Mood disorders among geriatric patients present a distinct problem in psychiatry due to the complication of treatment. The elderly are vulnerable to negative impacts and side effects of the drugs than the younger population. The condition is characterized by frequent depressive incidences, hypomania, and mania (Stahl, 2013). The number of elderly patients suffering from the disease has increased in the recent past. For this reason, effective psychological interventions of the health condition are required to deal with the problem. In the paper, an elderly Hispanic man is diagnosed with the major depressive disorder. In this paper, I will describe three decisions that I will make regarding the medications to prescribe to the patient, and each decision will be supported by the rationale for selecting it, its anticipated goals and the difference between anticipated goals and the actual outcomes.
Decision 1: Prescribe Lithium
Rationale for this decision
Food Drug Administration has certified the use of lithium prescriptions in the treatment of mood disorder among elderly patients. I have decided to use lithium in the treatment of the condition due to a wide range of reason. Firstly, lithium is classified as the best treatment in periodic unipolar depression and bipolar disorder (Dols et al., 2013). Secondly, it is successful in controlling suicidal behaviour or ideation. Lastly, the drug also helps in efficient management of mania. Similarly, mood disorders are linked with the heightened threat of suicide while geriatric aggravate the risk factor for committing suicide. In this regard, lithium offers the best treatment for this disease among elderly patients such as the Hispanic man (Stahl, 2013).
By prescribing this drug, I was expecting that it would help in stabilizing mood in the Hispanic man. Moreover, it would also help in the management of mania and reduce depressive relapses as well as aggressive behaviours (Lewitzka et al., 2015). Meanwhile, since the drug has antipsychotic and anti-suicide properties, I was expecting that the Hispanic man would exhibit fewer instances of suicide through the management of mood episodes during the next appointment.
Difference between my expectations and the actual results
After the Hispanic man arrived during the appointment date, I noted that there were several differences between what I projected to achieve and the actual result. Precisely, lithium drug failed to manage mania, reducing depressive relapses and aggressive behaviours. The main cause of these issues may be due to low compliance to treatment that is more common in elderly clients because of age-associated cognitive failure or unavailability of the caregivers (Dols et al., 2013). Additionally, it may be a source of major side effects such as tremor, polyuria, memory issues and ataxia. Such side effects are more prominent in geriatrics patients.
Decision 2: Divalproex
Rationale of the decision
My previous decision to use lithium drug was not effective in the management of depressive disorder in Hispanic man. For this reason, I decided to use Divalproex because it functions to stabilize and manage moods. More importantly, it triggers an increase of GAMA, a chemical neurotransmitter that is produced in the brain, which assists to relax and calm nerves hence stabilizing moods in patients with mood disorders (Katz et al., 2017). The prescriptions operate to trigger the level of GABA generation, which relax overstimulated nerves. Likewise, it also functions to hinder GABA breakdown. In case GABA is disintegrated, it becomes weak at handling overstimulated brain nerves leading to bipolar symptoms. Hindering the breakdown of GABA permits, the chemical operates more efficiently and for an extended period (Stahl, 2013). Subsequently, it controls mood swings and rapidly sending brain electrical impulses. Therefore, it is quite efficient in stabilizing the manic episodes, especially among men. FDA has approved the use of the drug in the treatment of a migraine headache and seizures. Therefore, it helps to manage symptoms such as heightened risk-taking, grandiosity, the reduced necessity for sleep, and hyperactivity (Katz et al., 2017).
By prescribing Divalproex, I anticipate that it would effectively treat manic phases such are irritated or elevated mood, heightened risk-taking, grandiosity, a diminished necessity for sleep and hyperactivity. Similarly, I also estimated it would deal with depressive symptoms such as helplessness, hopelessness, and depressive mood (Katz et al., 2017). Since Divalproex has an extended half-life and hinder lamotrigine metabolism in elderly patients, I expected that it would lead to various side effects such as thrombocytopenia, hair thinning, weight gain, ataxia, tremor, and sedation.
After two weeks since the Divalproex prescription, it was able to manage various manic symptoms such as feeling irritable, aggravated self-esteem, hyper-talkativeness, a sense of distraction, and racing thoughts. However, the patient experienced anti-manic impacts, which could be attributed to interactions with other drugs such as vitamins, or medications that the patient could have taken (Stahl, 2013). Precisely, interactions occur when an ingredient alters the manner in which the drug functions which can detrimental or reduce the effectiveness of the drug.
Although using Divalproex drugs helps in better management of depressive symptoms for the Hispanic man, introducing olanzapine drug would be instrumental in the treatment of depression. Essentially, the use of this drug would help the elderly patient to reduce the levels of hallucinations and become less agitated (Gareri et al., 2014). The drug is quite effective in helping such patient to think positively and clearly about his life and participate in active processes of his work. The drug is classified as antipsychotic thus quite essential in reducing aggression, calling out, agitation, delusions, and paranoia, which are prevalent among geriatric patients experiencing bipolar disorders. Moreover, studies have pointed to the fact that olanzapine drugs generate better enhancement in social wellbeing of elderly patients suffering from these conditions (Prommer, 2013). Among the benefits of this drug is that is fairly tolerated by geriatrics populations experiencing the mood disorder. Therefore, it is safe and effective in managing depressive issues in the Hispanic patient with the depressive disorder.
The frequency of depressive symptoms is likely to reduce in the Hispanic patient after one week. Similarly, the patient will exhibit social behaviours because he will demonstrate less agitation, thinking positively and clearly and reduce hallucinations (Stahl, 2013). Olanzapine is expected to eliminate suicidal ideations, crying, helplessness, and feeling of guilt as well as decreased energy, and depressed mood. Several side effects are expected to occur including weight gain, heightened appetite, dizziness, and drowsiness.
The depression levels and mania of the elderly Hispanic male had significantly reduced. The patient will manifest ability to perform daily routine, increased level of happiness and socialization skills (Gareri et al., 2014). However, the patient will exhibit mild side effects such as light-headedness, which raise the susceptibility of falling. The patient would not have fully recovered hence becomes sluggish when sitting or rising.
Various ethical issues should be considered when prescribing the drugs to the patient. Firstly, since the patient is an elderly man it is pertinent to exercise cause when defining the drug dosage. It would be prudent to provide small dosage to the geriatric coupled with a small increment to protect his well-being (Segal & Haskell, 2014). Moreover, I would ensure that a caregiver accompanies the patient in order to guarantee the compliance with communicated guidelines. The communication effectiveness would also be ascertained by utilizing simple terms for easier comprehension.
Dols, A., Sienaert, P., van Gerven, H., Schouws, S., Stevens, A., Kupka, R., & Stek, M. L. (2013). The prevalence and management of side effects of lithium and anticonvulsants as mood stabilizers in bipolar disorder from a clinical perspective: a review. International clinical psychopharmacology, 28(6), 287-296.
Gareri, P., Segura-García, C., Manfredi, V. G. L., Bruni, A., Ciambrone, P., Cerminara, G., … & De Fazio, P. (2014). Use of atypical antipsychotics in the elderly: a clinical review. Clinical interventions in aging, 9, 1363.
Katz, T. C., Georgakas, J., Motyl, C., Quayle, W., & Forester, B. P. (2017). Pharmacological Treatment of Bipolar Disorder in the Elderly. Current Treatment Options in Psychiatry, 4(1), 13-32.
Lewitzka, U., Severus, E., Bauer, R., Ritter, P., Müller-Oerlinghausen, B., & Bauer, M. (2015). The suicide prevention effect of lithium: more than 20 years of evidence—a narrative review. International journal of bipolar disorders, 3(1), 15.
Prommer, E. (2013). Olanzapine: palliative medicine update. American Journal of Hospice and Palliative Medicine®, 30(1), 75-82.
Segal E. S., & Haskell B. S., (2014). Ethnic and Ethical Challenges In Treatment Planning: Dealing With Diversity During the 21st Century. The EH Angle Educationa and Research Foundation. Angle Orthodontist, Vol 84, No 2, 2014. Accessed from, http://www.angle.org/doi/pdf/10.2319/0003-3219-84.2.380?code=angf-site Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge Unive