The psychiatrist on call comes in to evaluate J.B. after meeting ...

[formula1]

The psychiatrist on call comes in to evaluate J.B. after meeting with J.B., the psychiatrist writes an order for escitalopram (Lexapro) 10 mg daily at bedtime.
 
  J.B. is scheduled to see the psychiatrist the day after he
  is discharged from the hospital.
 
  What special instructions will you give him regarding the Lexapro? Select all that apply.
  a. The full effects of the medication might not be seen for 4 to 6 weeks.
  b. The medication may cause nausea, dry mouth, sedation, and insomnia.
  c. There are no known food interactions.
  d. The herbal product St. John's wort will enhance the action of the Lexapro.
  e. Taking a glass of wine at bedtime will help him go to sleep.
 
  Why do you think that a drug in the SSRI class was chosen over a tricyclic antidepressant or a
  monoamine oxidase inhibitor (MAOI)?

Question 2

You decide to notify J.B.'s physician about your findings. the attending physician calls in a psychiatrist to evaluate J.B.
 
  Identify two treatments that are available for depression.
 
  Would J.B. be a candidate for electroconvulsive therapy (ECT)? Why or why not?

[atrochim]

Answer to Question 1

Answers: a, b, c
Taking St. John's wort with an SSRI such as Lexapro might increase the risk of serotonin syndrome.
Drinking alcohol with SSRIs might increase sedative effects. Both of these interactions are potentially
dangerous.

Tricyclic antidepressants would be risky, considering J.B.'s history of heart problems. MAOIs are
effective antidepressants. However, these drugs require food restrictions and have the potential
to cause hypertensive crisis; if these food restrictions will not be followed, MAOIs are not the first
choice.

Answer to Question 2

 Antidepressant medications: selective serotonin reuptake inhibitors (SSRIs), tricyclics, and
monoamine oxidase inhibitors (MAOIs)
 Psychotherapy
 Electroconvulsive therapy

Although ECT is successful in many patients with depression and those with suicidal thoughts, ECT
would be very risky for J.B., considering his heart problems and recent heart valve replacement. The
seizure induced by ECT will stress the heart at the onset and for up to 10 minutes afterward.