The Impact of Ethnicity on Antidepressant Therapy

The Case: The man whose antidepressants stopped working

The Question: Do depressive episodes become more difficult to treat and more recurrent over time?
The Dilemma: When can you stop antidepressant treatment and what do you do if medications that worked in the past no longer work?
When should antidepressant maintenance become indefinite?
63-year-old man with the worst depression and anxiety he has ever felt

Psychiatric History: First Episode The Case: The man whose antidepressants stopped working

• Age 42, became depressed and anxious after his episode of atrial
fi brillation
• Felt vulnerable and afraid of death
• After his hospitalization for atrial fi brillation, which resolved with medications, he felt depression, anxiety, “butterfl ies in his stomach” and felt like his whole body was “plugged into an electrical circuit”
• Began having suicidal thoughts
• This episode also coincided with the death of his mother
• Treatment with alprazolam (Xanax) and clonazepam (Klonopin): no improvement
• Sertraline (Zoloft) treatment 100 mg/day and he was much improved within 2–3 months, functioning normally at work but had sexual side effects
• Felt totally normal after 6 months and discontinued sertraline Social and Personal History
• Married 33 years, 3 children
• Non smoker
• No drug or alcohol abuse

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
Provide the case number in the subject line of the

List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.

Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations, The Case: The man whose antidepressants stopped working.

 

MORE INFO 

The Impact of Ethnicity on Antidepressant Therapy

Introduction

Antidepressant use is a complex issue. While some studies have shown that ethnic minorities are more likely to get treatment for depression, others suggest that they’re less likely to do so than whites. What’s more, there has been much debate over whether this gap is due to discrimination or other factors. In this article we’ll explore the impact of ethnicity on antidepressant therapy and offer some tips for counseling clients who may be reluctant about taking medication for mental health problems.

The impact of ethnicity on antidepressant use

Ethnicity is a factor in the effectiveness of antidepressant use and side effects.

• Antidepressant effectiveness: Some ethnic groups have been shown to benefit more than others from antidepressant therapy. For example, African Americans are less likely to respond positively to antidepressants than European Americans. Studies have also found that Asian Americans may experience withdrawal symptoms after discontinuing an antidepressant medication.

• Side effects: Side effects vary by ethnicity, but some studies show that African American patients may experience more severe adverse effects on their physical health when taking different medications compared with white patients. White individuals may report nausea or headaches as common side effects during treatment for depression; however, many other ethnicities experience these symptoms at lower rates than whites do (for example).

How does ethnicity affect treatment choices?

To understand what ethnicity affects treatment choices, you need to understand how it affects treatment choices.

Ethnicity plays a role in the way antidepressants are prescribed. The type of depression and the antidepressant are important factors in determining whether or not an ethnic population will be prescribed one or another antidepressant. For example, if you’re Caucasian and have been diagnosed with major depressive disorder (MDD), then your doctor may prescribe an SSRI such as Prozac or Zoloft because these medications are better tolerated by Caucasians than other types of antidepressants like MAOIs or MAO-inhibitors (SNRIs) which are known for their side effects on those with non-Caucasian skin tones.*

If you’re African American, however, then your doctor may prescribe bupropion XL instead since it has fewer side effects than other second generation antidepressants like sertraline HCl + dapoxetine HCl

Race, mental health and self-medication

You might be wondering: “Why does this matter?” Well, there are many reasons. First, ethnicity and race are not the same thing. Ethnicity is a social construct—a group of people who share common cultural traditions and values—while race is a biological construct—a group of people who share common biological traits (e.g., skin color). In addition to these differences in how we categorize ourselves socially and biologically, there are no universally accepted racial or ethnic categories because they don’t exist!

Therefore it’s important for healthcare providers to understand how ethnicity can affect treatment decisions when it comes to mental health issues like depression or anxiety disorder management

Takeaway:

You should pay attention to your own treatment decisions, but also consider the impact of ethnicity. If you’re Caucasian, you might want to avoid medication if it’s not necessary for you. If your doctor prescribes an antidepressant medication, be sure that it will work for you because some people can’t tolerate them.

Now that we’ve covered how race and ethnicity affect treatment choices and symptoms of depression, let’s discuss why self-medication is a bad idea when dealing with mental health issues like depression or anxiety disorders like panic attacks or phobias (such as fear of flying).

Conclusion

There are several factors that can affect treatment choices when someone is depressed or anxious. These include personal and social circumstances, but also ethnicity, which we have explored here in terms of the differences in prevalence between ethnic groups. As a result, it is clear that different cultures have different beliefs about mental health and how it should be treated—and this may influence how effective antidepressants are for some people who try them out.