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The case study is based on ST, a 37-year-old woman who is currently being managed for depressive symptoms. She has a prescription for depression drugs, which entails using 20 mg of fluoxetine in the evening. ST has been complaining of insomnia and gastrointestinal upset. The case study is based on determining whether her current treatment is related to her poor sleep patterns and the GI upset. ST also thinks that the fluoxetine is not effective and is considering trying out alternative therapies or taking fluoxetine weekly.
Suggestions for Avoiding Insomnia
Most antidepressant medications cause insomnia. Some of the approaches that ST can use to avoid insomnia while using fluoxetine include taking this drug in the morning instead of taking it in the evening, avoid drinking caffeinated drinks after taking fluoxetine, especially if she plans to continue taking the drug at night, engagement in physical exercise, or use of a sedative. By taking fluoxetine in the morning, the effects of the drug will wear off before her bedtime, ensuring that she can get adequate sleep at night. Caffeinated drinks are associated with hyperactivity or increased wakefulness. Taking caffeinated drinks at night or alongside fluoxetine could increase the effects of fluoxetine in her body. If changing the time she takes fluoxetine does not help, she should avoid taking caffeinated drinks at night or close to her bedtime (Everitt, Baldwin and Stuart). Use of sedatives should be last option as they can have depressive symptoms if not regulated well.
If she plans to use exercise to reduce her insomnia, she should consider the time and intensity of the exercise. Engaging in exercise is bound to help her utilizer some of her energy and promote exhaustion, which can make her sleepy. Getting involved in exercise just before sleeping could lead to release of endorphins, which have a euphoric effect that promotes relaxation. Exercise has been associated with increased sleep efficiency due to its ability to reduce anxiety and depressive symptoms, and trigger increased body temperature, which can help in soothing the body into a deep sleep (Dolezal, Neufeld and Boland 8-9). Exercise is an effective way of inducing sleep.
Suggestion for Avoiding GI Upset
GI upsets can be caused by the irritation effect of a drug on the mucosal lining of the gastrointestinal tract. Some of the measures that ST can apply to avoid GI upsets include taking fluoxetine with food or immediately after a meal to ensure that, it does not interact directly with the lining of the stomach, drinking plenty of water while taking the drug, and ensuring that she does not stay for prolonged periods before taking a small meal. Drinking plenty of water or other fluids while taking the drug, will ensure that it does not remain stuck on the upper part of the GI, a problem that could lead to deterioration of the mucosal layer of the GI or irritation. Taking small frequent meals will also ensure that her stomach is not empty when she takes her medication (Carvalho, Sharma and Brunoni). These suggestions could also help her avoid conditions like gastritis and peptic ulcers, which are linked to deterioration of the GI mucosal layer.
Fluoxetine Dosage Range
Fluoxetine is available in the brand names Prozac and Sarafem or in its generic form as fluoxetine. ST is on fluoxetine because it is used to manage depression. ST’s fluoxetine’s dosage is within the normal range. The dosage of fluoxetine ranges based on the type of condition being managed. The tablets are usually available in 10mg, 20mg, and 60 mg while the capsules are available in 10mg, 20mg, and 40mg. An alternative capsule for delayed-release is available in 90mg and is usually taken once a week. For patients with depression the initial dosage should be 20mg per oral taken once daily. After several weeks, the dosage can be adjusted gradually up to 80mg per oral taken once daily. The adjustment of fluoxetine in geriatric population should be conducted carefully because they have a slow metabolism and drugs are likely to remain in their system for a longer time when compared with younger adults (McCuistion, Yeager and Winton 267). The mechanism of fluoxetine is based on the enhancement of serotonin action in nerve cells because of the selective serotonin reuptake blockage at the membrane of neurons.
Adhering to a safe dosage when taking fluoxetine is important. Some of the side effects that should be monitored when prescribing or adjusting fluoxetine include headaches, dizziness, insomnia, general body malaise, confusion, drowsiness, tremors, nausea, pharyngitis, and constipation. Some of the adverse reactions that ST among other patients might experience include seizures, hyper and hypokalemia, dehydration, GI bleeding, osteoporosis, and tachycardia (McCuistion, Yeager and Winton 267). Looking out for these side effects and adverse reactions is important when prescribing fluoxetine.
Use of Complementary and Alternative Therapies
Complementary and alternative therapies have been associated with management of depressive symptoms among other conditions. In the case of SI, I would offer her the option of either progressing with the use of fluoxetine for the next one month to determine its effectiveness or stopping fluoxetine completely and taking up a complementary and alternative therapy approach. The decision on progressing with the use of fluoxetine would be based on evidence that suggests that the effectiveness of fluoxetine in managing depression might not be noticed until after a few weeks of using the drug. As such, placing her on the drug for an additional one month and adjusting the dosage gradually within the duration would help me to determine whether it is effective in managing her depressive symptoms.
In the event that fluoxetine fails to manage her depression even after the one-month duration, I would allow her to consider complementary and alternative therapies but caution her on the need to discontinue fluoxetine before using the other drugs or supplements. I would also educate her on the possible drug-supplement interactions associated with using fluoxetine alongside complementary and alternative therapies like St. John’s wort, which increases risk of serotonin syndrome and may increase risk of hypoglycemia when used alongside fluoxetine (McCuistion, Yeager and Winton 267). I would also encourage her to tell me the complementary and alternative therapies that she has considered before using them to ensure that we rule out the risks of other side effects or adverse reactions.
Response on Use of Weekly Use
In response to the option of using fluoxetine as a weekly dose, I would educate her about the existence of the delayed-release drug. Most delayed-release drugs are created as capsules to prevent nausea and GI irritation as they usually bypass the stomach and deliver the drug in the small intestines (McCuistion, Yeager and Winton 267). I would inform her that although using the weekly dose might assist her avoid the GI upsets, it might not be effective in helping her deal with her insomnia unless she applied the recommended suggestions for managing insomnia.
Fluoxetine is an effective drug in managing depression among other mental health problems. The difference between the effectiveness of fluoxetine and its adverse reactions is based on its dosage and the response of the patient while using the drug. In the case of ST, her inability to notice the effectiveness of the drug could be linked to the period she had been using the drug and the dosage. Titrating the drug within the next three weeks or one month could improve its effectiveness in treating her depressive symptoms. Adhering to the recommendation for managing her insomnia and GI irritation could also improve her tolerance of the drug.
Carvalho, A. F., et al. “The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature.” Psychotherapy and Psychosomatics (2016): 85, 270-288. https://www.karger.com/Article/FullText/447034.
Dolezal, Brett A., et al. “Interrelationship between Sleep and Exercise: A Systematic Review.” Advances in Preventive Medicine (2017): Article ID 1364387. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385214/.
Everitt, Hazel, et al. “Antidepressants for insomnia in adults.” Cochrane Database Systematic Reviews (2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494576/.
McCuistion, Linda E., et al. Pharmacology E-Book: A Patient-Centered Nursing Process Approach. Elsevier Health Sciences, 2020.