Assessing and Treating Vulnerable Populations for Depressive Disorders
Major depression is a mental disorder among most of the American population. Depression affects health, wellbeing and quality of life of the patients and their families. Psychiatric practitioners should be competent in the assessment, diagnosis, treatment, monitoring, and evaluation of depression. They should be able to select evidence-based treatments for vulnerable populations for their recovery and health. Therefore, this essay examines depression among the elderly populations. It focuses on topics such as causes and symptoms, diagnosis, medication treatment options, monitoring and special considerations.
Causes and Symptoms of Depression
Depression among the elderly is attributed to several causes. One of the causes is genetics. An elderly patient born to a family with a history of major depression is at a risk of developing the disorder because of the role of genetics. Chronic illnesses also contribute to the development of major depression. For example, the experiences with health issues such as cancer or chronic obstructive pulmonary disease predispose patients to major depression. The use of alcohol and other drugs can also cause depression. Substance use and abuse may produce side effects, which include major depression. Traumatic experiences in life also cause major depression. Patients with histories such as loss of a significant other, job, or undergoing challenges such as a divorce also increases the risk of developing major depression. Imbalances in the neurotransmitters and hormones in the brain also cause major depression. Imbalances in hormones such as acetylcholine and dopamine predispose individuals to major depression (Trenoweth, 2022). Similarly, any disruption in the levels of neurotransmitters such as serotonin and norepinephrine also cause major depression.
The elderly patients suffering from major depression experience several symptoms. One of them is feeling sad in most of the days, nearly every day. They also raise a significant decline in their interest or pleasure nearly every day. The patients also report weight gain from increased appetite or loss because of decline in appetite. They also experience slowed thought processes, fatigue, and feel worthless or guilty almost every day. The depressed mood makes it hard for them to concentrate or make decisions. In some cases, patients report recurrent suicidal thoughts, attempts, with or without a plan. A comprehensive history taking reveals that the symptoms are not because of a medical condition, medication use or substance abuse (Trenoweth, 2022). In addition, the symptoms affect the normal functioning of the patients in their environments.
Diagnosis
The diagnosis of major depression in the elderly patients require a detailed history taking and physical assessment. History taking provides subjective information about the disorder to the practitioner. The psychiatric nurse asks questions that quantify the existence and severity of a health problem. History taking provides insights into potential causes of major depression such as family history of the disease, substance abuse, a history of depression, and the patient experiencing a traumatic event. Physical examination provides subjective information about the disorder. The practitioner relies on methods such as inspection, palpation, percussion, and auscultation. There are also the use of diagnostic and laboratory investigations in physical assessment. The investigations help rule out other potential causes of major depression symptoms in this population (Alshawwa et al., 2019). Nurse practitioners use both subjective and objective assessments to develop accurate diagnoses of their clients’ problems.
The elderly are considered a vulnerable population when diagnosing and treating mental health problems. First, they are a vulnerable population because of their increased predisposition to multiple comorbidities. Besides major depression, the elderly people also have a high risk of developing chronic conditions such as hypertension, heart failure, and dementia. The elderly patients are also a vulnerable population because of their decline in productivity. Social and occupational productivity decline with aging. The elderly patients have limited involvement in most of the social and occupational roles. As a result, their access to healthcare and other social opportunities is low, making them a vulnerable population. Aging is also associated with decline in physiological functioning. Accordingly, the elderly patients have reduced functioning of the vital organs such as the liver and kidneys. The reduced functioning alters the normal processes such as drug metabolism and excretion (Saedi et al., 2019). The changes places them at a high risk of drug toxicity in disease management, hence, them being a vulnerable population.
Medication Treatment Options
Pharmacotherapy is the gold approach to depression treatment in the elderly patients. The treatment phases are three. They include acute, continuation, and maintenance phase. Prescription of drugs for this population should consider their environmental and social contexts. For example, the availability of adequate social support and socialization improves outcomes in the elderly patients suffering from major depression. Most of the elderly patients have pre-existing comorbid conditions such as diabetes and heart failure (Hoel et al., 2021). As a result, the treatment options for major depression should be considered for safety and quality outcomes.
Antidepressants are the primary drugs of choice in major depression among the elderly. Tricyclic antidepressants such as amitriptyline, desipramine, and nortriptyline are used in some patients. However, patients should be monitored for cardiac and cognition abnormalities. Selective serotonin reuptake inhibitors have a high preference rate for major depression in the elderly patients because of their safety and efficacy levels. Patients should be monitored closely for falls, insomnia, weight gain, and suicidal thoughts and attempts among patients (Li et al., 2021; Miller et al., 2020). The FDA approved antidepressants for use among the elderly patients with major depression include sertraline, citalopram, venlafaxine, mirtazapine, and bupropion.
Medication Considerations
Practitioners can consider several medications for treating major depression among the elderly patients. They include sertraline, citalopram, venlafaxine, mirtazapine, and bupropion. The other options for the disorder are venlafaxine, amitriptyline, desipramine, and nortriptyline (Li et al., 2021; Miller et al., 2020). Practitioners should always weigh the risks and benefits associated with the different classes of medications utilized for major depression.
Monitoring
Psychiatric mental health nurse practitioners should monitor patients for the side effects associated with the prescribed medications. The use of antidepressants have side effects such as dizziness, constipation, nausea, insomnia, headache, and sexual dysfunction. Patients should be informed that these side effects improve over time. It is important to monitor patients for any cognitive or cardiac abnormalities with the use of tricyclic antidepressants. The risk of falls is also high with the use of antidepressants. Fall risk assessment should be undertaken before prescribing antidepressants to mitigate the risk. Laboratory investigations for serum electrolytes should also be undertaken. Drugs such as selective serotonin reuptake inhibitors increase the risk of hyponatremia due to the development of syndrome of inappropriate antidiuretic hormone secretion. The risk of suicide with antidepressants is also elevated. Follow-up should seek to establish if the patient has developed suicidal thoughts, plans, or attempts (Krause et al., 2019; Perini et al., 2019). Weight changes should also be monitored with the use of antidepressants. Excessive weight gain may predispose the elderly to comorbidities such as diabetes, cardiovascular complications, and fractures.
Special Consideration and Follow-Up
Some special considerations influence the choice of treatment for major depression in the elderly patients. As identified initially, most of the elderly patients also suffer from comorbid conditions and decline in physiological processes. The risk of harm during the treatment is high. Psychiatric mental health nurse practitioners must ensure the use of evidence-based treatments that align with the patients’ needs. The focus should be on ensuring quality and safety of the treatment, hence, benevolence and non-maleficence. The treatment of major depression in this population may also demand care coordination. Care coordination requires sharing of information among the different healthcare providers involved in disorder management. As a result, practitioners must ensure data privacy and confidentiality. They should seek informed consent from the patients before sharing any information with the healthcare providers, hence, the protection of autonomy in the care process. Follow-up care is often after four weeks of the first and subsequent treatments (Kupfer, 2005; Pilotto et al., 2020). Patients can benefit from community resources such those by the American Psychological Association and the Centers for Disease Control and Prevention.
Example of Prescriptions
Po escitalopram 10 mg od
Po Sertraline 50 mg od
Po venlafaxine 37.5 mg bd
Conclusion
In conclusion, this paper has explored major depression among elderly populations. The elderly populations are considered vulnerable because of changes in their physiological and physical functioning. Safety should be considered when treating this population due to these changes and existence of multiple comorbidities. Antidepressants are largely used for major depression in the elderly patients. Ethical considerations should inform the selected treatments.
Assessing and Treating Vulnerable Populations for Depressive Disorders
Mental health disorders comprise a major public health concern in the modern world. Mental health problems such as major depression have been increasing in rates, translating into high disease burden for the population. Psychiatric mental health practitioners adopt evidence-based interventions to reduce the overall impacts of these conditions on the population. The adopted treatments are patient-centered to minimize the potential of harm to the populations. Therefore, this paper explores the causes, diagnosis, treatments, monitoring, special considerations, and follow-up for children diagnosed with major depression.
Depressive Disorder Causes and Symptoms
The selected topic of focus is major depression in children. Major depression is a mental health problem that is associated with depressed mood in the affected populations. Children affected by major depression present the hospital with several symptoms. One of them is complaints of persistently depressed mood everyday almost throughout the day. They are also report feelings of guilt or hopelessness everyday almost throughout the day. These patients also lack interest in pleasure. They may be isolated in their communities. They also report changes in sleep quality and quantity and appetite. The accompanying symptoms include weight changes due to the alterations in their appetite. Patients also report difficulties in concentrating, making decisions, and become easily irritated. Some may report suicidal thoughts, attempts, or plans. These symptoms are not attributable to any other cause such as medications use, medical conditions or substance abuse (Y. Kim et al., 2021; Rice et al., 2019). They also affect the social and school function of the children.
Major depression arises from an imbalance between neurotransmitters such as serotonin in the brain. The imbalance affects the patient’s mood, hence, the depressive symptoms. Genetics also contribute to major depression. Children born to families with a history of major depression are highly likely to suffer from the problem. A history of major depression also increases the risk of subsequent depressive episode in the future. Women are also highly likely to develop major depression as compared to males. Life events such as trauma and death of a loved one may also predispose children to depression. The experiences cause stress that potentiate the risk of depression (Gutiérrez-Rojas et al., 2020; Lindberg et al., 2020). Substance abuse and use of some medications may also contribute to the development of major depression.
Diagnosis
Children are considered a vulnerable population because of several reasons. First, children have a specific pattern of development that is highly influenced by different environmental exposures. Accordingly, development issues such as immature immune status increases their risk of harm based on toxic environmental exposures. Children also have decreased autonomy. They do not have the power or abilities to make informed decisions on issues affecting them as compared to the adults. As a result,
their risk of being exploited in the society is high. The treatment of different mental and medical health problems in children and adolescent populations also predisposes them to significant harm. Often, the FDA has not approved most of the drugs used in the treatment of mental health disorders in the children. Instead, practitioners rely mainly on the use of off-label treatments, which increases the vulnerability of the children to unwanted harm (Cuijpers et al., 2020). Therefore, these explain why children are considered a vulnerable population in mental health.
Accurate diagnosis of major depression in children is crucial. Mental health practitioners rely on comprehensive history taking and physical examinations to diagnose children with major depression. History taking provides the practitioners with the understanding of the patient’s subjective experiences with the disorder. Physical examinations help the practitioner to rule out other potential causes of major depression such as child abuse in the family or community. The practitioners also conduct mental status examination to determine the potential distortion of the patient’s mental health and wellbeing (Cuijpers et al., 2020). Diagnostic investigations also help in ruling out potential causes such as hypothyroidism.
Medication Treatment Options
Several medications can be used in treating major depression. The recommended treatment of major depression in children and adolescents entail the use of selective serotonin reuptake inhibitors. This group of antidepressant medications work to improve response and depressive symptoms experienced by children and adolescents with major depression. The drugs include fluoxetine, escitalopram, and paroxetine. Other antidepressants that have demonstrated some effectiveness include desvenlafaxine, venlafaxine, and duloxetine. The use of antidepressants in major depression among the children are associated with side effects such as insomnia and weight gain. The main risk attributed to these drugs is suicidal thoughts, attempts, or plans.
Medication Considerations of Medication Examples
As noted above, several serotonin reuptake inhibitors can be considered for children with major depression. The drugs work by inhibiting the reuptake of serotonin, leading to its accumulatio in the brain and improved mood. The drugs include fluoxetine, escitalopram, and paroxetine. The second line of drugs that may be used include desvenlafaxine, venlafaxine, and duloxetine.
Monitoring Labs and Comorbid Medical Issues
Children using antidepressants for major depression should be monitored for comorbid medical issues. One of them is monitoring the patient’s risk of self-harm. Antidepressants have the increased risk of suicidality among the patients. Practitioners should follow their patients closely to detect and prevent any safety issues in the treatment process. Obese children should also be monitored closely for weight gain. Antidepressants may cause weight gain as its side effect, predisposing the children to obesity and its associated comorbid conditions. Patients should also be monitored for use of any other drugs. Drugs such as non-steroidal anti-inflammatory drugs increase the risk of toxicity with antidepressants use. In addition, concurrent use of antidepressants other antidepressants such as monoamine oxidase inhibitors increases the risk of hypertensive crises among the patients. Serum or plasma monitoring are also important to determine the drug target concentration (Barreto, 2020). Therapeutic drug monitoring enables the optimization of outcomes with the adopted treatments.
Special Considerations
There exist special considerations when prescribing antidepressants to children suffering from major depression. One of them is the ethical considerations in psychiatric mental health nursing practice. Practitioners should adopt evidence-based practices in prescribing antidepressants to ensure safety in the care process. They should also obtain informed assent from the parents and guardians to ensure justice. Cultural considerations also inform the treatment of major depression. The practitioners should prioritize the diverse cultural values, beliefs, and practices of their patients in the treatment. Cultural practices characterized by the stigmatization of patients suffering from mental health problems may increase the risk of suboptimal outcomes. In addition, cultural practices such as the use of traditional medicines may affect the realization of the desired outcomes (Y.-K. Kim, 2021). Practitioners should ensure that the developed treatments align with the cultural expectations of their patients for optimum outcomes such as satisfaction and improved adherence.
Legal aspects such as practicing within the scope of practice when prescribing antidepressants also influences practitioners’ role in treating major depression in children. Prescribing within the scope prevents legal issues that would hinder optimum care outcomes in depression treatment. Data privacy and confidentiality must also be maintained in the treatment process. Social determinants of health such as educational level, employment status, income, and poverty also influence treatment effectiveness. Factors such as educational level affect patient and family understanding of the need for the treatment and adherence. Income and poverty affect the utilization of the available care services by the population (Y.-K. Kim, 2021). Therefore, they affect the effectiveness of the desired treatments for children and adolescents with major depression.
Follow-up in Local Community
Children and their families can acquire more information about major depression from organizations such as the American Psychological Association and the Centers for Disease Control and Prevention. The other organizations include the National Institute of Mental Health, Mental Health America, Anxiety and Depression Association of America, and National Suicide Prevention Lifeline. They can also benefit from social support groups for people with mental health problems within their communities. The groups help patients in learning how to manage major depression optimally.
Examples of Prescription
Name: A.Y
Age: 12 years
Diagnosis: Major depression
Treatment
Paroxetine po 50 mg od
Fluoxetine po 20 mg od
Escitalopram po 10 mg od
Medication refill: none
Signature: Date:
Conclusion
In summary, major depression is among the mental health disorders that affect children. Children present the hospital with symptoms such as depressed mood. Antidepressants are the mainstay treatment for major depression in children. Benefits and risks should be considered before prescribing antidepressants. Practitioners should be aware of the special considerations that inform their practice.
References
Barreto, T. (2020). Treatment of Depression in Children and Adolescents. American Family Physician, 102(9), 558–561.
Cuijpers, P., Stringaris, A., & Wolpert, M. (2020). Treatment outcomes for depression: Challenges and opportunities. The Lancet Psychiatry, 7(11), 925–927. https://doi.org/10.1016/S2215-0366(20)30036-5
Gutiérrez-Rojas, L., Porras-Segovia, A., Dunne, H., Andrade-González, N., & Cervilla, J. A. (2020). Prevalence and correlates of major depressive disorder: A systematic review. Brazilian Journal of Psychiatry, 42, 657–672. https://doi.org/10.1590/1516-4446-2020-0650
Kim, Y., Kim, K., Chartier, K. G., Wike, T. L., & McDonald, S. E. (2021). Adverse childhood experience patterns, major depressive disorder, and substance use disorder in older adults. Aging & Mental Health, 25(3), 484–491. https://doi.org/10.1080/13607863.2019.1693974
Kim, Y.-K. (2021). Major Depressive Disorder: Rethinking and Understanding Recent Discoveries. Springer Nature.
Lindberg, L., Hagman, E., Danielsson, P., Marcus, C., & Persson, M. (2020). Anxiety and depression in children and adolescents with obesity: A nationwide study in Sweden. BMC Medicine, 18(1), 30. https://doi.org/10.1186/s12916-020-1498-z
Rice, F., Riglin, L., Lomax, T., Souter, E., Potter, R., Smith, D. J., Thapar, A. K., & Thapar, A. (2019). Adolescent and adult differences in major depression symptom profiles. Journal of Affective Disorders, 243, 175–181. https://doi.org/10.1016/j.jad.2018.09.015
| Excellent | Good | Fair | Poor | ||
| Main Posting | 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. |
40 (40%) – 44 (44%)
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At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. |
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
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Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors. |
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style. |
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| Main Post: Timeliness | 10 (10%) – 10 (10%)
Posts main post by day 3. |
0 (0%) – 0 (0%) | 0 (0%) – 0 (0%) | 0 (0%) – 0 (0%)
Does not post by day 3. |
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| First Response | 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English. |
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English. |
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
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0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited. |
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| Second Response | 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English. |
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English. |
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. |
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited. |
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| Participation | 5 (5%) – 5 (5%)
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0 (0%) – 0 (0%) | 0 (0%) – 0 (0%) | 0 (0%) – 0 (0%)
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| Total Points: 100 | |||||