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Assessing and Treating Adult and Geriatric Clients With Mood Disorders
When the 32-year-old Hispanic American male was presented to me, my first decision involved a prescription of Effexor XR 37.5mg to be taken orally daily for four weeks. Venlafaxine hydrochloride – an antidepressant that belongs to a category of medications referred to as Serotinin-Noradrenaline Reuptake Inhibitors – is one of the key components that make up Effexor XR (Wyeth Pharmaceuticals Inc., 2004).
Previous clinical studies on this drug reveal that Effexor XR has an active metabolite (O-desmethylvenlafaxine, ODV) effect, which facilitates the inhibition of norepinephrine and neuronal serotonin absorption. It also facilitates the reabsorption of weak inhibitors of dopamine. Venlafaxine component affects certain chemicals in the human brain that tend to be unbalanced in patients suffering from depression. As such Effexor XR is prescribed to patients with severe depressive disorder, panic disorder and anxiety. Moreover, the antidepressant effects of this drug last for three days after ingestion. This means that the chances of depression relapse are minimal.
Expectations
By prescribing Effexor XR 37.5 mg I hoped to achieve satisfactory results. First of all, since this drug has venlafaxine component, I expected the severity of depression to reduce by at least 4 points (Federal Drug Association, 2012). On the same note, It was anticipated that the symptoms would start to improve within 14 days. The full beneficial implications of Effexor ought to have been felt by the end of the fourth week.
Difference between Expectations and Outcomes
To start with, by prescribing a lower dosage of Effexor XR (37.5mg), I expected the severity of depression to reduce by at least four points. The preclinical trials of the drug show that 136 mg daily is the optimum dosage of the medication. My decision to administer a lower dosage was informed by the fact that I was determined to reduce the possibility of triggering hypersensitive reactions (Federal Drug Association, 2012). Apparently, there was no change in depressive symptoms at all. In addition, given O-desmethylvenlafaxine is an active metabolite, I expected the patient to experience mild side effects of the drug such as nausea, myoclonus, hyperthermia, delirium, and vomiting. The outcome was totally the opposite. These differences between expectations and outcome can be attributed to the lower dosage of Effexor XR.
Decision Two
Following the inability of Effexor XR 37.5mg to treat the symptoms of depression presented by the patient, I found it necessary to change the medication to Cymbalta 30 mg orally daily. A number of reasons informed my decision.
First, Cymbalta is more effective in the treatment of depression symptoms compared to Effexor XR. It is used in the treatment of acute depression (symptom remission), preventing depression relapse (continuation phase), as well as eliminating the possibility of recurrence or new episodes of depression (maintenance phase) (EMEA, 2005). Moreover, Cymbalta has duloxetine component which is more effective in inhibiting the absorption of norepinephrine and neuronal serotonin compared to venlafaxine.
On the same note, the drug has no substantial affinity for cholinergic, histamine, glutamate, opioid, adrenergic, dopaminergic as well as GABA rec…………….
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