This individual assignment discusses the case study of Margaret, who is suffering from depression. It covers the symptoms, pathophysiology, risk factors, treatment options, and plan. The treatment plan includes pharmacological and non-pharmacological interventions.
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Running head: INDIVIDUAL ASSIGNMENT INDIVIDUAL ASSIGNMENT ON CASE STUDY OF MARGARET Name of the Student Name of the University Author note
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1INDIVIDUAL ASSIGNMENT Problems Depression is a mental health condition in which people generally feel low and less enthusiastic about activities they used to enjoy previously. People always feel sad and miserable and severity of this condition can range from mild to extreme. Thesigns and symptomsof depression in women includes consistently sad mood with anxiety, decreased energy and suicidal thoughts, weight gain due to overeating [1]. Besides this the patient is unable to concentrate or make appropriate decisions, cries excessively and feels guilt, worthlessness or helpless. Besides this, patient suffers from physiological disorders such as headache, pain and chronic digestive issues which never respond to medical treatments [2]. Despite the presence of several theories regarding thepathophysiology of depression, there is no specific theory present to demonstrate the pathway that leads to depression. Within this the Monoaminergic theory is relevant in which inactivity of monoamine neurotransmitters is the leading cause behind depressive symptoms [3]. Further, it is also evident from researches that due to acute depletion of tryptophan, which is a precursor of serotonin can cause depression symptoms within the patient. Further, therisk factorsassociated with depression can be of three types, medical, social and substance risk factor. Sleep disorder, serious illness, substance abuse, lacking social support are few of the risk factors associated with depression [4]. The treatment goal for Margaret will be- Providing her with the strategies to manage anger. Explore the issue of her depression condition and discuss the technique to cope up the stressful situation.
2INDIVIDUAL ASSIGNMENT Improve her overall behavior such as her attitude and mood and provide her strategies to maintain that. Improve her reasoning and decision making skills. Options WhileformulatingthecareplanforMargaret,thetreatmentoptionssuchas pharmacologicalandnon-pharmacologicaltreatmentshouldbeassessed.The pharmacological treatment of depression includes the application of second generation of anti- depressants or SGAs that help in reducing the quotient of depressants generated in the human body. Further it should be mentioned that maximum people suffering from depression depends on the non-pharmacological interventions which are helpful in reducing the symptoms [5]. The applied interventions depend on the severity of depression as for low intensity depression guided help, cognitive behavioral therapy, light therapy, programs with physical activities and relapse prevention for moderate depression are applied. However to determine the nest treatment plan for Margaret, evidences from researches should be collected. Research determined that CBT or cognitive behavioral therapy is an important intervention that can be applied to patients affected with sub-threshold depression and using this, identification of changing thoughts, and changing behaviors can be maintained [6]. However, there are very few researches available regarding the combinationofpharmacologicalandnon-pharmacologicalinterventionsthatcanhelpthe patients affected with depression. It has been seen in the research it was shown that CBT along with SGAs and physical activities can lead to improve the patient condition and has shown great efficacy in treating the clinical depression syndrome. Hence, these are the available treatment options for Margaret [7].
3INDIVIDUAL ASSIGNMENT As per the above-mentioned treatment plan, Margaret will be recommended with drugs such as fluoxetine, Sertraline (which are a serotonin reuptake inhibitors), venlafaxine (which is norepinephrine reuptake inhibitor). These drugs are SGAs which are used extensively to treat depression along with non-pharmacological interventions [8]. However, there are people who are unable to respond to the depression monotherapy and hence requires the use of Risperidone, which is the first line of medication for the atypical antipsychotic drugs. In the case of Margaret, it is evident that her symptoms of mild depression is persistent and due to which she is suffering from associated health concerns such as headache, mild fever and common cold (for which she uses aspirin 1000 mg) and she suffers from digestive disorders (for which she uses Simvastatin 40 mg medications) [9]. Therefore, these above mentioned serotonin reuptake inhibitors and norepinephrine reuptake inhibitor will be used as medication for Margaret so that her body can achieve balanced serotonin production. Further, she will also be provided with counselling session so that the suicidal thoughts, low self-esteem, and helplessness related thoughts can be altered and she can be provided with positive motivation for her upcoming life [10]. Plan After 10 weeks of the above mentioned medications, it was seen that Margaret did not improved her health condition and the dose of sertraline 200 mg and even three months later the drug mirtazapine 15 mg has failed to improve her depression symptom.Hence in this situation the medication for atypical psychosis will be used. The drug Risperidone is the antipsychotic drug which is implemented on the patients who are unable to respond to antidepressant drug such as sertraline and mirtazapine, which are evident to provide health improvement in patients affected with mild to severe depression symptoms [11]. This drug is useful in balancing the level
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4INDIVIDUAL ASSIGNMENT of dopamine and serotonin in the brain and also helps to improve the mood, thinking and behaviorofthepersonaffectedwithdepression.However,thenon-pharmacological interventions will remain similar as it will help Margaret to improve her physical health which generally gets affected due to excessive medication usage [12]. In this changed treatment circumstances, Margaret will be asked to consume the medicine for 4 to 6 weeks so that the effectiveness of the drugs can be clearly identified and depending on the effect the dose and frequency of the medicine can be decided.
5INDIVIDUAL ASSIGNMENT References 1.Duman RS. Pathophysiology of depression and innovative treatments: remodeling glutamatergicsynapticconnections.Dialoguesinclinicalneuroscience.2014 Mar;16(1):11. 2.AbelairaHM,ReusGZ,QuevedoJ.Animalmodelsastoolstostudythe pathophysiology of depression. Revista brasileira de psiquiatria. 2013;35:S112-20. 3.ValkanovaV,EbmeierKP.Vascularriskfactorsanddepressioninlaterlife:a systematic review and meta-analysis. Biological psychiatry. 2013 Mar 1;73(5):406-13. 4.Hawton K, i Comabella CC, Haw C, Saunders K. Risk factors for suicide in individuals with depression: a systematic review. Journal of affective disorders. 2013 May 1;147(1- 3):17-28. 5.BauneBT,RengerL.Pharmacologicalandnon-pharmacologicalinterventionsto improve cognitive dysfunction and functional ability in clinical depression–a systematic review. Psychiatry research. 2014 Sep 30;219(1):25-50. 6.Dennis CL, Dowswell T. Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression. 7.De Groot M, Doyle T, Kushnick M, Shubrook J, Merrill J, Rabideau E, Schwartz F. Can lifestyle interventions do more than reduce diabetes risk? Treating depression in adults with type 2 diabetes with exercise and cognitive behavioral therapy. Current diabetes reports. 2012 Apr 1;12(2):157-66. 8.Pehrson AL, Leiser SC, Gulinello M, Dale E, Li Y, Waller JA, Sanchez C. Treatment of cognitive dysfunction in major depressive disorder—a review of the preclinical evidence forefficacyofselectiveserotoninreuptakeinhibitors,serotonin–norepinephrine
6INDIVIDUAL ASSIGNMENT reuptake inhibitors and the multimodal-acting antidepressant vortioxetine. European journal of pharmacology. 2015 Apr 15;753:19-31. 9.NulmanI,KorenG,RovetJ,BarreraM,PulverA,StreinerD,FeldmanB. Neurodevelopment of children following prenatal exposure to venlafaxine, selective serotonin reuptake inhibitors, or untreated maternal depression. American Journal of Psychiatry. 2012 Nov;169(11):1165-74. 10.Montgomery SA, Nielsen RZ, Poulsen LH, Häggström L. A randomised, double‐blind study in adults with major depressive disorder with an inadequate response to a single course of selective serotonin reuptake inhibitor or serotonin–noradrenaline reuptake inhibitortreatmentswitchedtovortioxetineoragomelatine.Human Psychopharmacology: Clinical and Experimental. 2014 Sep;29(5):470-82. 11.Simpson HB, Foa EB, Liebowitz MR, Huppert JD, Cahill S, Maher MJ, McLean CP, Bender J, Marcus SM, Williams MT, Weaver J. Cognitive-behavioral therapy vs risperidoneforaugmentingserotoninreuptakeinhibitorsinobsessive-compulsive disorder: a randomized clinical trial. JAMA psychiatry. 2013 Nov 1;70(11):1190-9. 12.De Fruyt J, Deschepper E, Audenaert K, Constant E, Floris M, Pitchot W, Sienaert P, Souery D, Claes S. Second generation antipsychotics in the treatment of bipolar depression: a systematic review and meta-analysis. Journal of psychopharmacology. 2012 May;26(5):603-17.