Case Study #10

Leslie Wiley
The Robert B. Miller College
Jim Middleton, Professor
BSRN 340- Pharmacology
May 1, 2015

Case Study #10

A 14 year old patient was admitted to an inpatient psychiatric unit
after he refused to go to school, wouldnt eat meals, and has been irritable
for several months. This patient has started cognitive behavioral therapy as
well as a prescription for SSRI antidepressants.
Serotonin syndrome occurs when the body accumulates too much of
the serotonin chemical. This can happen within several hours of taking a
new drug or increasing the dose of a drug that has already been prescribed
and started. Symptoms of this syndrome include:

Agitation or restlessness
Confusion
Rapid heart rate and high blood pressure
Dilated pupils
Loss of muscle coordination or twitching muscles
Muscle rigidity
Heavy sweating
Diarrhea
Headache
Shivering
Goose bumps

Severe serotonin syndrome is life threatening and includes the following

symptoms:

High fever
Seizures
Irregular heartbeat
Unconsciousness (Mayoclinic.com, 2014)

Education should be done with the parents on signs and symptoms that
they should be looking for. Other useful information would be that serotonin
syndrome could possible occur when taking the antidepressant along with
other medication such as migraine medication. Certain over the counter
medications also increase the risk. For example, OTC cough and cold
medication, herbal supplements, or illicit drugs can cause serotonin
syndrome when taken with antidepressants. (Mayoclinic.com, 2014)
Nurses should caution the parents that suicide is a high risk during the
first few months of therapy and when doses are changed on medications.
Because of this risk the patient should see a health care professional weekly
and parents should monitor behavior closely. Also, prescriptions should be
written for a small amount of medication at one time and the patients
parents should watch the patient take the medication and make sure it was
swallowed. If that doesnt occur, the patient could be hiding the medication
in their cheek or under the tongue to use at a later time with more pills.
(Lehne, 2013)
According to the Diagnostic criteria for major depression this patient
qualifies for prescribing antidepressants. There are three diagnostic criteria
for major depression. One of those is a presence of a single major
depressive episode such as:

Depressed mood most of the day, nearly every day (in

children/adolescents it can be irritability)

Markedly diminished interest or pleasure in all or almost all activities

Significant weight loss or weight gain without dieting or decrease or

increase in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate
Recurrent thoughts of death, recurrent suicidal ideation, a suicide
attempt, or a specific plan

At least five of the previously listed symptoms must be present for 2 weeks
or more. (Lehne, 2013)
Antidepressants do have a role in the treatment of anxiety and pain. I
personally used to suffer from migraines. After trying numerous different
medications, a physician started me on an antidepressant. I continued on
those pills for one year and then weaned off of them. The migraines are
gone! Many studies have been done on this topic and have found that (i)
doses necessary to improve pain are often lower than those used to treat
depression; (ii) at these dosed, the onset of activity is more rapid; (iii)
analgesic efficacy is usually obtained in non-depressed patients and does
not correlate with improvement in mood is depressed patients; and (iv) the
drugs are useful in acute and experimental pain (Ryder and Stannard,
2005).
References

Lehne, R. A. (2013). Pharmacology for nursing care (8th ed., pp. 354-359).
St. Louis, MO: Elsevier Saunders.
Ryder, S., & Stannard, C. F. (2005). Treatment of chronic pain:
antidepressant, antiepileptic and antiarrhythmic drugs. Oxford
Journal: Continuing Education in Anesthesia, Critical Care and Pain,
5(1), 18-21. doi:doi: 10.1093/bjaceaccp/mki003
Serotonin syndrome. (2014, March 13). In Mayo Clinic. Retrieved April 23,
2015.