Reference no: EM133635285

History: Angela is a 54-year-old married woman with three adult children. She has been the office manager of a small law firm for 20 years and has enjoyed her work until this past year. She has rheumatoid arthritis with minimal impairment that has been managed well with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). She has been taking conjugated estrogens for 8 years and decided to stop taking them because of her concern of their risks without sufficient medical benefit. She has tolerated the discontinuation without difficulty.

Assessment: At her annual medical checkup appointment, she reports feeling tired all of the time, and she was gaining weight because she had no interest in her usual exercise activities and had been overeating, not from appetite but out of boredom. She denied that she and her husband have had marital difficulties beyond the ordinary and she was pleased with the achievements of her children. She noticed that she has difficulty falling asleep at night and awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep even though she still feels tired. She finds little joy in her life but cannot pinpoint any particular concern. Although she denies suicidal feelings, she does not feel that there is meaning to her life: "My husband and kids would go on fine if I died and probably would not miss me that much." The CNS asks Angela to fill out a Beck's Depression Scale, which indicates that she has moderate depression.

Answer the following questions related to this case study.  

1. What classes of drugs are used in the management of depression? .
2. What would be the initial pharmacotherapy management plan for the patient's depression?
3. What are the monitoring parameters for a patient receiving an antidepressant?
4.  At the follow-up visit the patient reports no improvement in symptoms and states she stopped taking the citalopram (Celexa) because it wasn't working. What additional information does the patient need regarding the achievement of results from an SSRI?
5. The patient complains of morning nausea and vertigo while taking citalopram. What would be another pharmacotherapy treatment option?
6. How soon should the patient return to the clinic after the change in medication for follow-up of drug effectiveness?
7. After taking 2 weeks of escitalopram (Lexapro), Angela returns to the clinic for a follow-up visit. She states that she does not feel much different but may be less tired. She reports that the nausea and vertigo she experienced with citalopram has not occurred with escitalopram. What would be the next step in treatment?
8. At what point should the provider consider tapering Angela off the SSRI therapy?
9. Prepare a CNS Prescriber Drug Therapy Plan for the patient in this case study.