Medication Guide for Patient 2: 16-Year-Old Male with Major Depressive Disorder, Severe Chosen Medication Class: Selective Serotonin Reuptake Inhibitors (SSRIs)

Medication Guide for Patient 2: 16-Year-Old Male with Major Depressive Disorder, Severe

Chosen Medication Class: Selective Serotonin Reuptake Inhibitors (SSRIs)

Medication: Fluoxetine (Prozac)

1. Classification of Medication

Fluoxetine belongs to the class of medications known as Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs work by increasing the amount of serotonin in the brain, which is a neurotransmitter that helps regulate mood, anxiety, and overall emotional balance. Serotonin imbalances have been linked to depression and anxiety disorders, so SSRIs are commonly used to treat conditions like major depressive disorder (MDD), anxiety disorders, and panic attacks.

Rationale for Medication Choice:

SSRIs are often the first-line treatment for depression in adolescents because they are generally well-tolerated and have a lower risk of side effects compared to other antidepressant classes like tricyclic antidepressants (TCAs). Given the patient's severe depression and expressed thoughts of dying, it is crucial to treat the depressive symptoms promptly and safely. SSRIs like fluoxetine are known to have a favorable safety profile in younger patients when used correctly.

2. Starting Dose and Frequency

Starting Dose: 10 mg per day, taken in the morning.
(The dose can be gradually increased based on patient response, typically in increments of 10 mg per week, up to a maximum dose of 40 mg per day for adolescents.)
Frequency: Once daily in the morning.

Rationale: Starting at a low dose helps minimize potential side effects, and the dose can be adjusted based on the patient’s tolerance and response to the medication.

3. How the Medication Works

Fluoxetine increases serotonin levels in the brain by inhibiting the reuptake of serotonin in the synaptic cleft. This action enhances the neurotransmitter’s availability in the brain, which helps improve mood, reduce feelings of sadness, and alleviate symptoms of depression. This can help reduce the severity of depressive symptoms, improve motivation, and decrease suicidal ideation in some patients.

4. Duration of Treatment

Duration: The patient should take fluoxetine for at least 6 months after symptoms improve to prevent relapse.
Long-term use may be recommended depending on the patient's response and the persistence of symptoms. Regular follow-up visits should be scheduled to monitor the patient's progress and any side effects.

5. Common Side Effects

Gastrointestinal issues (nausea, diarrhea)
Headache
Sleep disturbances (insomnia or drowsiness)
Sexual dysfunction (reduced libido, difficulty achieving orgasm)
Increased anxiety or agitation (especially during the initial weeks)

6. Urgent or Emergent Considerations

Suicidal thoughts or behavior: SSRIs, especially in adolescents, have been associated with an increased risk of suicidal thoughts and behaviors, particularly during the initial treatment phase. Immediate medical attention is required if the patient shows any signs of worsening depression or suicidal behavior.
Serotonin Syndrome: Symptoms include high fever, seizures, irregular heartbeat, and unconsciousness. If the patient experiences these symptoms, they should seek emergency medical care immediately.
Withdrawal symptoms: Fluoxetine should not be stopped abruptly. Gradual tapering is necessary to avoid withdrawal effects like dizziness, irritability, and flu-like symptoms.

7. Instructions for Taking the Medication

Take fluoxetine once daily in the morning with or without food.
Swallow the tablet whole; do not crush, chew, or break it.
If you experience any trouble swallowing the tablet, discuss other options with your healthcare provider.

8. Instructions for Missed Dose

If you miss a dose of fluoxetine:

Take it as soon as you remember unless it is almost time for your next dose.
Do not double the dose to make up for a missed one. Simply take your next scheduled dose at the usual time.

9. Other Medications, OTC, and Supplements to Avoid

Avoid taking monoamine oxidase inhibitors (MAOIs) or other SSRIs while on fluoxetine.
Avoid St. John's Wort, as it may interact with fluoxetine and increase the risk of serotonin syndrome.
Caution with over-the-counter cold medications or any medications that contain serotonin, like certain migraine treatments.

10. Foods to Avoid

There are no specific food restrictions with fluoxetine. However, excessive alcohol use can increase side effects, such as dizziness and drowsiness. It is recommended to limit or avoid alcohol while taking this medication.

11. Follow-Up Visit

The patient should return for a follow-up appointment within 2 weeks after starting the medication to assess any side effects or concerns.
A routine follow-up visit should be scheduled every 4-6 weeks to monitor progress, side effects, and any signs of suicidal thoughts.

12. Legal and Ethical Considerations

As a prescriber, it is important to ensure that the patient and their family are fully informed of the potential risks and benefits of fluoxetine. Parental consent may be required for a minor.
Close monitoring is essential due to the risk of suicidality in adolescents. Consent should be obtained, and the risks should be clearly communicated to both the patient and their guardians.

13. Social Determinants of Health Considerations

Financial Hardship: If the patient cannot afford the prescribed medication, I would assist by exploring generic fluoxetine options, which are more affordable. Additionally, I would provide information about patient assistance programs, such as the pharmaceutical company's patient support programs, which may offer discounts or free medication.
Transportation Issues: For patients who struggle with transportation, I would consider telehealth follow-ups or coordinate with local community resources to assist with transportation to appointments. I would also explore flexible scheduling for appointments to ensure the patient does not miss crucial follow-ups.

Impact of Financial Hardship and Lack of Transportation

Financial hardship and transportation barriers are important social determinants of health as they directly affect the patient’s ability to access and adhere to necessary medical treatments. Without adequate resources to pay for medications or attend regular appointments, patients may not receive the care they need, which can exacerbate their condition. This highlights the importance of a holistic approach in prescribing, considering not just the clinical aspects but also these external factors that may influence the patient's overall health and treatment outcomes.