Discussion
Angela has a moderate depression and has no other serious health conditions. It is necessary to note that the patient report certain sleep issues as she wakes up early in the morning and cannot fall asleep even though she feels tired. The majority of first-line antidepressants are associated with the occurrence of such side effect as insomnia (Weber & Estes, 2015). This health condition makes them inappropriate for the woman with sleep disturbances.
Citalopram can cause sleep issues, but the medication is worth trying since the woman does not reveal any signs of improvement after the initial prescriptions. This drug is appropriate for adults and the elderly, so Angela should take 20mg of citalopram each day in the morning. This regimen should be maintained for two weeks in order to make sure that the medication is appropriate or, on the contrary, has no effect.
It is also noteworthy that the patient should be warned about the adverse impact of overdosing and the possible side effects of the medication. Moreover, it is essential to discuss non-pharmacological methods to treat depression. She can be advised to try a new kind of sport if she is not interested in the physical exercise she used to have. Massage can also be recommended as well as other types of relaxation strategies including meditation or reading a book (depending on the patient’s preferences).
She can also be advised to write a list of things that make her happy and something that make her feel bad, which can help her identify the reason for her condition. Certain dietary recommendations should also be provided in order to address the woman’s weight gain. Angela should eat more fruit and vegetables, low-fat dairy products, and decrease the intake of red meat and sweets. If no improvement is apparent in a week, the patient should visit the doctor again.
One of the reasons for the patient’s state can be sleep issues, so it can be necessary to choose the medication that does not disturb sleep patterns. Fluoxetine can be the most optimal medication for Angela in this case. This drug can cause such side effects as hives, skin rash or itches, restlessness, and inability to remain still. It is stated that the use of fluoxetine can also result in fever, or muscle and joint pain, but these conditions are not very common.
Therefore, although Angela has certain issues with joints, the medication can be prescribed. As far as the dosage is concerned, it is advisable to take 20mg of fluoxetine (immediate-release oral formulations) each day in the morning. It is also important to make sure that the patient accurately follows all the recommendations including the dosage and non-pharmacological strategies. If no significant outcomes are observed, but no side effects, the patient should continue taking the medication following the same regimen. This medication may need several weeks to have the necessary effect.
To sum up, it is possible to prescribe first-line antidepressants and provide recommendations concerning the woman’s lifestyle and dietary habits. It is likely that the improvement will occur within two weeks of proper treatment. If the patient still has disturbing symptoms, she can be prescribed second-line antidepressants. The healthcare professional should also emphasize the importance of having a healthy lifestyle and diet. If this treatment does not improve Angela’s state in several weeks, it will be necessary to consider another type of treatment.
Reference
Weber, M., & Estes, K. (2015). Anxiety and depression. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (pp. 897-912). Philadelphia, PA: F.A. Davis.