Answer

Analyzing a Case of Severe Depression

Clinical Presentation and Symptoms

            To make a diagnosis of major depressive disorder, several clinical presentations are likely to be experienced. The patient can display somatic complaints such as abdominal stress, weight changes, and fatigue. Additionally, the patient should also complain of irritability alongside a low mood (Halverson, 2020). It is also expected that the patient should show signs of a dysphoric mood which may be expressed by numbness, sadness, and mood swings. In this case, the patient should show a loss of interest in her usual activities, or loss of motivation and energy. In most cases, the patient should show signs of negative thinking, a high sense of hopelessness, worthlessness and helplessness (Halverson, 2020). Moreover, it will also be expected that the patient should show signs of ruminative thinking.

Lab Tests

            Blood tests will be order to diagnose the patient’s depressive condition. Halverson, (2020) states that lab tests are effective in establishing if a patient is suffering from depression since it checks for other diseases such as anemia, thyroid or the possibility for other hormones. The blood test will also diagnose the level of calcium and Vitamin D levels. Blood tests will also be ordered as a means of checking the liver functionality, the kidney function and the toxicology screening. This is founded on the fact that liver and kidneys are directly responsible for the depression medication elimination. In case of any impairment to the two organs, the drugs provided to the patient can accumulate in the body, thus resulting to other side effects (Halverson, 2020).

Additional Information

            To establish if Erica requires inpatient hospitalization for her depression, the patient’s mother will be required to provide additional information. Erica’s mother will be required to provide information about the patient’s social interaction with the other members of the family. Additionally, she will be required to communicate if she accompanied her daughter to offer her with social support. Moreover, Erica’s mother will also be required to communicate if a record of mental illness has been reported in the family or if the patient is allergic to any medication. Also, it is the duty of the patient’s mother to state if Erica has been involved in any instances of substance abuse in the past or engaged in a legal problem. It is also necessary to establish if the patient has proven to be dangerous to herself and to those around her.

Medication Treatment

            Medication treatment is discussed through short patient and family education session. In this case, Erica’s parents will be educated about the need for medication treatment based on the patient’s presenting signs and symptoms. The parents will also be educated about the effectiveness of the use of medication treatment in comparison to other alternatives such as talk therapy in treating depression. A child aged less than 8 years is considered as too young to undertake the depression medication. Mullen (2018) reiterates this factor by unveiling that Prozac, one of the medication recommended for the treatment of depression is approved for children who are as young as 8 years. However, the US FDA provides a black box warning for all the antidepressants for young people aged below 24 (Hurley, 2021). This is based on the fact that the medication has the potential of increasing their suicidal behavior and thoughts, especially during the first month of the treatment administration. Despite this, the child opinion will only be considered after she attains the age of 18 years. On the contrary, only the parents input will be provided with a priority.

Pharmacological and non-pharmacological interventions

             A combination of therapy and antidepressants is considered as the most effective intervention for Erica. In this case, fluoxetine alongside a cognitive behavioral therapy will be considered. After the remission symptom is achieved, the patient will be allowed to continue the medication for  period of 6 to 12 months before the initiation of a slow taper (Mullen, 2018).  The recommended starting dose for the fluoxetine will be 5-10mg daily. The recommended effective dose for the medication is 10mg. However, the maximum allowed dose that the patient can take is 40 mg (Mullen, 2018). Combining the two forms of treatment are considered as the most effective means of addressing the patient’s symptoms. Dizziness, drowsiness, loss of appetite, sleeping trouble and sweating are some of the common side effects to be experienced after the administration of the medication.

            Fluoxetine becomes effective by blocking the serotonin reuptake within the presynaptic serotonin neurons through the process of blocking the reuptake protein available in the presynaptic terminal (Sohel, Shutter & Molla, 2020). Fluoxetine is metabolized in the patient’s liver.

Readiness for a Safe Discharge

            Erica will be ready for a safe discharge if she does not exhibit any risks of self-harm or self-neglect. Moreover, when the patient is showing signs of compliance with the medication instructions and diet, she will be considered as a ready for discharge (Gowda, Gajera, Srinivasa & Ameen, 2019). Failure to manage the patient’s symptoms effectively can result to risks such as going back into the depressive state or death especially if the suicidal ideation is not properly managed (Gowda, Gajera, Srinivasa & Ameen, 2019).

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