Introduction
People who belong to LGBTQI populations are at risk of social exclusion and prejudice, even in the most developed countries with progressive views on human rights. This factor may influence the rates of behavioral and mental health issues among these groups. Depression is one of the most frequent states diagnosed among LGBT. This paper determines the care plan for people from these populations suffering from depression, including diagnostics and treatment interventions.
Epidemiology and Economic Costs
Depression rates for LGBT people are acknowledged to be higher than those for heterosexuals. According to the literature studies, up to 10% of youth demonstrated the symptoms of mood disorders and depression (Russell & Fish, 2016). The issue remains persistent in adult populations. Thus, depression is considered prevalent among gay men, who are three times more likely to develop it compared to heterosexual males (Lee, Oliffe, Kelly, & Ferlatte, 2017). The risk factors include stress processes unique for LGBT patients. Based on the minority stress theory, they are likely to experience institutionalized discrimination, an expectation of victimization, or internalized homophobia (Russell & Fish, 2016). Social influence is one of the critical determinants for developing depression among LGBT people.
The economic costs of this issue are associated with the adverse effect on the social and work life of an individual. Patients suffering from depression are likely to have changes to their normal daily activities (Ceskova, 2016). Depression prevents them from adequately performing their work duties. Also, since depression is frequently linked to suicide, it increases mortality rates within a population. Together, these factors influence the local economy, resulting in the loss of potential profit.
Assessment
Depression within LGBT populations is diagnosed the same way as for other patients. The evaluation is based on criteria outlined in the DSM-5 guidelines (Tolentino & Schmidt, 2018). To have this diagnosis, a patient should have either a depressed mood or loss of interest in life or its pleasure. Secondary symptoms include weight fluctuations, sleep issues, psychomotor agitation or retardation, loss of energy, cognitive and concentration problems, excessive guilt and worthless feeling, and suicidal mood or behavior (Tolentino & Schmidt, 2018). The depression is diagnosed when at least five of them were persistent during at least two weeks.
Pharmacotherapy
Antidepressants (ADs) are considered the primary means for pharmacological treatment of the issue. Levomilnacipran (LVM), which was recently approved for being prescribed to patients with depression, belongs to the group of selective serotonin-norepinephrine reuptake inhibitors (Asnis & Henderson, 2015). The dynamics of the medication are based on its particular effect on transporters of serotonin and norepinephrine. Other receptors, such as dopaminergic or histaminic, are not influenced by LVM. The pharmacokinetics are characterized by a half-life of 12 hours, while in 6-8 hours, concentrations are at the maximum (Asnis & Henderson, 2015). The medication is absorbed in the gastrointestinal system, is bound to protein, and then distributed to the CNS. Metabolism is linked to cytochrome 3A4, which makes LVM a risk factor for interaction with ketoconazole or clarithromycin (Asnins & Henderson, 2015). The medication is excreted from the body by kidneys, which is why it should not be used by patients with severe renal disease symptoms. Common side effects include nausea, hypertension, insomnia, and erectile dysfunction.
Nowadays, antidepressants are frequently classified according to their multimodal influence. This approach may help to better access the patient’s needs based on his or her unique clinical symptoms (Ceskova, 2016). Targeting different networks and neurotransmitters is a factor that allows ADs to have a varying rate of effectiveness based on the initial depression profile. The synergetic effect of different modes of action results in multimodal antidepressants causing a more prolonged remission.
Care Plan
Depression in LGBT patients relies heavily on social factors, which must be considered by an APRN while determining a care plan. Studies suggest that cognitive-behavioral therapy (CBT) helps to improve depression symptoms (Pachankis, Hatzenbuehler, Rendina, Safren, & Parsons, 2015). CBT adapted to the clinical profiles of LGBT patients is based on reliving social stress factors. For example, the results show that people demonstrated a decrease in sensitivity to such stressors as rejection and internalized homophobia (Pachankis et al., 2015). Although the research was conducted within a group of gay men, its implications can be utilized for designing therapy plans for female and youth populations.
Considering the dimension of the LGBT stigma and its effect on depression, it is highly significant for an APRN to develop interactions with patients based on trust. Those people should feel comfortable discussing during therapy social issues they are facing. Questioners filled out by patients, including their LGBT involvement, may help health care providers better understand their needs (Lee et al., 2017). APRNs should also use the appropriate language during therapy to ensure a non-discriminative attitude. Finally, depression symptoms among LGBT youth may be effectively influenced by family support (Lee et al., 2017). An APRN may include parent consulting in a treatment plan to increase the level of family support for such patients.
Conclusion
LGBT people are more likely to suffer from depression than heterosexuals. Risk factors have a social dimension and are associated with homophobia on community and family levels. Pharmacotherapy for LGBT patients with depression would be based on ADs like Levomilnacipran that interfere with neurotransmitters. An APRN should create a treatment plan that would include cognitive-behavioral therapy based on trust and adapted to the individual needs of such people.
References
Asnis, G. M., & Henderson, M. A. (2015). Levomilnacipran for the treatment of major depressive disorder: A review. Neuropsychiatric Disease and Treatment, 11, 125-135. Web.
Ceskova, E. (2016). Current pharmacotherapy of depression – focused on multimodal/multifunctional antidepressants. Expert Opinion on Pharmacotherapy, 17(14), 1835-1837. Web.
Lee, C., Oliffe, J. L., Kelly, M. T., & Ferlatte, O. (2017). Depression and suicidality in gay men: Implications for health care providers. American Journal of Men’s Health, 11(4), 910-919. Web.
Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (2015). LGBT-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: A randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83(5), 875-889. Web.
Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual Review of Clinical Psychology, 12, 465-487. Web.
Tolentino, J. C., & Schmidt, S. L. (2018). DSM-5 criteria and depression severity: Implications for clinical practice. Frontiers in Psychiatry, 9, 450. Web.