After assessing and diagnosing a patient, PMHNPs must take into consideration special characteristics of the patient before determining an appropriate course of treatment. For pharmacological treatments that are not FDA-approved for a particular use or population, off-label use may be considered when the potential benefits could outweigh the risks. Prescribing for Older Adults and Pregnant Women
In this Discussion, you will investigate a specific disorder and determine potential appropriate treatments for when it occurs in an older adult or pregnant woman.
Prescribing for Older Adults and Pregnant Women
- Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.
The selected population is older adults. The specific DSM-5-TR disorder to use is major depressive disorder (MDD).
One of the FDA-approved drugs for treating major depressive disorder is Sertraline (Zoloft). Sertraline is a Selective Serotonin Reuptake Inhibitor (SSRI) approved to treat MDD in older adults because it is associated with fewer side effects, lower risk of sedation, and has minimal drug-to-drug interactions. Its mechanism of action is that it inhibits the reuptake of serotonin. It increases its availability in the synaptic cleft to help regulate mood, emotion, and sleep.
An example of an off-label drug that can be used to treat MDD in older adults is Mirtazapine (Remeron). Mirtazapine is an atypical antidepressant commonly prescribed to older adults diagnosed with depression. It is prescribed because of its sedating effects, ability to stimulate appetite, and the minimal risks it has on sexual dysfunction. Mirtazapine increases the release of norepinephrine, thus improving mood, sleep, and appetite.
Prescribing for Older Adults and Pregnant Women
The most appropriate nonpharmacological intervention for treating major depressive disorder among older adults is cognitive behavioral therapy (CBT). CBT is effective for treating depression in late life, both when used alone or combined with medications. It is often used to address grief, loneliness, or chronic conditions. CBT helps to challenge negative thought patterns contributing to psychological distress and replace them with more rational, positive self-talk.
- Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
- Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
- Support your reasoning with at least three current credible scholarly resources one each on the FDA-approved drug the off-label, and a nonpharmacological intervention for the disorder.