Please respond to 2 peers. At least one peer reviewed reference needed
I have seen the use of Cytomel and Abilify on the family practice side of the house used to augment depression treatments. In clinical, I have seen those two and also lithium, Rexulti, Wellbutrin, Remeron, Seroquel, mondafinil all used in an augmenting method. I wanted to read more on the use of Cytomel because Iâ€™ve seen it used the least of those agents. The mechanism of action is to increase transcription of serotonin and subsequently causing a net increase (Touma et al., 2017). It does require some monitoring but shown to be quite safe with augmentation of SSRI and TCAs.
The risk of using T3 in the treatment of depression is arrhythmias and osteoporosis. Prior to treatment you will need to evaluate TSH and T4 to ensure there isnâ€™t an underlying hyperthyroidism. Bone density will need to be monitored in post-menopausal women (Touma et al., 2017).
Brain stimulation technique to augment depression treatment is electroconvulsive therapy (ECT). There are not a lot of providers in OK providing ECT services. Dr. Vinekar practices out of the Saints system and performs them at the OKC locations (SSM Health, 2022). They only take insured clients so a bit limiting when considering much of the uninsured population suffer from treatment resistant depression.
Discussion 2.1: Augmenting and Off-Label Use of Medication
- Either from personal or professional experience, describe a medication used to treat depression off-label. Find at least one research article that supports this use of the medication.
Bipolar disorder, largely defined by recurring periods of depression, mania, and hypomania, is often treated with lithium. However, lithium is also can be used to treat depression off-label. Notably, lithium is used as a treatment for acute episodes of unipolar depression and as a maintenance medication to avoid the recurrence of such episodes (Post, 2018). The recommended adjunctive lithium dosage is 300 mg per day. The target dose is 900 mg per day, or a dose adequate to achieve half a day serum levels of 0.6 to 0.9 mEq/L. An increase of the dosage after two days is recommended based on its effect on the patient. Additionally, clinicians give adjunctive lithium for a month before ascertaining its effectiveness (Post, 2018).
- What would be an appropriate medication to augment an SSRI medication? Please provide information on both the risks and the benefits and provide a reference.
Bupropion is an effective supplement for SSRIs. This medicine inhibits the absorption of the neurotransmitters dopamine and norepinephrine and is frequently used with serotonin-acting drugs such as SSRIs. Occasionally, bupropion is given to counteract the sexual adverse effects of SSRIs (Mohamed et al., 2017). Also, aripiprazole can be used to augment an SSRI medication. In a study conducted by Mohamed et al. (2020), augmentation with aripiprazole resulted in a marked substantial and yet only moderately enhanced probability of recovery after 3 months of treatment as opposed to reverting to bupropion alone. However, aripiprazole can cause dizziness and headaches when combined with SSRIs.
- Find and share a resource for one brain stimulation method (such as a video, research article, company website, and so on) that discusses its application and relevance to practice.
According to Li et al. (2020), depression is among the most prevalent causes of death worldwide. Although electroconvulsive therapy (ECT) is one of the 3 key therapies for depression, alongside medications and therapy, it is inadequately used among depressed patients seeking treatment. Electroconvulsive Therapy (ECT) seems to be a great remedy that primarily involves a highly monitored electrical current through the brain in order to encourage a seizure and a quick release of nerve signals all across the nervous system, thus leading to the treatment of various psychiatric illnesses and severe depression. (Li et al., 2020).