Please respond to 2 Peers. Have at least one reference/article
For Summerton, it seems that Aricept that he is taking due to memory loss which could be associated with Alzheimerâ€™s disease, has not been effective at 5 mg. Aricept also can have a few side effects, notable being insomnia (Stahl, 2017). Mr. Summerton is taking Ambien, yet he has sleepless nights which could result from Ariceptâ€™s side effects. That being the case, I would consider changing Aricept and starting Mr. Summerton with Memantine 5 mg daily. This medication is approved to treat moderate to severe Alzheimerâ€™s disease. This medication is safe and tolerable and significantly benefits cognition, mental state, and activities of daily living (Jiang & Jiang, 2015). Memantine has fewer side effects and does not cause insomnia. Even though Mr. Summerton says he does not have suicidal ideations, he says he wishes not to be â€˜around for longerâ€™, which should be a red flag for suicide. One of the side effects of Ambien, especially among the elderly, is risk for suicide. In addition, concurrent use of Ambien with antidepressants, Benzodiazepines, and Opioid analgesics can increase the risk of suicide (Sung et al.,2019). I would also, therefore, consider changing Ambien to Mirtazapine 15 mg daily in the evening, which will help Mr. Summerton with his insomnia and also improve his symptoms of depression.
Mr. Summerton is suffering from Major Depressive disorder, exhibited by his depressed mood, loss of pleasure, weight loss, thoughts of death, and poor sleep (American Psychiatric Association, 2022). Additionally, 30-50% of older adults living in long-term care facilities are clinically depressed (Unitzer & Park, 2012). His symptoms appear to largely stem from grief. Given the scenario of increased mood swings, worsening depression, poor sleep, and poor appetite, re-evaluating his medication regime seems very appropriate following laboratory studies such as CBC, TSH, and urinalysis, to rule out a potential medical condition.
Though he is not at the upper limit of Sertraline 200mg (Stahl, 2017), I donâ€™t believe I would increase the dose. I also would not change the Aricept, which could be increased to 10mg (Stahl, 2017), if symptoms continue despite changing his therapy. I feel an augmenting strategy might be beneficial, but with high polypharmacy in the older adult population, monotherapy, if possible, is preferrable. I would suggest an initial starting dose of Mirtazapine 7.5mg at bedtime, to aid in sleep and depressive symptoms, increase his appetite, and hopefully will subsequently improve some cognitive symptoms (Stahl, 2017). The Sertraline would be reduced/tapered to mitigate risk of serotonin syndrome as well as discontinuation syndrome.