The Impact Of Ethnicity On Antidepressant Therapy

: The man whose antidepressants stopped working

Major depressive disorder is one of the most prevalent disorders we will see in our clinical practice.  Treatment options for MDD can vary greatly contingent on the appropriate psychopharmacologic interventions being adopted for our clients.

Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions (Kleinsinger, 2018). Nonadherence isn’t a new problem.  However, offering clients valuable interventions and education to overcome any potential compliance barriers will help the provider identify any challenges and decide how to achieve mutually agreed-upon goals to improve their health.

Questions

1.  Do you ever feel that taking your medications is a nuisance or inconvenience?  Do you have a difficult time remembering to take your medications or forget?

•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;Developing a medication schedule, It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective.

2.  Does your prescribed medications and treatment regimen still leave you feeling depressed?  Do you have a difficult time adhering to a prescribed regimen?

•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not following the prescribed regimen and come up with a solution together.

•&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;&νβσπ;It is crucial for the patient to take his antidepressants accordingly, as well as not skip or alter the dosage, nor terminate the medication once you start feeling better.

3.  Have the side effects of your medications been difficult to cope with or manage?  Do you sometimes stop taking your medications because of the adverse effects?

  • Sertraline has been prescribed in the past and discontinued several times. The patient experienced side effects of sexual dysfunction and stopped taking.  Encourage the patient to monitor any side effects, physical and emotional changes or occurrences.
  • Stopping medications and treatment regimens prematurely or abruptly have been associated with high relapse rates and can cause serious withdrawal symptoms (Henssler, Heinz, Brandt, & Bschor, 2019).

Important People

Family members and other caregivers bring personal knowledge on the suitability or lack thereof regarding different treatments for the patient’s circumstances and preferences (Smith, 2013).  The patient is married, so I would address additional questions to his wife.  After getting permission to discuss his medical records with his family members, I would ask the wife if she knew what medications her husband was taking?  If she knew why he was taking them?  Informed and engaged patients, invested in their own health care as well as in the improvement of the broader health care system, are crucial to a learning system (Smith, 2013).  Family support is essential for patients suffering from depression where patients are feeling less motivated or forgetful when taking medications.  Asking family members if the patient has been experiencing any side effects or illnesses since starting the medication emphasizes self-centered care and mutually agreed-upon goals (Siminoff, 2013).

Physical Exams and Diagnostic Tests

CC: worst depression and anxiety he has ever felt

HPI: 63-year-old male presents to the clinic stating his antidepressants have stopped working.  The patient has a 13-year history of recurrent unipolar major depressive episodes.  His first 4 episodes were readily treated to full remission and he discontinued treatment each time several months to a year after remitting.  His subsequent episodes came in an ever-escalating pattern, with less and less time between them.  By the time of his fifth episode, he had become treatment-resistant and took two years to get better.

Current Medications: 1 year following first depressive episode: antiarrhythmic, a statin for cholesterol, antihypertensive, aspirin, transdermal Selegilene 6 mg/24hrs after failing multiple SSRI and SNRI treatments plus multiple augmentation strategies.

PMHx: Atrial fibrillation age 42, resolved with medication, hypercholesterolemia, HTN

Soc Hx: Married 33 years, 3 children, nonsmoker, denies illicit drug or alcohol abuse.

Fam Hx: Mother: depression and alcohol abuse; Maternal uncle: alcohol abuse; Son: depression; Daughters: one with mild depression, one with postpartum depression.

ROS:

 
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Also posted onApril 24, 2020 @ 10:16 pm