Case Study: An Elderly Hispanic Man with Major Depressive Disorder
NURS: 6630 Psychopharmacologic Approaches to Treatment of Psychopathology
Walden University
1/1/2021
Case Study: An Elderly Hispanic Man with Major Depressive Disorder
“The client is a 32-year-old Hispanic American male who came to theUnited States when
he was in high school with his father. His mother died back in Mexico when he was in school.
, He presents today to thePMHNPs office for an initial appointment for complaints of depression.
theclient was referred by his PCP after “routine” medical work-up to rule out an organic basis for
his depression. He has no other health issues with theexception of some occasional back pain and
“stiff” shoulders which he attributes to his current work as a laborer in a warehouse.”
Decision #1
My first decision in this case study was to begin Effexor XR 37.5mg orally daily. I chose
Venlafaxine XR because at low doses theside effects of themedication are less likely to occur.
Venlafaxine XR boosts neurotransmitters serotonin, norepinephrine/noradrenaline and dopamine
(Stahl, 2013). It has been shown to have good efficacy and tolerance, and also to have greater
efficacy than SSRI in thetreatment of severe depression (Ivanets et. al, 2016). It blocks serotonin
reuptake pump which then increases serotonergic neurotransmission (Stahl, 2013). I chose not to
prescribe Zoloft because this is a fairly young man and one of themost common side effects of
Zoloft is sexual dysfunction (Stahl, 2013). I did not want to start him on Phenelzine because it is
an MAOI and these are usually used when other antidepressants do not work. There are also
rigid dietary restrictions for this medication (Stahl, 2013). In theextended release Venlafaxine
theinitial dose starts at 37.5mg (Walters Kluwer Clinical Drug Information, 2018). With this
decision I was hoping to see at least a 25% reduction in symptoms because this was a low dose
of themedication. thedifference between what I was hoping for and theactual outcome was that
thepatient returned in four weeks and had no change in depressive symptoms.
Decision #2
After this patient returned with no change in symptoms after four weeksmy second
decision was to increase his dose to 75mg of Effexor XR orally daily. This is therecommended
increase after theinitial dosing of 37.5mg (Walters Kluwer Clinical Drug Information, 2018).
NURS: 6630 Psychopharmacologic Approaches to Treatment of Psychopathology
Walden University
1/1/2021
Case Study: An Elderly Hispanic Man with Major Depressive Disorder
“The client is a 32-year-old Hispanic American male who came to theUnited States when
he was in high school with his father. His mother died back in Mexico when he was in school.
, He presents today to thePMHNPs office for an initial appointment for complaints of depression.
theclient was referred by his PCP after “routine” medical work-up to rule out an organic basis for
his depression. He has no other health issues with theexception of some occasional back pain and
“stiff” shoulders which he attributes to his current work as a laborer in a warehouse.”
Decision #1
My first decision in this case study was to begin Effexor XR 37.5mg orally daily. I chose
Venlafaxine XR because at low doses theside effects of themedication are less likely to occur.
Venlafaxine XR boosts neurotransmitters serotonin, norepinephrine/noradrenaline and dopamine
(Stahl, 2013). It has been shown to have good efficacy and tolerance, and also to have greater
efficacy than SSRI in thetreatment of severe depression (Ivanets et. al, 2016). It blocks serotonin
reuptake pump which then increases serotonergic neurotransmission (Stahl, 2013). I chose not to
prescribe Zoloft because this is a fairly young man and one of themost common side effects of
Zoloft is sexual dysfunction (Stahl, 2013). I did not want to start him on Phenelzine because it is
an MAOI and these are usually used when other antidepressants do not work. There are also
rigid dietary restrictions for this medication (Stahl, 2013). In theextended release Venlafaxine
theinitial dose starts at 37.5mg (Walters Kluwer Clinical Drug Information, 2018). With this
decision I was hoping to see at least a 25% reduction in symptoms because this was a low dose
of themedication. thedifference between what I was hoping for and theactual outcome was that
thepatient returned in four weeks and had no change in depressive symptoms.
Decision #2
After this patient returned with no change in symptoms after four weeksmy second
decision was to increase his dose to 75mg of Effexor XR orally daily. This is therecommended
increase after theinitial dosing of 37.5mg (Walters Kluwer Clinical Drug Information, 2018).
