Olivia is a 16-year-old biracial female. She reports feeling down and depressed nearly every day for the past 2 weeks. She has also withdrawn from drama club, an extracurricular activity that she previously enjoyed. She denies any recent losses or being bullied but feels that her ability to concentrate has decreased. Her mother shares that Olivia is spending more time sleeping or napping alone in her room, seems sullen and withdrawn and irritable when she does interact with family. Olivia’s mother notes that Olivia’s appetite has declined and that Olivia remarks that she is not hungry with most meals. Olivia’s mother tells the provider that Olivia does not seem interested in most of her usual activities or her phone. Olivia comments to the provider that she feels that her family and friends would be better off if she “weren’t around.” She denies thoughts or plans of hurting herself or others.
Select a first-line medication, based on tolerability and low side effect profile, for the treatment of her severe depression. Please include the available evidence and treatment guidelines. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including interactions with CAM. Identify an additional (possibly off-labeled) use of the medication not related to depression or psychosis. Discuss evidence and treatment guidelines to determine appropriate therapeutic options for this patient. Include the name of the medication in the subject line so that the medications can be followed. Include references using APA format.
TOPIC 4 DQ 1
TOPIC 4 DQ 1
Fluoxetine (Prozac) is the most prescribed SSRI. Fluoxetine (Prozac) and different drugs in this classification work well by blocking neuronal reuptake of the neurotransmitter serotonin. The blockage causes an increment in serotonin in synapses, thus treatment deficiencies that lead to depression. It is critical to note that depression can be caused by inadequate serotonin. The blocking occurs within hours of drug ingestion; the patient does not encounter symptom relief for another six months of continuous treatment. Fluoxetine (Prozac) is certified to be utilized in treating bipolar, panic disorder, and OCD.
The off-label utilization of Fluoxetine (Prozac) entails premature ejaculation, generalized panic disorder, treatment of diabetic neuropathy, migraine headaches, and fibromyalgia (Li et al., 2019). In the case of premature ejaculation, a 20mg daily dose of Fluoxetine (Prozac) is appropriate and effective. Adverse impacts of Fluoxetine (Prozac) are milder than MAOI and tricyclic antidepressants (Jannini et all., 2022). The most prevalent side effects are nausea, anxiety, headache, sexual dysfunction, and insomnia. The symptoms include fever, myoclonus, altered mental status, excessive sweating, tremor, and hyperreflexia.
One of the effects of SSRIs is a likelihood for the serotonin syndrome to arise, which occur soon, that is, 2-72 hours after initiation of the drug. It resolves instinctively after stopping using the medication. The risk of the syndrome leads to an increment in the concurrent utilization of MAOIs. It is essential to highlight that Fluoxetine should not be used together with lithium or tricyclic antidepressants (Rosenthal & Burchum, 2021). When Fluoxetine is combined with warfarin and aspirin or leads to increment risks of gastrointestinal bleeding, discontinuing the use of Fluoxetine should not occur abruptly; instead, it should be done through tapering. Generally, except for serotonin syndrome, the adverse side effects of as compared to MAOI or tricyclic antidepressants are minor.
Jannini, T. B., Lorenzo, G. D., Bianciardi, E., Niolu, C., Toscano, M., Ciocca, G., … & Siracusano, A. (2022). Off-label uses of selective serotonin reuptake inhibitors (SSRIs). Current Neuropharmacology, 20(4), 693-712.
Li, X., Li, J., Li, X., Wang, J., Dai, H., & Wang, J. (2019). Effectiveness and safety of fluoxetine for premature ejaculation: Protocol for a systematic review. Medicine, 98(7).
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier.