Respond to at least two of your colleagues on 2 different days who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature.
One of the mental health disorders that need to be treated in pregnant women is schizophrenia. The benefits of treating pregnant women for schizophrenia are much more than the costs associated with treating the women with medications. In this regard, it has to be noted that there several different ways in which schizophrenia can be treated in pregnant women, which include pharmacological, non-pharmacological, as well as off-brand or non-FDA-approved medications that can be used (Robinson, 2021). The thing to note is that providing the necessary care to pregnant women with regards to their schizophrenia is something that is extremely necessary. The reason for that is that many women tend to stop taking medications for their schizophrenia, as they feel that the medications might harm the baby. This can lead to relapse to occur. This is why most of the women prefer non-pharmacological interventions.
One of the non-pharmacological interventions that is used for pregnant women who have schizophrenia include cognitive behavioral therapy (CBT). This is a type of talking therapy in which the patient starts to learn about their negative thinking and feelings and therefore change them. They can also help to reduce the anxiety that patients might feel. When women undergo CBT, they are able to challenge the negative thoughts that they might be having with positive ones by thinking about everything in a logical manner. This can also help the patients recognize their symptoms related to schizophrenia so that they can start the proper pharmacological interventions as soon as possible (Gentile & Fusco, 2019).
The thing to note is that psychotherapy and other types of non-pharmacological treatments and interventions can be used as supplementary or complimentary treatment methods, which are why pharmacological interventions remain the first line of interventions for schizophrenia, even in pregnancy. The FDA-approved medications that are used to treat schizophrenia include antipsychotics. These help the patients in reducing symptoms, such as their hallucinations and delusions. Moreover, many of the antipsychotic medications can help the patients in terms of improving their mood, as well as ensuring that they are able to think clearly and socialize with their peers. They can also help reduce the agitation that the patients might feel. Except for clozapine, the other antipsychotic medications are safe to be used in pregnancy, as they have minimum side effects. Researchers have concluded that the small risk that the antipsychotics do present for the fetus is acceptable because uncontrolled schizophrenia can have much more negative effects on the women as well as on the children (Breadon & Kukkarni, 2019).
One non-FDA-approved or off-label pharmacological intervention that is used to treat pregnant women who have schizophrenia includes medications that are used to reduce the symptoms of depression. Many pregnant women who have schizophrenia also tend to have other comorbidities, such as depression. This is why it is important to control the symptoms of depression as well. This is why women can be prescribed anti-depressive medications, such as selective serotonin reuptake inhibitors (SSRIs), which are safe to be used in pregnancy.
Breadon, C., & Kulkarni, J. (2019). An update on medication management of women
with schizophrenia in pregnancy. Expert Opinion on Pharmacotherapy, 20(11), 1365-1376.
Gentile, S., & Fusco, M. L. (2019). Schizophrenia and motherhood. Psychiatry and
Clinical Neurosciences, 73(7), 376-385.
Robinson, G. E. (2021). Treatment of schizophrenia in pregnancy and postpartum. Journal of Population Therapeutics and Clinical Pharmacology, 19(3).
Depression among Older Adults
The older adult population is the focus of this discussion. Older people—typically 65 and older—face specific mental health and well-being issues (Andrews et al., 2019). Older persons can have a major depressive disorder, which has certain unique symptoms. Depression is widespread among elderly persons but not typical. Chronic sickness and institutionalization may increase prevalence. Older adults with major depressive disorder experience persistent sadness, hopelessness, loss of interest or pleasure in activities, changes in appetite or weight, sleep disturbances, fatigue, difficulty concentrating, guilt or worthlessness, and thoughts of death or suicide. These symptoms are similar to those in other age groups, however, older persons may report more physical symptoms like pain or cognitive decline. Many reasons make elderly persons susceptible to depression. Social isolation, loneliness, death of relatives, retirement, financial troubles, physical health issues, and chronic pain or medical disorders can increase risk. Medication or past depression can also contribute.
FDA Approved Treatment
According to Parish et al. (2023), Lexapro (escitalopram) is approved by the Food and Drug Administration (FDA) for older adults with severe depressive disorder. Lexapro increases brain serotonin levels and improves depression and mood. Lexapro has been tested and proven safe and effective for older individuals with major depressive disorder by the FDA. Lexapro reduces depressive symptoms and improves well-being in older adults. Lexapro approval for older persons depends on various conditions. Age-related metabolic changes and drug interactions may affect older people’s pharmaceutical needs. Lexapro has fewer adverse effects and drug interactions than other antidepressants in older persons (Parish et al., 2023). The FDA’s clearance of Lexapro gives medical professionals confidence in its efficacy and safety, making it a suggested medication for seniors with major depressive disorder.
Off Label Drug
While buprenorphine is not FDA-approved for treating serious depression in the elderly, it has shown potential as an off-label treatment option. Off-label use of buprenorphine for older persons with major depressive disorder is rare. Buprenorphine’s pharmacological features suggest it may cure depression, however, there is little evidence of its efficacy and safety for MDD. Buprenorphine, known for its use in treating opioid addiction, is a partial opioid agonist that works on mu-opioid receptors (Dokucu & Janicak, 2021). As with any off-label usage, careful patient assessment and monitoring for side effects are essential when considering buprenorphine for older adults with major depressive illnesses.
Cognitive-behavioral treatment (CBT) helps older people with severe depression. Systematic psychotherapy like CBT targets detrimental depression-related thoughts and behaviors (Chen et al., 2021). CBT teaches older adults problem-solving, coping, and negative thinking reframes. CBT has been demonstrated to improve mood, lessen depressive symptoms, and improve general well-being in older persons. It is a non-pharmacological intervention that is suggested due to its evidence-based effectiveness and capacity to empower individuals in treating depression and increasing their quality of life.
Risks and Benefits
One of Lexapro’s numerous benefits is its well-documented effectiveness in treating depression, with several studies demonstrating this drug’s ability to lessen depressed symptoms and enhance general well-being in older adults (Parish et al., 2023). Lexapro enhances serotonin availability, which regulates mood, by reducing its reuptake. This system balances brain chemicals, alleviating depression and improving mood. Lexapro enters the bloodstream and binds to brain serotonin transporters when taken as advised. Lexapro blocks these transporters to keep serotonin in the synaptic gap between nerve cells longer. Increased serotonin levels improve mood, emotions, and mental health. Lexapro regulates mood and cognition by increasing serotonin neurotransmission. It calms anxiety, despondency, and sadness. Compared to other antidepressant drugs, it has a comparatively favorable side effect profile and is generally well tolerated. However, some potential hazards are connected to using Lexapro in older persons, such as an increased risk of falls, gastrointestinal issues, and possible prescription interactions with other drugs this population frequently takes (Parish et al., 2023). Nausea, diarrhea, and constipation are Lexapro’s most prevalent side effects. Appetite, sleep, and sexual function may also change. To reduce these risks, it is crucial to constantly monitor elderly patients taking Lexapro and change the dosage as necessary.
The off-label use of buprenorphine has shown promise in treating severe depressive disorder in older adults. The hazards and benefits of off-label use must be carefully considered. Buprenorphine can cause sleepiness, respiratory depression, and constipation because it is a partial opioid agonist. The potential for drug interactions and individual variations in drug response must also be taken into account. However, older people with major depressive disorder may have access to a novel therapy alternative if they use buprenorphine for purposes other than those allowed by the FDA. It has the potential to offer an alternative to conventional antidepressants and alleviate symptoms of depression (Dokucu & Janicak, 2021). However, due to the lack of data and the potential risks involved, buprenorphine should be taken with caution, and strict monitoring should be put in place when considering it as an off-label treatment for depression in the elderly.
Major depressive disorder treatment guidelines include older patients. The American Psychiatric Association (APA) and the National Institute for Health and Care Excellence (NICE) recommend treating depression in older adults based on evidence. These guidelines support Lexapro (escitalopram) as the first-line treatment for depression in older adults (Dunlop et al., 2019). The recommendations support the use of SSRIs in this population because of their shown effectiveness in reducing depressive symptoms and improving general functioning. CBT is recommended as an efficient non-pharmacological technique for treating elderly patients with severe depressive illness. CBT has been shown to benefit this demographic by reducing depression symptoms, enhancing coping mechanisms, and enhancing general well-being. These clinical practice recommendations support the use of the FDA-approved medication Lexapro and the non-pharmacological intervention CBT. These recommendations offer a strong foundation for evidence-based therapy in the treatment of major depressive illness in older patients since they are based on extensive research, systematic reviews, and expert opinion.
Andrews, J. A., Brown, L. J., Hawley, M. S., & Astell, A. J. (2019). Older adults’ perspectives on using digital technology to maintain good mental health: Interactive group study. Journal of Medical Internet Research, 21(2), e11694-99. https://doi.org/10.2196/11694
Chen, Y. J., Li, X. X., Pan, B., Wang, B., Jing, G. Z., Liu, Q. Q., & Ge, L. (2021). Non-pharmacological interventions for older adults with depressive symptoms: A network meta-analysis of 35 randomized controlled trials. Aging & Mental Health, 25(5), 773-786. https://doi.org/10.1080/13607863.2019.1704219
Dokucu, M. E., & Janicak, P. G. (2021). Nontraditional therapies for treatment-resistant depression: Some off-label agents show promise, but carry risks. Current Psychiatry, 20(9), 39-46. https://link.gale.com/apps/doc/A697175234/HRCA?u=anon~df15b98b&sid=googleScholar&xid=94888b78
Dunlop, B. W., LoParo, D., Kinkead, B., Mletzko-Crowe, T., Cole, S. P., Nemeroff, C. B., & Craighead, W. E. (2019). Benefits of sequentially adding cognitive-behavioral therapy or antidepressant medication for adults with unremitting depression. American Journal of Psychiatry, 176(4), 275-286. https://doi.org/10.1176/appi.ajp.2018.18091075