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Prescribing for Older Adults and Pregnant Women
PMHNPs need to take into account the diverse age-related psychological and physiological shifts that occur in older adults when evaluating and addressing their healthcare needs. When prescribing medications for this demographic, PMHNPs must be mindful of changes such as decreased metabolism and alterations in sleep patterns. Additionally, older adults are susceptible to developing concurrent conditions like hypertension, diabetes, and cardiovascular diseases, which can impact the efficacy of psychotropic medications. Factors such as social determinants of health, including poverty, can affect their access to healthcare services and overall well-being. Furthermore, the prevalence of major depressive disorder among older adults is notably high, influenced by various factors such as social isolation, reduced physical activity, cognitive decline, experiences of loss and grief, and the presence of chronic illnesses.
Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating MDD in older adults.
One medication approved by the FDA for managing major depressive disorder (MDD) among older individuals is Lexapro, categorized under the selective serotonin reuptake inhibitors (SSRIs) class (FDA, 2020). Cognitive behavioral therapy (CBT) stands out as a non-pharmacological approach to addressing MDD in older adults. According to Dafsari et al. (2019, p. 2), CBT is a well-established and effective form of psychotherapy for depression. Additionally, Buprenorphine is recognized as an off-label medication for depression treatment in older adults (Serafini et al., 2018).
Risk assessment I would use to inform my treatment decision-making.
Risks and benefits of FDA-approved medicine off-label drug?
To guide treatment decisions for older adults, I would utilize a risk assessment tool, such as the fall risk assessment. Falls among this demographic pose significant concerns, leading to injuries, prolonged hospital stays, and unfavorable outcomes. Moreover, older adults face heightened fall risks due to cognitive and physical decline. Regarding medication options, Lexapro offers several advantages, including its efficacy in depression treatment, minimal drug interactions, safety profile, and lower suicide risk. However, utilizing Lexapro for depression in older adults carries potential drawbacks, such as elevated fall risks due to drowsiness or dizziness, heightened bleeding tendencies, and decreased bone density. Using buprenorphine for depression treatment in older adults offers advantages such as fewer adverse effects, diminished addiction risks, enhanced cognitive function, and better pain control (Serafini et al., 2018). Nonetheless, buprenorphine administration can elevate the likelihood of falls and respiratory depression, as well as induce cognitive decline, potentially hindering their daily functioning (Serafini et al., 2018).
Clinical practice guidelines exist for this disorder and recommendations.
According to the American Psychological Association (2021), the recommended treatments for depression in older adults consist of three psychotherapy interventions and second-generation antidepressants, which encompass SSRIs, SNRIs, or NDRIs. The suggested psychotherapy approaches include group cognitive-behavioral therapy, interpersonal psychotherapy, and reminiscence therapy (American Psychological Association, 2021). SSRIs are prioritized as first-line medications for managing depression in older adults due to their comparatively lower incidence of side effects, as indicated by the National Health Service (2021).
Reference
American Psychological Association. (2021). Depression Treatments for Older Adults. Apa.org.
https://www.apa.org/depression-guideline/older-adults
Dafsari, F. S., Bewernick, B., Biewer, M., Christ, H., Domschke, K., Froelich, L., Hellmich, M.,
Luppa, M., Peters, O., Ramirez, A., Riedel-Heller, S., Schramm, E., Vry, M.-S., Wagner,
M., Hautzinger, M., & Jessen, F. (2019). Cognitive behavioural therapy for the treatment of
late life depression: Study protocol of a multicentre, randomized, observer-blinded,
controlled trial (CBTlate). BMC Psychiatry, 19(1). https://doi.org/10.1186/s12888-019-2412-0Links to an external site.
FDA. (2020). Depression medicines. FDA. https://www.fda.gov/consumers/free-publications-Links to an external site.
women/depression-medicines#SSRI National Health Service. (2021, February 15).
Overview – SSRI antidepressants.
NHS. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and- psychiatry/ssri-antidepressants/overview/Links to an external site.
Serafini, G., Adavastro, G., Canepa, G., De Berardis, D., Valchera, A., Pompili, M., Nasrallah,
H., & Amore, M. (2018). The efficacy of buprenorphine in major depression, treatment-
resistant depression and suicidal behavior: A systematic review.
International Journal of Molecular Sciences, 19(8), 2410.
https://doi.org/10.3390/ijms19082410Links to an external site.
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