Treating Insomnia Associated with Depression Essay

Treating Insomnia Associated with Depression Essay

Treating Insomnia Associated with Depression Essay

A 75-year-old patient presents with complaints of insomnia and worsening symptoms of depression, which started ten months ago following the death of her husband. She has been taking Sertraline, but she has no significant remission in symptoms.

Questions to ask the patient

How often do you feel sad or depressed?

Depressed mood is one of the primary markers of depression. The rationale for asking the patient the frequency of her symptoms is that a depressed mood should be experienced almost every day for the better part of the day (Tolentino & Schmidt, 2018).

Have you been taking your medications consistently since you were diagnosed with depression 10 months ago?

The patient has been taking an antidepressant with no remission in depressive symptoms. It is important to know if they have been compliant with the pharmacology or if the dosage is not enough to produce a therapeutic effect for consideration of dose increase.

Have you participated in any form of counseling or psychotherapy?

Since the patient lost her husband, she might be still grieving from the pain of loss, which is also the source of depression. Hence, psychosocial therapies are necessary to help her cope with the loss through healthy grieving, leading to acceptance.

ORDER A PLAGIARISM FREE-PAPER HERE

The people to speak with

I would get more assessment information from the patient’s adult child, who closely monitor their progress, and a caregiver, if any.

What changes have you noticed in your mother in the past two weeks?

The question assesses whether the patient has any other depressive symptoms apart from insomnia, for example, loss/gain of weight, issues with appetite, loss of interest in activities, loss of energy, and reduced ability to concentrate (Tolentino & Schmidt, 2018).

Does she stay alone? How often do you check on her?

At her age, the patient may not be able to handle activities of daily living and even remember to take medications. Hence, the question evaluates if the patient has a support system to help her with tasks that she cannot accomplish independently and provide social and emotional support.

Has she experienced any side effects with the antidepressant medication?

The question assesses the patient’s tolerance and response to medication.

Physical exam and diagnostic tests

For a physical exam, I would conduct a comprehensive assessment of the patient’s biopsychosocial issues, including history of mental health in the family, substance use, or cigarette. Psychosocial assessment helps to identify the vulnerabilities that expose the patient to poor health, as well as strengths that enhance resilience. A psychosocial assessment is essential for providing patient-centered and culturally congruent care that ensures the overall health and wellbeing of the patient (Thompson et al., 2018). The first diagnostic test would be a blood test to evaluate thyroid-stimulating hormones to test for hyperthyroidism. Hyperthyroidism is also associated with symptoms of depression such as insomnia, restlessness, irritability, impairment in concentration, and fatigue (Costache et al., 2020). The second evaluation would be to administer the Hamilton Depression Rating Scale (HDRS) to assess the depression and its severity.

ORDER A PLAGIARISM FREE-PAPER HERE

Differential diagnosis

Major depressive disorder

Anxiety disorder

Generalized anxiety disorder

The primary diagnosis is major depressive disorder supported by previous diagnosis and current clinical manifestation.

Pharmacology agents

The patient has been on Sertraline, presumably for 10 weeks, with a poor response; hence, a medication change is an option. Additionally, the treatment goal focuses on the remission of at least 50% of depressive symptoms, including insomnia. Treating insomnia alone would not be effective for the other depressive symptoms. The two choices for pharmacology are lithium augmenting Olanzapine-Fluoxetineon. These medications have proven efficacy in cases where patients present with treatment-resistant for the first-line antidepressants. I might choose lithium augmenting over Olanzapine-Fluoxetineon. According to Taylor et al. (2020), evidence supports the efficacy of lithium augmentation in cases where patients have failed to respond to SSRIs. Additionally, the pharmacotherapy is tolerated and produces 50% remission of symptoms in 1-2 weeks.

The contraindications to consider when using lithium include avoiding dehydration, over-the-counter NSAIDs, and a low-sodium diet. Additionally, the patient must avoid excessive intake of coffee and tea. Additionally, patient monitoring is important to identify any side effects. In old age, lithium presents the risk of toxicity; hence it is essential to monitor the patient closely (Malhi, Bell, Outhred, & Berk, 2020). Pharmacotherapy is guided by ethical and legal guidelines, for example, respecting patient autonomy. I would ensure this by giving the patient information about the treatment options, including risks and benefits, then letting them make an independent and informed decision on the treatment.

Checkpoints

Follow-up will occur at two weeks. The patient is expected to have at least 25-50% symptoms remission.

References

Costache, A., Riza, A., Popescu, M., Dinca, M., Glavan, D., Vladu, I., . . . Udristoiu, I. (2020). TSH and T4 Levels in a Cohort of Depressive Patients. Curr Health Sci J., 46(2),117-122. https://doi.10.12865/CHSJ.46.02.03.

Malhi, G., Bell, E., Outhred, T., & Berk, M. (2020). Lithium therapy and its interactions. Aust Prescr, 43(3), 91–93. https://doi.10.18773/austprescr.2020.024.

Taylor, R. W., Marwood, L., Oprea, E., DeAngel, V., Mather, S., Valentini, B., & Zahn, R. (2020). Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines. International Journal of Neuropsychopharmacology, 23(9), 587–625, https://doi.org/10.1093/ijnp/pyaa033.

Thompson, D. R., Saner, H., & Ski, C. (2018). Psychosocial assessment and intervention – are we doing enough? Heart and Lung The Journal of Acute and Critical Care, 47(4), https://doi.10.1016/j.hrtlng.2018.05.006.

Tolentino, J. C., & Schmidt, S. (2018). DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Front Psychiatry, 9, 450. https://doi.10.3389/fpsyt.2018.00450.

ORDER A PLAGIARISM FREE-PAPER HERE

  Case study analysis of insomnia/depression for discussion board post