I do not need a discussion board, just a couple replies to each post listed below. I need a good paragraph or two to each reply with a 2 good resources for each reply.
1.) Tanya’s question:
What off-label pharmacologic treatment has been used in treating adults over the age of 65 with Bipolar I disorder?
2.)Berinyuy’s posting:
Thank you for your thoughtful response and for highlighting the importance of pharmacological considerations when managing depression in elderly patients. I agree that selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are a suitable first-line treatment due to their efficacy and tolerability. Your point about the heightened risk of adverse effects in older adults is crucial. Monitoring for hyponatremia, fall risk, and gastrointestinal disturbances should indeed be prioritized during treatment, as these complications can significantly impact the patient’s quality of life (American Psychiatric Association, 2010).
I appreciate your mention of alternatives like escitalopram and citalopram. These options can be beneficial in cases where sertraline may not be well-tolerated or when individualized factors, such as comorbidities or drug interactions, necessitate alternative choices. Moreover, evidence suggests that a collaborative care model incorporating pharmacological treatment, psychotherapy, and lifestyle interventions can enhance outcomes in older adults with depression (Dubovsky et al., 2021).
In the case of my patient where she presents with grief-related depressive symptoms, integrating pharmacotherapy with therapies like reminiscence therapy or grief counseling could provide a more holistic approach. In this case, how would you incorporate psychotherapy or non-pharmacologic interventions alongside SSRIs in treating this patient, especially given that grief is a significant factor?
3.) Paolo’s Posting and question:
For A.G., the treatment plan includes grounding techniques in psychotherapy, such asdeep breathing and the 5-4-3-2-1 method, to help manage anxiety during panicepisodes (Schuldt, 2025). Encouraging exercise, such as walking, is a physical activityas a health promotion activity to reduce stress. His current medications, sertraline andmirtazapine will continue with sertraline reduced to address dizziness. Complementaryand alternative medicine (CAM), such as aromatherapy, can be effective relaxationtherapy. By using essential oils, aromatherapy promotes mental and physical relaxation while influencing the hypothalamus and nervous system to enhance blood flow, regulate vital signs, and alleviate anxiety (Tan et al., 2023). Follow-up visits every 4-6 weeks will monitor progress for anxiety and reassess for medication side effects and effectiveness. The patient’s lack of social support, a key social determinant of health, contributes to isolation and impacts his mental well-being. A referral to social services and community organizations (e.g., church, support groups, community centers) is recommended to build connections and reduce isolation for older adults. If the session could be repeated, I would gather more detailed information on A.G.’s stressors, triggers, and positive coping skills to better understand his anxiety. Follow-up sessions would assess the effectiveness of these interventions, with adjustments made as needed, such as exploring alternative therapy and treatments or revising medications.
How would you manage the patient’s side effects while ensuring his anxiety is treated? What other options might work better for older adults?
