The Impact of Ethnicity on Antidepressant Therapy NURS 6630N

Discussion: The Impact of Ethnicity on

Antidepressant Therapy

Major depressive disorder is one of the most prevalent disorders you will see in clinical
practice. Treatment for this disorder, however, can vary greatly depending on client
factors, such as ethnicity and culture. As a psychiatric mental health professional, you
must understand the influence of these factors to select appropriate
psychopharmacologic interventions. For this Discussion, consider how you might
assess and treat the individuals in the case studies based on the provided client factors,
including ethnicity and culture.The Impact of Ethnicity on Antidepressant Therapy NURS 6630N
To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have assigned you to one of the
following case studies to review for this Discussion. To access the following case
studies, click on the Case Studies tab on the Stahl Online website and select the
appropriate volume and case number.
Case 1: Volume 1, Case #1: The man whose antidepressants stopped working
Case 2: Volume 1, Case #7: The case of physician do not heal thyself
Case 3: Volume 1, Case #29: The depressed man who thought he was out of options
 Review this week's Learning Resources and reflect on the insights they provide.
 Go to the Stahl Online website and examine the case study you were assigned.
 Take the pretest for the case study.
 Review the patient intake documentation, psychiatric history, patient file, medication history, etc.
As you progress through each section, formulate a list of questions that you might ask the
patient if he or she were in your office.
 Based on the patient’s case history, consider other people in his or her life that you would need
to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
 Consider whether any additional physical exams or diagnostic testing may be necessary for the
patient.
 Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning
Resources for guidance.
 Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and
consider medications you might select for this patient.
 Review the posttest for the case study.
Note: For this Discussion, you are required to complete your initial post before you will
be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post
to Discussion Question" link and then select "Create Thread" to complete your initial
post. Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before clicking
on Submit!The Impact of Ethnicity on Antidepressant Therapy NURS 6630N
By Day 3
Post a response to the following:
 Provide the case number in the subject line of the Discussion thread.
 List three questions you might ask the patient if he or she were in your office. Provide a
rationale for why you might ask these questions.

 Identify people in the patient’s life you would need to speak to or get feedback from to further
assess the patient’s situation. Include specific questions you might ask these people and why.
 Explain what physical exams and diagnostic tests would be appropriate for the patient and how
the results would be used.
 List three differential diagnoses for the patient. Identify the one that you think is most likely and
explain why.
 List two pharmacologic agents and their dosing that would be appropriate for the patient’s
antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a
mechanism of action perspective, provide a rationale for why you might choose one agent over
the other.
 For the drug therapy you select, identify any contraindications to use or alterations in dosing that
may need to be considered based on the client’s ethnicity. Discuss why the
contraindication/alteration you identify exists. That is, what would be problematic with the use of
this drug in individuals of other ethnicities?
 If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate
any therapeutic changes that you might make based on the data provided.
 Explain “lessons learned” from this case study, including how you might apply this case to your
own practice when providing care to patients with similar clinical presentations
Read a selection of your colleagues' responses.
By Day 6
Respond to at least two of your colleagues who were assigned to a different case than
you. For example, if you were assigned to Case Study 1, respond to one colleague
assigned to Case Study 2 and one colleague assigned to Case Study 3. Explain how
you might apply knowledge gained from your colleagues’ case studies to you own
practice in clinical settings.
 If your colleagues’ posts influenced your understanding of these concepts, be sure to share how
and why. Include additional insights you gained.
 If you think your colleagues might have misunderstood these concepts, offer your alternative
perspective and be sure to provide an explanation for them. Include resources to support your
perspective.
Submission and Grading Information
Grading CriteriaLearning Resources
Note: To access this week’s required library resources, please click on the link to the
Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through this link provided.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and
practical applications (4th ed.). New York, NY: Cambridge University Press.

Note: To access the following chapters, click on the Essential Psychopharmacology,
4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to
read all sections on the left navigation bar for each chapter.
 Chapter 6, “Mood Disorders”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge
University Press.The Impact of Ethnicity on Antidepressant Therapy NURS 6630N

Note: To access the following medications, click on the The Prescriber's Guide, 5th
ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

 amitriptyline
 bupropion
 citalopram
 clomipramine
 desipramine
 desvenlafaxine
 doxepin
 duloxetine
 escitalopram
 fluoxetine
 fluvoxamine
 imipramine
 ketamine
 mirtazapine
 nortriptyline
 paroxetine
 selegiline
 sertraline
 trazodone
 venlafaxine
 vilazodone
 vortioxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, DC: Author.

Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression
(STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health
Services, 46(9), 21-24. doi:02793695-20081001-0510.3928/02793695-20080901-06

Howland, R. H. (2008). Sequenced Treatment Alternatives to Relieve Depression
(STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health
Services, 46(10), 21-24. doi:02793695-20081001-0510.3928/02793695-20080901-06