Posted: June 14th, 2023

You were called as a PMNHP to evaluate and treat a 34-year-old female

You were called as a PMNHP to evaluate and treat a 34-year-old female hospitalized in the local mental health facility. The client has a long history of depressed mood and anhedonia, but has never been on a psychiatric medication. You diagnosed the client with a major depressive disorder and decided to start the client on a medication for stabilization.
In a 2 page paper,
Discuss what would guide your decision in selecting a drug for this client?
Describe the medication you would prescribe, provide the rationale.
Discuss medication education on the medication selected, including pharmacological actions, therapeutic indications, precautions/side effects, dosage and clinical guideline, and any laboratory interferences.
Please use at least three sources from peer-reviewed journals less than 5 years old to justify evidence of information

___________________________
As a PMHNP, selecting an appropriate medication for the treatment of major depressive disorder (MDD) is critical to achieve symptom remission and improve the patient’s quality of life. The decision-making process for selecting a medication should be evidence-based and guided by the patient’s clinical presentation, medication history, comorbidities, medication side-effect profile, and patient preference. This paper discusses the factors guiding medication selection for MDD treatment, the medication that I would prescribe, and the medication education that would be provided to the patient.

Medication selection for MDD treatment depends on the severity of symptoms, the presence of comorbidities, and medication history. Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs), are the first-line pharmacological treatment options for MDD (American Psychiatric Association, 2020). SSRIs and SNRIs are preferred over TCAs and MAOIs due to their favorable side-effect profile, safety, and efficacy. The choice of medication depends on the patient’s clinical presentation, medication history, and comorbidities. For instance, SSRIs are recommended in patients with anxiety disorders, while bupropion or mirtazapine is recommended in patients with comorbid insomnia.

In this case, the patient has a long history of depressed mood and anhedonia and has never been on psychiatric medication. Therefore, an SSRI or SNRI would be the preferred choice of medication. After considering the patient’s clinical presentation, medication history, and comorbidities, I would prescribe escitalopram, an SSRI. Escitalopram is a highly selective serotonin reuptake inhibitor with fewer drug interactions and a lower incidence of side effects than other SSRIs. It has demonstrated efficacy in the treatment of MDD and is recommended as a first-line medication by the American Psychiatric Association (2020). In a randomized controlled trial comparing escitalopram with sertraline, escitalopram was found to be more effective in reducing depressive symptoms and had a lower incidence of adverse events (Chung et al., 2019).

Medication education is an essential component of medication management in patients with MDD. The patient should be educated on the pharmacological actions, therapeutic indications, precautions/side effects, dosage and clinical guideline, and any laboratory interferences of the medication. Pharmacological actions of escitalopram involve selective inhibition of serotonin reuptake, which increases serotonin levels in the synaptic cleft and improves mood and anxiety symptoms. Therapeutic indications of escitalopram include the treatment of MDD, generalized anxiety disorder, and social anxiety disorder. Precautions and side effects of escitalopram include sexual dysfunction, gastrointestinal disturbances, insomnia, and increased risk of suicidal ideation. The patient should be advised to report any new or worsening symptoms, particularly suicidal ideation. The recommended starting dose of escitalopram is 10 mg/day, which can be increased to 20 mg/day after one week. The patient should be instructed to take the medication at the same time each day and not to abruptly discontinue the medication as this can cause discontinuation symptoms such as headache, nausea, and dizziness. Laboratory interferences are minimal with escitalopram, and no routine monitoring is required (U.S. National Library of Medicine, 2022).

In conclusion, medication selection for MDD treatment should be guided by evidence-based practices, taking into account the patient’s clinical presentation, medication history, comorbidities, and medication side-effect profile. Escitalopram, an SSRI, is an