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(Remeron). Both of these can be sedating and are commonly prescribed to be taken at bedtime. The next classes are the tricyclic antidepressants and Monoamine oxidase inhibitors (MAOIs). These are rarely prescribed unless all other classes of medications and been trialed andfailed. Both classes have the potential for serious side effects and their use must be monitored closely (Post & Mígne, 2012). Patients prescribed MAOIs must avoid certain foods such as pickles, cheese, and wine to avoid possibly deadly food/drug interactions. There are also many drug and supplement interactions that must be monitored for patients taking MAOIs.Clinical Guidelines
DEPRESSION7The American Psychiatric Association (APA) has established clinical guidelines for the assessment, diagnosis and treatment of depression (Gelenberg et al., 2010). There are ten components the APA has established. The first is the establishment of a therapeutic alliance with the patient. Once this alliance has been established the clinician can effectively perform the psychiatric evaluation. This diagnosis of depression is based on the clinical assessment of the patient by the psychiatrist. There are no laboratory or radiologic procedures that can be used to diagnose major depression. They are generally ordered to rule out other medical conditions that may be causing the depressive symptoms (Andrew, 2016). Once other conditions have been eliminated the physician can make the diagnosis of Major Depressive Disorder. Once the evaluation is complete the provider must determine if the patient is at risk for harming themselves or others. Suicidal ideation is common in patients with depression and must be taken seriously (Gelenberg et al., 2010). Based on the safety risk to the patient the next component is to assess and decide on the most appropriate treatment setting for the patient. The patient may need to be admitted to the hospital if safety is a concern. If the patient is not willing to go to the hospital the provider may need to commit them involuntarily until they no longer wish to harm themselves. This process varies from state to state and there are different laws and time periods associated with the involuntary admission process in each state. Additional components of the APA Standard of practice include assessing the quality of life and ability of the patient to care for themselves, collaboration with other healthcare professionals, planning follow up and monitoring of the patient’s psychiatric care, monitoring treatment and medication adherence, and providing initial and ongoing education to the patient and the patient’s family (Gelenberg et al., 2010).
DEPRESSION8The patient will need to receive education on the importance of continuing their medications and continuing psychotherapy. They need to understand they have an illness that is treatable (Andrew, 2016). Patients should be educated on the risk of relapse and what they need to be aware of to recognize early warning signs of relapse. Including the family in this education is also important as they can sometimes see signs that the patient is not aware of. It should be