Patient Guide Chart

Step: 1 Select a vulnerable patient from the list provided.
Consider age, birth-assigned sex, FDA approvals, and risk and side-effect consideration.
Select the most appropriate medication for your selected patient based upon the information provided.
Review the textbook for commonly prescribed antidepressants, Fast Facts for Psychopharmacology for Nurse Practitioners.
Review the textbook Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Chapters assigned
Patient 3:
Patient Selected : 72-year-old male with diagnosis of major depressive disorder and panic disorder. He has cardiac history and takes antihypertensive medications. Choose one of the following vulnerable patients to create a Medication Guide for the patient: 2: Create a Medication Guide for a patient. In your guide, you should provide the following specific instructions for the patient:
a Medication Guide for a patient. In your guide, you should provide the following specific instructions for the patient:
Describe the chosen classification of medications, from the classification category, for your chosen vulnerable patient. Explain your rationale for your choice.
Explain what dose you would start the chosen medication with and the frequency.
Discuss how the medication works to treat their symptoms.
Explain how long they should take the medication.
Discuss the typical or common side effects of the medication.
Explain the urgent or emergent considerations for the patient taking the medication.
The Medication Guide should also include:

Directions you would provide the patient on how to take the prescribed medication
Instructions on what the patient should do if a medication dose is missed
List of any other medications, over-the-counter medications, and/or supplements/herbals the patient should avoid while taking the prescribed medication
List of foods the patient should avoid when taking this medication
Date when the patient should return for follow-up visit with you
Discussion about the legal and ethical considerations for the medication being prescribed
Answers in consideration of Social Determinants of Health on how you would:
Assist the patient who cannot not afford to pay financially for the medication you are recommending/prescribing; and/or
Has difficulty with transportation that impacts their ability to present for regular appointments with you
Discuss how financial hardship and lack of transportation could relate to Social Determinants of Health, as well as why they are important considerations for you as a prescriber.

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Medication Guide for Patients with Major Depressive and Panic Disorder

Chosen Medication: Sertraline (Zoloft)

Sertraline is a selective serotonin reuptake inhibitor (SSRI) whose mechanism of action is to enhance the activity of a chemical referred to as serotonin in the brain. Sertraline has been selected as a medication for the patient since it has been shown to be effective in treating major depressive disorder (Luo et al., 2023). Sertraline has further been shown to be well-tolerated, especially among older adults (Srifuengfung et al., 2023). Due to the patient’s cardiac history, SSRIs are preferred over other antidepressants since they have a lower risk of cardiac side effects. Sertraline has a lower risk of drug interactions with antihypertensive medications and is thus recommended for patients with a cardiac history due to the established safety profile (Gutlapalli et al., 2022).

Medication Classification and Rationale

Initial Dose: 25 mg orally once daily

Adjustment: Increase the dose gradually by 25 mg every week as tolerated, up to a maximum of 50 mg daily.

Frequency: Ensure you take the medication at the same time each day, preferably in the morning.

Sertraline’s Mechanism of Action

Sertraline’s mechanism of action involves increasing the levels of serotonin in the brain. Serotonin is a neurotransmitter that plays a major role in the process of mood regulation. In their study, Edinoff et al. (2021) noted that the primary mechanism of SSRIs, a class category to which sertraline belongs, is to inhibit the presynaptic reuptake of the serotonin transporter, which leads to a rise in serotonin levels at the postsynaptic membrane within the serotonergic synapse. By improving the level of serotonin activity, sertraline plays a critical role in enhancing mood, lowering anxiety, and alleviating symptoms of depression and panic disorder.

Duration of Treatment

The duration of the treatment will be based on the response and the severity of the symptoms. Continue taking the medication as prescribed, even when you start feeling better. Sertraline treatment is expected to last between six to 12 months from the first episode of depression (Luo et al., 2023). In this case, due to the recurrent depression, longer-term treatment with the medication may be necessary. Ensure you do not stop taking the medication without consultation with the healthcare provider.

Common Side Effects

While sertraline tends to be generally better tolerated than other antidepressants, it is also associated with common side effects. The common side effects associated with sertraline include nausea, vomiting, insomnia, headache, diarrhea, sexual dysfunction, and weight gain or loss (Edinoff et al., 2021). In their study, Renemane and Rancans (2024) noted that while sertraline is preferred due to its efficacy, safety, and tolerability, it is linked to several side effects such as nausea, insomnia, sexual dysfunction, diarrhea, dizziness, dry mouth, and fatigue, which ranges between mild to moderate but tends to reduce over time.

Urgent Consideration

Seek immediate medical attention in case you experience the following symptoms:

Severe allergic reactions: possible signs of allergic reactions include rash, itching, swelling, severe dizziness, and difficulty breathing.
Serotonin syndrome: While this is a rare condition, it is potentially a life-threatening condition that can be experienced due to excess serotonin in both peripheral (PNS) and central nervous systems (CNS) (Scotton et al., 2019). The condition presents with several symptoms, including agitation, confusion, fever, sweating, and muscle rigidity. In case these symptoms occur, it is important to seek immediate medical attention.
Sertraline-induced hypersensitivity pneumonitis; this condition is a granulomatous non-IfE-mediated hypersensitivity reaction of the alveoli and distal bronchioles that may present either as acute subacute or chronic effect. In their study, Virdee et al., (2019) noted that sertraline is an aetiological factor for the condition.
Suicidal thoughts or behaviors: It is important to monitor possible signs of suicidal thoughts or behavior, especially in the early stages of the treatment.

Specific Instructions for the Patient

Taking the Medication

Take sertraline orally once daily as per the prescription

You can take it with or without food.

Do not double dose.

Missed Doses

In case you miss a dose, take it as soon as you remember, unless it is close to the time for the next does.

Do not double the dose in an attempt to make up for the missed dose.

Avoidance

Other medications: Inform your doctor about all other medications you may be taking, including over-the-counter drugs, herbal supplements, and prescription medications.

Alcohol: Avoid excessive alcohol consumption while taking sertraline since it may worsen the risk of side effects.

Grapefruit and grapefruit juice: These products may interfere with sertraline’s metabolism and lead to an increase in blood levels.

Follow-up

Follow-up appointment to be scheduled in 4 weeks.

Legal and Ethical Considerations

The medication is prescribed based on the evaluation of the patient’s condition and medical history.

The medication should only be used as prescribed and should not be shared with others.

Your medication information and treatment plan are maintained confidential as per the HIPAA regulations.

Social Determinants of Health Considerations

Financial Assistance

In case of difficulty in affording this medication, it may be important to explore other options including but not limited to:

Use of generic alternatives
Patient assistance programs provided by various pharmaceutical companies

Transportation issues

In case of possible challenges with transportation, consider the following

Telehealth for follow-up appointments
Coordination with local community services offering transportation assistance
Extending the durations for prescriptions to reduce the frequency of the visits.

Social Determinants of Health, including financial stability and access to transportation, significantly impact a patient’s ability to adhere to treatment plans. Taking these factors into account helps to promote medication adherence, ensure regular follow-up care, and aid in enhancing the success of the treatment plan.

References

Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., … & Kaye, A. M. (2021). Selective serotonin reuptake inhibitors and adverse effects: a narrative review. Neurology International, 13(3), 387–401. https://doi.org/10.3390/neurolint13030038

Gutlapalli, S. D., Prakash, K., Swarnakari, K. M., Bai, M., Manoharan, M. P., Raja, R., … & Alfonso, M. (2022). The risk of fatal arrhythmias associated with sertraline in patients with post-myocardial infarction depression. Cureus, 14(9). https://doi.org/10.7759/cureus.28946

Luo, X., Zhu, D., Li, J., Ren, M., Liu, Y., Si, T., & Chen, Y. (2023). Selection of the optimal dose of sertraline for depression: A dose-response meta-analysis of randomized controlled trials. Psychiatry Research, 115391. https://doi.org/10.1016/j.psychres.2023.115391

Renemane, L., & Rancans, E. (2024). Sertraline induced acute hepatocellular liver injury in a patient with major depressive disorder: a case report. Frontiers in Psychiatry, 15, 1456455. https://doi.org/10.3389/fpsyt.2024.1456455

Scotton, W. J., Hill, L. J., Williams, A. C., & Barnes, N. M. (2019). Serotonin syndrome: pathophysiology, clinical features, management, and potential future directions. International Journal of Tryptophan Research, 12, 1178646919873925. 10.1177/1178646919873925

Srifuengfung, M., Pennington, B. R. T., & Lenze, E. J. (2023). Optimizing treatment for older adults with depression. Therapeutic Advances in Psychopharmacology, 13, 20451253231212327. https://doi.org/10.1177/20451253231212327

Virdee, G., Bleasdale, J., Ikramullah, M., & Graham-Clarke, E. (2019). Sertraline-induced hypersensitivity pneumonitis. BMJ Case Reports CP, 12(12), e230724. https://doi.org/10.1136/bcr-2019-230724

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Depression
Treatments
for Older
Adults
APA’s Clinical Practice Guideline recommends three psychotherapy interventions as
well as a second-generation antidepressant (selective-serotonin reuptake inhibitors —
SSRIs, selective-norepinephrine reuptake inhibitors — SNRIs or
norepinephrine-dopamine reuptake inhibitors — NDRIs) for the treatment of depression
in older adults.
The information below about the recommended interventions is intended to provide
clinicians with a basic understanding of the specific treatment approach. Clinicians are
encouraged to become familiar with each of the different interventions to determine
which of these might be consistent with their practice, to develop a plan for additional
training and professional development, and to become informed about the range of
evidence-based treatment options in order to help patients with decision-making and
any necessary referrals. The information contained herein is not sufficient to enable one
to become proficient in delivering these treatments. Clinicians are encouraged to pursue
training opportunities and, to become fully competent in new interventions, to receive
consultation or supervision while first delivering the intervention. Clinicians and patients
should engage in shared decision-making to determine which intervention is right for
each clinical situation.
Group Cognitive-Behavioral
Therapy (Group-CBT)
Cognitive-behavioral therapy targets current problems and symptoms and focuses on
the relationship among behaviors, thoughts, and feelings, and aims to change those
patterns that reduce pleasure and interfere with a person’s ability to function at their
best.
MORE
Interpersonal Psychotherapy
(IPT)
Interpersonal psychotherapy focuses on improving problematic relationships and
circumstances that are most closely linked to the current depressive episode. If
considering this treatment for older adults with depression, the panel recommends
augmenting with a second-generation antidepressant.
MORE
Group
Life-Review/Reminiscence
Therapy
Group life-review/reminiscence therapy helps older persons focus on their life arc,
reviewing and reflecting on transitions and challenges, to arrive at a more balanced and
accepting perspective of life.
MORE
Medications
Second-generation antidepressants (SSRIs, SNRIs or NDRIs) are recommended for
older adults due to the reduced risk of side effects and safety in the event of overdose.
If considering medication for older adults with depression, the panel recommends
combining it with interpersonal psychotherapy.
MORE
This website is for informational and educational purposes only. The content is not
intended to be a substitute for professional medical or psychological advice, diagnosis
or treatment. APA recommends that individuals consult with a mental health
professional in order to obtain an accurate diagnosis and to discuss various treatment
options. When you meet with a professional, be sure to work together to establish clear
treatment goals and to monitor progress toward those goals. Even treatments that have
scientific support will not work for everyone, and carefully monitoring your progress will
help you and your mental health professional decide if a different approach should be
tried.
Last updated: January 2023Date created: August 2019
Treatments by Age
CHILDREN AND ADOLESCENTS
ADULTS
OLDER ADULTS
CASE EXAMPLES
DECISION AID
RESOURCES
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