Decision #2
After beginning Zoloft, the client returned to the clinic four weeks later with no change in
depression symptoms reported. This is an expected outcome as symptom improvement for some
may occur within one or two weeks however, the desired therapeutic effect is generally achieved
in about eight weeks (Ankrom, 2021). For decision point #2, I was given the choice to increase
the Zoloft dosage to 37.5mg po daily, increase to 50mg po daily, or change to Prozac 10mg po
daily. I elected to increase the dosage to 50mg po daily as my first option. I initially thought
about going with 37.5mg but after considering the dosage options available from the
manufacture, I stuck with my initial choice. The reason be this is, although the tablet is scored,
the likelihood of a partial missed dose is increased, hindering us reaching our goal of maximum
therapeutic effect.
I did not choose the option of changing to Prozac because, in the absence of significant
side effects, we are not able to clinically tell if the prescribed Zoloft will produce the desired
results after only four weeks of therapy. If a patient’s medication is switched too early, they may
be needlessly abandoning an effective medication which will make the process of identifying an
effective treatment plan much more difficult (Kudlow, McIntyre, and Lam, 2014). Based upon
the patient scenario, I will assume that he has not previously been on antidepressant medications.
Given the age of the patient, along with the information we are given in the scenario, it would be
wise for us as the provider to exhibit patience during treatment. Generally, the trial
antidepressant duration is considered to be sufficient if enough time has passed to produce a
significant therapeutic effect. In clinical trials, 4–6 weeks has been used as the threshold for
sufficient duration, while others are using a longer period of up to 8–12 weeks (Baek, Nierenberg
and Fava, 2016)
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