I would first prescribe Selective serotonin reuptake inhibitors (SSRI) in particular fluoxetine
for Angela. Fluoxetine is preferred due to its limited side effects compared to other SSRI such as
paroxetine, escitalopram, citalopram, and sertraline. This drug would be prescribed in a low
dosage, which can be increased after 2 weeks upon assessing the progress of the client. SSRI is
more effective than other reuptake inhibitors, including SNRIs and NDRIs NNSRI’s. The
working mechanism of SSRIs involves neurotransmitters. These drugs prevent the reabsorption
of neurotransmitters back into nerve cells, which are found in the brain. Additionally, SSRI
offsets mood symptoms within a relatively short duration.
More so, SSRI is the most commonly prescribed antidepressants for the treatment of various
mental conditions, including major depressive disorder, depression, and anxiety disorders. The
symptoms portrayed by Angela indicates that she is likely to be suffering from a mental health
condition. For instance, Angela no longer enjoys doing what she used like before such as running
her firm and exercising. This symptom is mainly associated with mental health disorders,
including major depressive disorder. Additionally, Angela like overeating, which she never liked
before her condition. Overeating especially high-fat and low-nutrient foods increase the risk of
depression (Garcia et al, 2018). Angela is also experiencing insomnia. She has difficulty falling
asleep and wakes up at 4 a.m. even without an alarm. People suffering from depression
experience various symptoms of insomnia such as sleep disturbances, difficulty in falling asleep,
and sleeping for relatively shorter periods (Isaac & Greenwood, 2017).
Response to the client’s concern
CASE STUDY ANALYSIS 3
I would advise the patient to be patient since SSRI does not work instantly but rather take
2 to 4 weeks to have a therapeutic impact (Woo & Robinson, 2016). Additionally, I would advise
the client that the full benefits of antidepressant therapy would be realized after using this
medication for 8 to 12 weeks. Nonetheless, this period is likely to vary among individuals.
Antidepressant medications take a relatively long duration to change the chemicals
(neurotransmitters) found in the brain, which have an impact on mood and emotions. In
particular, the working mechanism of SSRIs involves raising the levels of serotonin in the brain.
Serotonin is a neurotransmitter, which transmits signals from one nerve cells to another in the
brain. This neurotransmitter has a significant impact on mood, sleep, and emotions. Under
normal circumstances, reuptake takes place once this neurotransmitter has carried the message.
Reuptake involves the reabsorption of serotonin by the nerve cells. SSRIs inhibit reuptake from
taking place, thus making more serotonin available in the brain to continue transmitting
messages between nerve cells. Although it is not clear whether mental conditions such as
depression are caused by are low levels of serotonin in the brain, an increase in the level of
serotonin decreases the symptoms of these conditions significantly. Additionally, an increase in
the level of serotonin in the brain enhances responsiveness to other types of therapies, including
Therefore, I would advise the patient to come back if the symptoms do not improve
gradually after taking SSRI for 4 to 6 weeks (PubMed Health, 2017). However, I would increase
the prescribed dosage of the medication to make it more effective in improving the symptoms. I
can also prescribe an alternative antidepressant if no improvement will be noticed during the next
visit. Meanwhile, I would recommend non-pharmaceutical therapies such as regular exercise and
having adequate sleep for her to regulate mood symptoms.
CASE STUDY ANALYSIS 4
Taking fluoxetine is associated with various problems. First, fluoxetine tends to interfere
with the working mechanism pimozide, thioridazine or methylene blue injection if the patient
had been treated using any of these drugs. Additionally, a dangerous drug interaction is likely to
occur if the patient had been treated using MAO inhibitors such as rasagiline, phenelzine,
selegiline, or tranylcypromine in the past 14 days. Therefore, a person is required to wait for a
minimum of 14 days before taking fluoxetine after stopping an MAO inhibitor. Also, one should
wait for at least 5 weeks before taking thioridazine or an MAOI after stopping fluoxetine.
Furthermore, fluoxetine is associated with adverse side effects. The patient particularly
young people are much likely to have some suicidal thoughts when they start taking this
antidepressant. Additionally, fluoxetine tends to impair one’s judgment, motor skills or thinking
capacity (Durbin, 2018). Thus, accidents are likely to occur if a person is driving or operating
machinery after taking this medication. Consequently, caregivers and family members are
required to monitor mood or symptoms changes closely. Besides, SSRI antidepressant is likely to
result in serious lung problems if they are taken during pregnancy (Durbin, 2018). Fluoxetine is
also not recommendable for breast-feeding mothers since it is likely to pass into breast milk, thus
feeding it to the baby. More so, fluoxetine is not fit for individuals below 18 years (Durbin,
2018). Also, this medication is associated with weight gain especially during the first days of the
therapy. Therefore, it will be recommendable for the client to start exercising after starting this
therapy. Other side effects associated with this drug include sexual dysfunction, nausea,
nervousness and feeling anxious, headache and changes in vision, insomnia and strange dreams
as well as anxiety.
CASE STUDY ANALYSIS 5
However, I would advise Angela not to discontinue her medication to avoid experiencing
severe withdrawals, including dizziness, nausea, headache, sensory disturbances, anxiety, tremor,
and dysphoria. Additionally, discontinuing this medication would prevent mood symptoms from
Duration of the treatment
SSRIs are taken between 8 to 12 weeks. However, the client starts to respond to the
treatment between 2 to 4 weeks (Woo & Robinson, 2016). During this period, the patient might
experience a gradual improvement in mood symptoms. A person is likely to experience mild side
effects at the beginning of the therapeutic session, including excessive weight gain. These
symptoms depend on individuals. They are mild among some people and severe in others.
However, one is not supposed to discontinue the medication to avoid withdrawal symptoms.
Upon minimizing the symptoms, the client is advised to discontinue the treatment for around
four to nine months. This period gives healthcare providers an opportunity to monitor the
progress of the client. Therefore, I would recommend the client to stop taking the treatment for a
period of 1 year, thus giving me an opportunity to decide whether to continue with the
medication or not. In most cases, taking the medication for a longer duration prevents relapse.
Additionally, this duration will allow me to decide whether to prescribe an alternative medication
for the patient or not depending on her progress. Therefore, monitoring the progress of the client
will enhance the outcomes of the treatment plan.
CASE STUDY ANALYSIS 6
Durbin, K. (2018). Fluoxetine. Drug.com. Retrieved from
Garcia, G. D., Pompeo, D. A., Eid, L. P., Cesarino, C. B., Pinto, M. H., & Gonçalves, L. W. P.
(2018). Relationship between anxiety, depressive symptoms and compulsive overeating
disorder in patients with cardiovascular diseases. Revista latino-Americana de
Isaac, F., & Greenwood, K. M. (2017). The relationship between insomnia and depressive
symptoms: genuine or artifact. Neuropsychiatric disease and treatment, 7, 57.
PubMed Health (2017). Depression: How effective are antidepressants? National Institute of
Health. Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0087089/
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advanced practice nurse
prescribers (4thed.). Philadelphia, PA, F. A. Davis Company.