Based on the two attached discussions: Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the lite
DISCUSSION A
Week 9 Main Discussion Post
Major depressive disorder (MDD) is characterized by a persistently depressed mood, decreased interest in or enjoyment of formerly enjoyable activities, recurrent suicide ideation, as well as physical and cognitive symptoms. People with MDD may have a decreased quality of life because of the illness itself, related medical comorbidities, social issues, and compromised functional outcomes. There is no single biochemical or environmental mechanism that can fully explain MDD because it is a complex condition. Instead, a confluence of biological, psychological, environmental, and hereditary variables are present in the etiology of MDD. . Treatment for Major Depressive Disorder (MDD) frequently involves psychotherapy, pharmacological therapy, or a combination of the two (Marx et al., 2023).
Pharmacological And Non-Pharmacological Interventions for Treating Major Depressive Disorder in Pregnant Women
About 20% of pregnant women experience depression; 12% of these cases need to be treated. These conditions are linked to smoking, malnutrition, alcohol use, inadequate weight gain, the use of other psychoactive substances, and a higher risk of postpartum depression. This percentage stays the same for women during the first six months following childbirth. Suppose depression is left untreated during this period of rapid changes and adaptations. In that case, the mother-baby binomial may experience significant negative outcomes, including the disease worsening, premature birth, low birth weight, preeclampsia, hypertension, impaired child development, a higher risk of psychiatric disorders in children, and issues with affective attachment. In severe circumstances, it may raise the chance of newborn death due to abuse, neglect, reckless behavior, or murder (Junkes et al., 2024).
Prescription medication is still widely used during pregnancy, with antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), being the ones that are commonly used when compared with other drugs that are linked to potentially adverse effects on the neonate. Sertraline, an FDA-approved drug, is a first-choice treatment for depression during pregnancy and is one of the most commonly utilized SSRIs globally. This is due to its safety and effectiveness in treating MDD (Junkes et al., 2024). Buspirone is an FDA-approved drug for anxiety disorders but was my off-label medication of choice for MDD due to studies of its effectiveness in the treatment of MDD during pregnancy and its classification as a category B medication (Butkevich et al., 2019). Some pregnant women might not be comfortable with using medications during pregnancy. This might be due to the fear of the teratogenic effects of medications on the unborn child. One non-pharmacological treatment for MDD during pregnancy is cognitive behavioral therapy (CBT). It is one of the first psychotherapy options for depression and focuses on altering detrimental ideas and cognitive distortions as well as persistently distressing behavioral habits (Li et al., 2022).
Risk Assessment for Treatment Decision-Making
The risk assessment used to inform my treatment decision-making is the severity of the depression and how long the condition has persisted. The outcome of untreated depression during pregnancy was also weighed against using pharmacological treatment during pregnancy. The risks of using sertraline during pregnancy, according to animal studies, include withdrawal symptoms in the neonate, decreased body weight, and impaired growth of the heart (Creeley & Denton, 2019). Despite these negative effects, Sertraline is one of the drugs that is recommended for the treatment of depression due to its overall safety profile and effectiveness. Buspirone, though not an FDA-approved medication for MDD, has been used off-label for the treatment of MDD during pregnancy due to its effectiveness and safety profile. Research has found no congenital malformations associated with using Buspirone during pregnancy (Freeman et al., 2022).
Clinical guidelines exist for the treatment of MDD during pregnancy. It includes recommendations on how to treat and manage mental health illnesses that affect pregnant women, such as anxiety, depression, bipolar disorders, and acute postpartum psychosis. They place a special emphasis on psychopharmacotherapy. Recommendations are categorized based on the strength and quality of evidence. Guidelines according to the American College of Obstetricians and Gynecologists (ACOG) include the recommendation that psychotherapy should be the first line of treatment for mild-to-moderate perinatal depression. Also, SSRIs are to be used as first-line pharmacotherapy for depression during pregnancy, with sertraline or escitalopram as first-line medications. Furthermore, ACOG recommends against the discontinuation of mood stabilizers except for valproate during pregnancy due to the risk of exacerbation of mood symptoms (ACOG PUBLICATIONS, 2023).
DISCUSSION B
One of the prevalent conditions in elderly people is Generalized anxiety disorder (GAD), which results in a permanent sense of concern and anxiety. The DSM-5-TR describes GAD as involving excessive and moderate worry, occurring for more than half the days in the last six months. Some of the symptoms are headache, itching, leg restlessness, tiredness, temper, muscle rigidity, and insomnia. When diagnosing and treating GAD, it is essential to take into consideration older people’s physiological changes, different diseases, and complications while using polypharmacy. (Boland, Verdiun & Ruiz 2022). This debate provides an FDA-approved medication, possibly an off-label drug, and a nonpharmacologic option for this person with GAD using risk-benefit analysis.
FDA-Approved Drug: Sertraline
Sertraline in GAD treatment is approved by the FDA (Singh & Saadabadi, 2023). Because of their effectiveness and favorable risk profile, SSRIs are usually the first choice of treatment for anxiety disorders.
Risks and benefits
Sertraline reduces anxiety symptoms, has low adverse effects compared to tricyclic antidepressants (TCAs), and is used once a day, which improves adherence. However, sertraline has hazards. Older people are more likely to experience adverse effects, including gastrointestinal problems, hyponatremia, and bleeding, especially when coupled with NSAIDs or anticoagulants. These side effects must be monitored and dosage adjusted.
Off-Label Medication: Pregabalin
Its anxiolytic qualities make pregabalin a popular off-label treatment for GAD. Pregabalin modulates calcium channels to diminish glutamate, norepinephrine, and substance P release.
Risks and benefits
Pregabalin reduces physical and psychological anxiety and has a fast beginning of action, which is helpful for patients who need immediate relief (Cross et al., 2020). Possible side effects include dizziness, sedation, and dependence. These adverse effects may increase falls and fractures in older people. Renal impairment, which is frequent in elderly people, may require dose changes.
Nonpharmacological Intervention: Cognitive-Behavioral Therapy (CBT)
CBT for GAD is a proven, nonpharmacological treatment. CBT helps patients discover and change faulty thinking and create healthier coping skills.
Risks and Benefits
CBT reduces anxiety symptoms and provides long-term relief using its skills. For elderly people on many drugs, CBT is ideal because it has no physiological side effects. CBT needs regular sessions and homework, which may be difficult for older people with cognitive or physical impairments. Accessibility and individualized therapy can help older adults overcome these barriers.
Clinical Practice Guidelines and Risk Assessment
Risk evaluation for treating GAD in older persons should incorporate age-related pharmacokinetic and pharmacodynamic changes, drug-drug interactions, comorbidities, and functional status. More specific intervention implies progressive observation of patients and further modification of treatment programs, as well as the detection and minimization of side effects.
Clinical Practice Guidelines
The APA and NICE have the GAD clinical practice guidelines. These guidelines recommend SSRIs for GAD as first-line treatments on the basis of the drugs’ favorable risk-benefit ratio. They also identify CBT as the nonpharmacological treatment for the condition. In general, pregabalin is far from being recommended as a first-line medication; nonetheless, it is beneficial for patients who still cannot tolerate SSRIs.
In conclusion, the discussion guided by the case of GAD in an older adult highlights that the management of this condition requires a cautious and patient-specific approach to choosing between pharmacological and nonpharmacological interventions. Sertraline has the characteristics of an FDA-approved drug with good efficacy and safety. Pregabalin can be recommended as an excellent off-label drug, especially for patients requiring quick relief from the symptoms. CBT continues to be described as the gold standard for engaging patients and appears to confer lasting advantages over medications without side effects. Clinically grounded practice guidelines and risk assessment can enable clinically safe, effective, and individualized treatment planning for older adults.
