I am going to attach 2 differnt inital discussion post. I need 150 words reply f

I am going to attach 2 differnt inital discussion post. I need 150 words reply for each post!!! “You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts” 1 cite APA per response.
Response 1:
Summarize the clinical case.
In this case we have A 45-year-old African American female patient, who recently separated from her husband of 25 years, after he had an affair. The patient started having trouble sleeping, causing her to be tired during the day, and she also experienced increased levels of anxiety. Over the past four weeks she started losing her appetite, having decreased energy levels, feeling sad, and having feelings of inappropriate guilt. She does not have any suicidal ideation, but she has been feeling hopeless, and has been struggling to maintain her daily activities, such as running the household, managing her 18-year-old fraternal twins, and working part-time at a local dry-cleaning business. The patient has no family history of any psychiatric illness. She consumes limited amounts of alcohol occasionally, once or twice a month. Her past medical history includes lower-extremity neuropathy.
What is the DSM5 diagnosis? Identify the rationale for your diagnosis.
Based to her symptoms, this patient presents with major depressive disorder. According to the DSM-5, at least five of the following symptoms must be present during the same 2-week period:
Depressed mood almost every day, most of the day
Decreased interest or pleasure in activities, almost every day, most of the day
Significant change in weight or a change in appetite
Problems sleeping or hypersomnia
Psychomotor changes, such as retardation or agitation almost every day
Lack of energy or fatigue
Feelings of guilt, even though it is inappropriate and excessive, or feelings of worthlessness, almost every day
Trouble concentrating almost every day
Thoughts of death, or suicidal ideation, with or without a plan.
These symptoms must also represent a change from previous functioning, and at least one of the symptoms must be decreased interest and pleasure, or depressed mood. Another aspect mentioned in the DSM-5 is that this episode is not related to the physiological effects caused by a substance or a medical condition, and the symptoms cause major distress and impairment in the patient’s occupational, social, or other area of functioning (DSM-5, 2013).
Which pharmacological treatment would you prescribe? Include the medication name, dose, frequency and rationale for this treatment.
For this patient, I would recommend a selective serotonin reuptake inhibitor (SSRI), such as sertraline. The typical dose range for sertraline is 50-200 mg/day. I would choose this medication due to the fact that it does not cause any sedation, and the patient could continue her daily activities safely. SSRIs have less side effects than older tricyclic antidepressants (Sinacola, Peters-Strickland, & Wyner, 2020). Another option would be a tricyclic antidepressant, such as amitriptyline, which is also indicated in the treatment of neuropathic pain, which the patient suffers from (Thour & Marwaha, 2022).
Which non-pharmacological treatment would you prescribe? Include the rationale for this treatment.
As a non-pharmacological treatment, I would recommend light therapy, such as light boxes or commercially produced lamps, which are affordable. Studies show that light therapy might be beneficial for depression, especially for patients who live in colder, darker climates, and suffer from seasonal depression, but it is also efficacious for patients with nonseasonal major depressive disorder. Patients should use the light therapy for 30 to 60 minutes every day, sitting 10 to 12 inches from the light source (Sinacola, Peters-Strickland, & Wyner, 2020).
Include an assessment of the medication’s appropriateness, cost, effectiveness, safety, and potential for patient adherence.
In this case, sertraline would be an appropriate treatment, as it is used as a first-line treatment for major depressive disorder (Singh & Saadabadi, 2022). Although there are multiple studies evaluating the tolerability and efficacy of sertraline, cost-effectiveness data is limited. A cost-effectiveness analysis comparing the costs for sertraline, venlafaxine, and bupropion, conducted by Singhet al., in which the costs included the outpatient and emergency room visit costs, the medications costs, and costs for hospitalization, concluded that the sertraline and bupropion costs were similar to each other, but venlafaxine costs were much higher (Singh et al, 2016). Sertraline is considered a safe medication even for patients who have a history of myocardial infarction, and in pregnant or breastfeeding women. However, patients should be monitored for changes in behavior, suicidal thoughts, increased anxiety, and any signs of a manic episode, as sertraline can precipitate mania in patients who suffer from bipolar disorder. Providers should also monitor any signs of bleeding, especially if the patient is taking anticoagulants or non-steroidal anti-inflammatory drugs, as sertraline can cause platelet aggregation impairment. Sertraline should be taken once a day, which helps the patient adhere to the treatment. Educating the patient about the medication and compliance will ensure patient safety and lead to better outcomes (Singh & Saadabadi, 2022).
Response 2: Helen is a 45-year-old female patient presenting with increasing sadness, anxiety, daytime tiredness, lack of ability to fall asleep, inappropriate guilt, poor appetite, and decreased energy levels. There is no history of psychiatric illness, and there is a history of occasional alcohol use, but it is not excessive. The only other significant medical history involves lower extremity neuropathy of unknown origin. She reports that she recently divorced her husband after finding out he had an extramarital affair. During the marriage, they had two children – 18-year-old fraternal twins. In addition to running the household, Helen has a part-time job at a local dry cleaning business. She is starting to feel that “life is not worth living” and reports that she struggles to maintain her usual activity level.
The DSM5 diagnosis would be major depressive disorder (MDD). According to Durand, Barlow & Hofmann (2019), a diagnosis of MDD involves feeling a depressed mood, markedly diminished interest in activities of daily living, significant weight loss or weight gain involving possible changes in appetite, insomnia or hypersomnia, and noticeable agitation or retardation. Other symptoms involved in MDD include fatigue, feelings of worthlessness or excessive guilt, and diminished ability to think or concentrate (Durand, Barlow & Hofmann, 2019). Recurrent thoughts of death may or may not involve suicidal ideation or an attempt at suicide, clinically significant distress or impairment, and symptoms that are not due to the effects of a substance or medical condition may also be present in patients experiencing MDD (Durand, Barlow & Hofmann, 2019). Helen is experiencing several symptoms expected for the clinical diagnosis of MDD. She has a depressed mood, markedly diminished interest in her activities of daily living, insomnia, fatigue, and excessive guilt.
According to Sinacola, Peters-Strickland, & Wyner (2020), the prescribed treatment for Helen includes Duloxetine or Cymbalta. Her primary prescribed the medication at 30 milligrams (mg) once daily for one week, and then the primary increased it to 60mg once daily. Her primary care provider prescribed it to help with her neuropathy. According to Cunha (2022), Cymbalta uses include depression, neuropathic pain, generalized anxiety, fibromyalgia, and chronic muscle pain. This medication is a serotonin-norepinephrine reuptake inhibitor (SNRI), which means that serotonin and norepinephrine reuptake is blocked. Depression is associated with a lack of both serotonin and norepinephrine. The more serotonin and norepinephrine available to the brain, the less depressed the patient will be.
Non-pharmacological treatment includes a suicide contract with the patient. If she is going to experience symptoms of suicidal ideation, then it must be reported right away. Her safety is of the utmost importance. Helen would also need a follow-up appointment to confirm whether or not her symptoms are being managed appropriately with the medication. Follow-up would be scheduled approximately one month after initiation of treatment and then again at the six-month mark.
The case study reported that the patient looked up the medication and suggested it to the provider. This medication works well for this patient because it also helps with her neuropathic pain. This medication has side effects like all medications, but one upside is that this medication does not cause drowsiness (Sinacola, Peters-Strickland, & Wyner, 2020). According to Cunha (2022), the most common side effects include dry mouth, nausea, constipation, loss of appetite, and increased sweating. The side effects of this medication are not severe, which bodes well for patient adherence. According to Goodrx (n.d.), Cymbalta is moderately priced at local pharmacies ranging from just over $5 to $54. The cost of this medication bodes well for patient adherence since many patients cannot afford expensive medications. The case study reports that Helen does not experience any side effects from the medication and is doing better at the one-month point of treatment and the six-month point.