In this scenario, the patient’s main complaint is insomnia, so she should be asked additional questions to determine how best to treat her. I would inquire about the patient’s current sleeping habits. By asking this question, the patient should be able to describe her insomnia, including how long she sleeps for, what time she usually sleeps, and if anything currently helps her sleep. I would also ask the patient how long she has had problems with her sleeping habits in order to determine if the patient had problems prior to her husband’s death. I would also inquire as to what time of day the patient takes her medications. The patient is currently taking Sertraline on a daily basis, which may affect her sleeping pattern. Another question I would ask the patient is what symptoms she is having as a result of her insomnia. Examining the patient’s cognitive and physical symptoms may aid in determining the source of her insomnia.
If the patient has close family or friends, they should also be contacted. It is unclear whether the patient has children, but if she does, it is critical that she speak with them. Her children are most likely her next of kin because her husband is deceased. If her children assist in her care, they may be able to provide additional information about the patient’s condition. To rule out any familial/biological causes, she should ask her children if they suffer from insomnia. It would also be beneficial to consult with the patient’s Primary Care Physician, who may be able to provide additional information about the patient’s medical history and current medication use.
This patient would benefit from a physical exam as well as additional diagnostic testing. A thorough physical examination should be performed to rule out any other potential health conditions that may be interfering with the patient’s sleeping habits. Blood tests may also be performed to assess the patient’s thyroid function (Pacheco, 2022). A polysomnogram test, also known as a sleep study, can be used to “monitor brain wave activity, heart and breathing rates, oxygen levels, and muscle movements that occur prior to, during, and after sleep” (Pacheco, 2022).
It is stated that the patient had no prior history of depression prior to the death of her husband, but it is unclear whether or not the patient had prior insomnia. This patient is most likely experiencing insomnia as a result of her major depressive disorder (MDD). Significant life events, such as the death of a loved one, can set off depression (Chand & Arif, 2022). In adult patients, insomnia is one of the most common sleep problems associated with depression (Pacheco, 2022).
Trazodone 25 milligrams and Fluoxetine 10 milligrams are two pharmacologic agents that would be appropriate for the patient’s antidepressant therapy. Trazodone is a serotonin receptor antagonist that is commonly used to treat insomnia caused by antidepressant use (Fava & Papakostas, 2016). Fluoxetine belongs to the Selective Serotonin Reuptake Inhibitors (SSRIs) class of antidepressants, which work by increasing serotonin activity in the brain. Because of their low side-effect profile, SSRIs are commonly used as first-line treatment for MDD (Chand & Arif, 2022). Furthermore, fluoxetine has been shown to safely reduce the severity of depression in diabetic patients without compromising glycemic control, which is important to consider given that this patient is diabetic (Khazaie, et al., 2011). In this case, I would choose Trazadone over Fluoxetine because the patient is already on Sertraline and experiencing insomnia.
It is critical to think about medication contraindications. Trazadone should not be taken with monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping MAOIs. When combined with other serotonergic agents, there is also a risk of developing serotonin syndrome (U.S. Food and Drug Administration, n.d.). Before prescribing, these contraindications should be thoroughly discussed with the patient.
When taking Trazodone, it is critical to keep track of your medication. Baseline bloodwork may be required to check baseline liver function and then monitored on a regular basis. A four-week follow-up appointment should be scheduled for the patient to assess the medication’s effectiveness. If the patient is not experiencing a reduction in symptoms at this point, it may be necessary to increase her daily dose to 50 milligrams and re-evaluate in four weeks.
Chand, S. P., & Arif, H. (2022). Depression. National Library of Medicine. Retrieved October 12, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK430847/
Fava, M., & Papakostas, G. I. (2016). Antidepressants. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 27–43). Elsevier.
Khazaie, H., Rahimi, M., Tatari, F., Rezaei, M., Najafi, F., & Tahmasian, M. (2011). Treatment of depression in type 2 diabetes with Fluoxetine or Citalopram?. Neurosciences (Riyadh, Saudi Arabia), 16(1), 42–45.
Pacheco, D. (2022). Diagnosing insomnia. Sleep Foundation. Retrieved from https://www.sleepfoundation.org/insomnia/diagnosis
U.S. Food and Drug Administration. (n.d.). Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/017812s028,018421s027lbl.pdf – essay writers