Ann is a 34-year-old African American woman who presents with a 6-week history of initial and terminal insomnia and a 10-pound weight loss over that same period. She admits to feeling sad almost every day for the past 6 weeks that occurred after she lost her job. She denies feeling enjoyment, has not engaged in any previously enjoyable activities, and wonders if life is worth living. Her physical examination is negative, vital signs and blood work, including a thyroid profile, are all within normal limits, and her body mass index is 22. Her mother and sister both had episodes of depression and were treated successfully with sertraline.

Answer the following questions.

1.            Which medication would you anticipate starting Ann on and why?

2.            What is critical education to share with her?

WK 9 CS-history of initial and terminal insomnia

Ann’s presentation suggests major depressive disorder (MDD). This common mood disorder affects an estimated 16.2 million adults in the United States, with a higher prevalence among women, racial and ethnic minorities, and those with chronic medical conditions (National Institute of Mental Health, 2022). Based on her family history and clinical presentation, I anticipate starting Ann on sertraline, a selective serotonin reuptake inhibitor (SSRI) that effectively treats MDD (Edinoff et al., 2021). Sertraline is a well-tolerated first-line agent, has a favorable side-effect profile, and can be used safely in patients with normal liver and renal function, which is the case with Ann. Although psychotherapy is also an effective treatment option for MDD, medication is often preferred as a first-line intervention in moderate to severe cases or in patients who have not responded adequately to psychotherapy alone (National Institute of Mental Health, 2022)

In addition to starting Ann on sertraline, educating her about the medication and her condition is critical. First, I will explain to Ann how sertraline works and let her know that it would take a few weeks for her to experience the full effectiveness of the medication.in addition, I will also let her know the potential side effects of the medications such as gastrointestinal symptoms, sexual dysfunction, and insomnia and reassure her that these are usually transient and can be managed effectively. Furthermore, I will educate Ann about the significance of drug compliance and the necessity of continuing the medication even after she feels better. Finally, it’s crucial to let Ann know that MDD is a disease that is treatable. If her symptoms get worse or she exhibits any suicidal ideas or actions, she needs to get help right away by calling emergency contacts such as 999 or contact her primary care physician. By receiving this education, Ann will be better able to decide on her course of therapy, follow her medication regimen, and increase her odds of experiencing a remission from her symptoms.

References

Edinoff, A. N., Fort, J. M., Woo, J. J., Causey, C. D., Burroughs, C. R., Cornett, E. M., … &

Kaye, A. D. (2021). Selective serotonin reuptake inhibitors and clozapine: clinically relevant interactions and considerations. Neurology International13(3), 445-463. https://doi.org/10.3390/neurolint13030044

National Institute of Mental Health. (2022, January). Major Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression

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