social interactions. Recent studies have further validated this approach, demonstrating that optimizing sertraline dosage can lead to significant reductions in depressive symptoms and improvements in overall functioning (Luo et al., 2023). FDA guidelines also support the safety of prescribing 50mg to depressed patients for symptom reduction (Potter, 2019). Moreover, research consistently shows that increasing the dosage to 50mg is generally safe and can enhance the drug’s therapeutic potential.
Two weeks after implementing the increased dosage, the patient returned to the clinic. The expected outcomes were largely met, with the patient demonstrating notable improvements in mood and appetite. Social interactions had also markedly improved compared to the initial clinic visit. The patient’s overall well-being showed significant enhancement. These positive changes align with recent findings that highlight the importance of dose optimization in achieving maximal therapeutic benefits, particularly in geriatric populations (Luo et al., 2023).
The observed results closely matched the expected outcomes, with depressive symptoms reportedly reduced by approximately 50%. This alignment can be attributed to the increased dosage, as FDA guidelines indicate that higher Zoloft doses typically result in enhanced therapeutic efficacy (Potter, 2019). The 50mg oral daily dose of Zoloft has been shown to effectively boost interaction levels, appetite, and mood. Notably, the patient did not exhibit any adverse effects related to the higher dosage. A key consideration throughout the treatment process was to avoid disrupting the patient’s metabolism, absorption, and excretion processes (National Alliance on Mental Illness, 2017). This precaution is particularly crucial for elderly patients, who often have more vulnerable organ systems, including the liver and heart, which play critical roles in drug metabolism, distribution, absorption, and excretion. Recent research has emphasized the importance of considering age-related changes in pharmacokinetics and pharmacodynamics when treating older adults with antidepressants (Srifuengfung et al., 2023).
Decision #3
The third decision involved continuing the Zoloft 50mg orally daily regimen for an additional two to four weeks, with a follow-up assessment scheduled after two weeks. This decision is supported by randomized control trials indicating that Zoloft can produce significant positive results after two weeks of consistent administration (Potter, 2019). Recent studies have also highlighted the importance of maintaining an effective dosage for an adequate duration to achieve optimal therapeutic outcomes in geriatric patients with depression (Srifuengfung et al., 2023).
The primary expectations for continuing the medication at this dosage were to further enhance appetite, promote social interactions, reduce panic and anxiety levels, and improve sleep patterns. Zoloft has been consistently recognized as one of the most effective medications for treating Major Depressive Disorder (National Alliance on Mental Illness, 2017). Building on the 50% symptom reduction observed in the previous decision, the goal for this phase was to achieve a near-complete (100%) reduction in negative symptoms and promotion of positive behaviors. The ultimate aim was to facilitate the patient’s return to normal daily functioning and social engagement. This approach aligns with recent research emphasizing the importance of comprehensive treatment strategies that address both symptomatic improvement and functional recovery in older adults with depression (Srifuengfung et al., 2023).
The outcomes of this decision closely matched the expectations. Upon returning to the clinic after two weeks, the patient exhibited significant improvements across all targeted areas. They demonstrated positive social interactions, increased appetite, and improved sleep patterns. Notably, the patient reported no instances of anxiety or panic that could disrupt their sleep (Potter, 2019). Given these positive results, the recommendation is to continue monitoring the patient for an additional two weeks to assess ongoing progress before considering any medication withdrawal or dosage reduction. Recent studies have emphasized the importance of careful monitoring and gradual tapering of antidepressants in older adults to minimize the risk of relapse and discontinuation symptoms (Singh et al., 2023).
Ethical Considerations
Ethical considerations play a crucial role in prescribing medications, particularly for mood disorders. A primary ethical obligation is to fully inform patients about potential side effects associated with the prescribed drug (Potter, 2019). For instance, Zoloft carries a risk of inducing suicidal thoughts in some patients, which could potentially endanger their lives. Healthcare providers have an ethical duty to closely monitor patients to mitigate the risk of adverse effects. The FDA mandates that pharmaceutical companies clearly label drugs with appropriate warnings to ensure patient safety. FDA guidelines also stipulate that patients under 18 years of age must obtain parental consent before being prescribed Zoloft (National Alliance on Mental Illness, 2017). Recent ethical discussions have also highlighted the importance of shared decision-making in geriatric psychiatry, emphasizing the need to involve older patients and their caregivers in treatment decisions (Srifuengfung et al., 2023).
Another critical ethical consideration is the patient’s age. Elderly patients metabolize and respond to medications differently compared to younger individuals. Consequently, older patients typically require lower initial dosages, with careful monitoring before any dose increases. Clinicians have an ethical responsibility to closely observe treatment outcomes and assess for any negative impacts on the patient (National Alliance on Mental Illness, 2017). These ethical guidelines are essential for maintaining a balance between effective treatment and minimizing potential side effects. Recent research has underscored the importance of considering the unique physiological and psychosocial factors that influence medication response in older adults, emphasizing the need for personalized treatment approaches (Singh et al., 2023).
Conclusion
Prompt treatment of mood disorders in adult and elderly patients is crucial to prevent significant deterioration in their quality of life. These disorders can profoundly impact daily activities, social interactions, appetite, and sleep patterns, often accompanied by heightened levels of panic or anxiety. Such symptoms can severely compromise an elderly patient’s overall well-being. The treatment approach described in this case study began with the prescription of Zoloft, a widely recognized and effective medication for mood disorders. Initially, a 25mg oral daily dose proved insufficient, necessitating an increase to 50mg oral daily. This adjustment led to a marked improvement, with the patient showing a 50% reduction in depressive symptoms. The decision to maintain this dosage resulted in further positive changes, including enhanced social interactions, improved appetite and sleep patterns, and a reduction in panic or anxiety attacks. Recent research has further validated the efficacy of sertraline in treating depression in older adults, emphasizing the importance of individualized dosing strategies and comprehensive care approaches (Srifuengfung et al., 2023; Luo et al., 2023). These findings underscore the critical role of appropriate pharmacological interventions in managing mood disorders among elderly patients, potentially significantly enhancing their quality of life and overall functioning.
References
Crocco, E. A., Jaramillo, S., Cruz-Ortiz, C., & Camfield, K. (2017). Pharmacological management of anxiety disorders in the elderly. Current treatment options in psychiatry, 4(1), 33-46.
Gordon, M. S., & Melvin, G. A. (2015). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. DOI:10.1111/jpc.12655
Luo, X., Peng, L., Xiang, Y., Ren, H., Zhao, J., & Wu, Y. (2023). Selection of the optimal dose of sertraline for depression: A systematic review and meta-analysis. Psychiatry Research, 323, 115103. https://doi.org/10.1016/j.psychres.2023.115103
National Alliance on Mental Illness. (2017). What Is Sertraline and What Does It Treat? Retrieved from: https://www.nami.org/learn-more/treatment/mental-health-medications/sertraline-(Zoloft)
Potter, D. R. (2019). Major Depression Disorder in Adults: A Review of Antidepressants. International Journal of Caring Sciences, 12(3), 1936.
Singh, H. K., Saadabadi, A., & Patel, K. (2023). Sertraline. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK547689/
Srifuengfung, M., Thana-Udom, K., Pattanaseri, K., Suantawee, T., & Lopetcharat, A. (2023). Optimizing treatment for older adults with depression. International Journal of General Medicine, 16, 7365-7379. https://doi.org/10.2147/IJGM.S425380
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
