Peer 1

What medication would you first prescribe to this patient?
SSRI’s are commonly the initial drug of choice for patients with depression and many of the anxiety disorders (Woo et al., 2020). These drugs demonstrate equal efficacy to the nonspecific SNRI’s with a safe and lower side effect profile (Woo et al., 2020). Sertraline (Zoloft) would be the treatment of choice. Angela would be started on Zoloft 50mg PO daily. The medication must be started in low doses and the doses must be titrated, depending on the response and the side effects experienced (Grover et al., 2017).

She comes back in 2 weeks and states she has not noticed and change in her mood since starting on the medication. What would be your response?
Educating Angela on Zoloft and how long it may take to see results is key and should be initiated prior to starting any Antidepressant and re-educated throughout visits. During acute treatment phase of depression, it is important to monitor the patient’s response to ensure the treatment has been given for a sufficient duration, frequency and dose (Woo et al., 2020). A patient needs about 4 to 8 weeks of optimal dosing of medication to appropriately evaluate whether there is a partial response or no response at all (Woo et al., 2020). If there is some improvement in mood and symptoms, increasing the dose is may be effective.

What are the possible problems with the medication you prescribed?
Zoloft is the most effective and safe of all SSRI’s. Of course, patient’s must be educated on the FDA Black Box warning for any antidepressant: possibility for increase thoughts of suicide. Zoloft can cause birth defects; women of childbearing age should be advised to use birth control to prevent pregnancy. Angela is 54 but should still be educated on this if she has yet to go through menopause.

How long should you continue the treatment regimen?
Patients taking SSRI’s like Zoloft start to see improvement in mood/symptoms after 4 to 8 weeks of treatment (Woo et al., 2020). At times longer if the dose has to be titrated up. Patients show not stop treatment quickly after symptoms improve due to having depression return. It is recommended for patients to stay on their antidepressants after symptoms improve for 6 months to a year. Discussing tapering off any antidepressant is extremely important. Discontinuation syndrome may occur when a patient takes an NNSRI or an SSRI for more than 5 weeks and the dose is sharply reduced or stopped suddenly (Woo et al., 2020). Symptoms include agitation, anxiety, balance problems, nightmares, dizziness, diarrhea, nausea, vomiting, electric shock-like sensations, and flu-like symptoms (Woo et al., 2020).

Reference:

Grover, S., Gautam, S., Jain, A., Gautam, M., & Vahia, V. N. (2017). Clinical practice guidelines for the management of Depression. Indian Journal of Psychiatry, 59(5), 34. https://doi.org/10.4103/0019-5545.196973

Woo, T. M., Wynne, A. L., & Robinson, M. V. (2020). Pharmacotherapeutics for Advanced Practice Nurse prescribers. F.A. Davis Company.