Introduction
Currently, we are facing psychological disorders, especially in youths, and not many are ready to face reality. Research has explored different pharmacological approaches and psychotherapy interventions in managing adolescents with mental health issues. Psychotherapy interventions are always used, but their combination with psychotropics is linked with better outcomes (Yang et al., 2018). Like in the case explored for Lola, a 14-year-old with a family history of depression, anxiety, and suicide. Lola has different manifestations, including loss of appetite, fatigue, and disrupted sleep patterns for about 15 months. Since the intervention had no significant effect on Lola, the paper will explore the physical health implication of anxiolytics and antidepressants in adolescents, including the teaching strategies that nurses can utilize on consumers to recognize insufficient medication effects and the aftermaths.
Physiological Health Implications
Psychotropic drugs work in the body to adjust significant neurotransmitters in the brain. Also, they play a critical role in adults and adolescents with depression (Smogur et al., 2022). The medications either increase or decrease specific neurotransmitters within the body to counter the manifestations of mental health conditions (Himmerich et al., 2019). Psychotropics are often combined with psychotherapy to reduce the signs and symptoms of mental health issues such as depression (Yang et al., 2018). However, despite their numerous benefits, antidepressants are known for their multiple adverse outcomes. The goal of managing the patients entails monitoring for suicidal ideations, symptom reduction, and tracking the patient’s functional status (Himmerich et al., 2019). Psychotropic medications reflect critical intervention in managing psychiatric conditions. Prompt initiation of psychotropics has potential effects of lowering adult mortalities.
In recent years, there has been a growing population of patients seeking different mental health concerns in primary care. Therefore, the process has increased the prescription of psychotropic drugs. For instance, in the clinical scenario hurdle, Lola has been having depression and has commenced fluoxetine and diazepam after a failed cognitive behavior therapy intervention. Fluoxetine is indicated for major depressive disorder and panic disorder linked with bipolar disorder (Porter & Meldrum, 2001). The drug acts by selectively inhibiting serotonin reuptake in the central nervous system (Himmerich et al., 2019). Therefore, fluoxetine is an effective antidepressant.
The use of psychotropics among adolescents elevates the predisposition to clinically significant drug interactions (Rognli et al., 2021). Despite life-threatening drug interactions with psychotropics such as fluoxetine, clinically significant drug interactions that impact patients’ responses, including the presentation of adverse effects, have been documented by research that exhibits long-term outcomes (Smogur et al., 2022). As illustrated by Yang et al. (2018), the manifestations are prevalent initially, though they may improve as time progresses following the initiation of antidepressants. The unpleasant side effects linked with antidepressants that likely affect Lola’s physical health include weight gain, nausea, and sleep problems (Yang et al., 2018). However, different people respond differently and experience distinct adverse drug reactions.
Gastrointestinal disturbances, particularly nausea, are a frequent adverse effect of antidepressant medication. Research has explored the incidence and severity, including the duration of nausea among individuals diagnosed with antidepressants such as fluoxetine (Fond et al., 2020). Vomiting reflects an endpoint in neurotransmission changes that manifest in the gastrointestinal tract and the central nervous system (CNS). Nausea and vomiting occur due to chemoreceptor trigger zone stimulation in the fourth ventricle floor (Ritter et al., 2020). Serotonin reuptake inhibitors such as fluoxetine and anxiolytics such as diazepam stimulate vomiting trigger zones in the central and peripheral nervous system serotonin receptors. Fond et al. (2020) offer that selective serotonin reuptake inhibitors induce nausea in about 20 to 40% of patients under antidepressant medications. Noteworthy, nausea is a common manifestation that may reflect mild or severe ailments such as cardiovascular conditions. Nausea is often accompanied by vomiting (Fond et al., 2020). Vomiting presents numerous adverse effects on the body.
Among the complications linked to nausea includes dehydration and malnutrition, which eventually leads to hypovolemia given diminished digestion. Vomiting causes losses of electrolytes; hence the sequelae incorporate dehydration coupled with hypokalemia, hyponatremia, and hypochloremia (Fond et al., 2020). The aforementioned makes the clients feel sick, impacting their biological productivity and functioning. Fond et al. (2020) offer that among patients’ receiving antidepressants and anxiolytics, the prolongation in manifestation should prompt cessation of the drug.
Moreover, antianxiety medications, including antidepressants, may trigger breathlessness and shortness of breath (Abraham et al., 2018). Frequently encountered side effects of anxiolytics and antidepressants, such as shortness of breath, accrue as psychotropic medications produce calming effects given hyperventilation triggered by anxiety (Fond et al., 2020). Prolonged drug use may also irritate the airway and increase dyspnea risk (Fond et al., 2020). Additionally, shortness of breath affects the patient’s ability to execute their daily activities effectively. Sudden onset of cough spells, including cough, may lead to the accumulation of secretions. The manifestations may contribute to adverse respiratory effects that may affect the overall patient outcomes (Abraham et al., 2018). Given their association with adverse effects, caution should be taken, and patients under antidepressants and anxiolytics should be carefully monitored.
In addition, the adverse biological effects of psychotropics are also linked with psychological effects, including social detachment, emotional numbness, and a decline in optimistic feelings (Smogur et al., 2022). Like Lola, the introduction of fluoxetine may reduce the depressive manifestations, though the patient is likely to feel overwhelmed by waves of gloom. Research offers that during the initiation of antidepressants, most patients may not feel themselves (Katzung & Trevor, 2012). Those as mentioned above often may accompany periods of emotional inertness that hinder the capacity of the patient to execute their daily functioning successfully. Also, emotional blunting occurs in numerous patients under antidepressants (Liu et al., 2021). They lose the required motivation, including the drive to effectively complete activities of daily living. Patients such as Lola are an increased likelihood of emotional blunting.
Emotional blunting reflects a negative impact of antidepressant treatment, including failure in the regimen (Katzung & Trevor, 2012). The individual may experience slowed thinking and other adverse effects such as insomnia. Moreover, the patient may lack the capacity to respond to enjoyment at the same levels that she would typically do. Research offers that the prevalence of emotional blunting accounts for about 50-70% among individuals with antidepressants (Liu et al., 2021). An online survey by Liu et al. (2021) of nearly 1280 users from different regions found that the most adverse effects linked with antidepressants include loss of interest in initially pleasurable activities. From the survey, about 70% of the patients reported feeling distant and detached (DeBattista, 2018). A small population of the patients said that emotional blunting prompts their discontinuation of therapy, impacting their overall outcomes (Fond et al., 2020). Literature suggests the consideration of addressing limited emotional reactivity through engaging in outdoor activities that stimulate serotonin (Liu et al., 2021). Other psychotherapeutic interventions such as role-plays are also critical in improving the outcomes for patients under antidepressants presenting with symptoms (Dooley et al., 2021). These strategies help in ensuring positive health results for patients.
Another common psychological implication with antidepressants and anxiolytics incorporates reduced optimism. This affects the individual drive of patients to engage in activities that were initially considered pleasurable (Dooley et al., 2021). Reduced optimism affects the capacity of the patient to be productive. It aggregates complications such as intrusive thoughts and lack of pleasure that may significantly affect the patient’s ability to execute daily functions, i.e., completing school assignments and interacting with friends (Dooley et al., 2021). Research has explored the association between optimism and burnout with anxiolytics and antidepressants (Dooley et al., 2021). Based on research, the use of the identified psychotropic drugs has a personal impact and motivational abandonment.
Furthermore, research has found that optimism negatively correlates with psychotropic drug use (Smogur et al., 2021). Overall, prolonged use of anxiolytics depletes individuals’ drive and motivation. While, in most instances, the patients report a decline in the initial feelings of depression and anxiety, most of the patients experience mild to severe forms of motivational abandonment prompted by drug use (Dooley et al., 2021). Social detachment is a common side effect of benzodiazepines such as diazepam (Smogur et al., 2021). For Lola, who has received a diazepam prescription, loneliness and social isolation are anticipated.
Social isolation may prompt fear, insecurity, and depression in the patient (Dooley et al., 2021). Lola may experience social isolation, including loneliness within the school environment. Isolation may increase the patients’ dependence on drugs and other psychoactive substances like alcohol and caffeine, contributing to poor outcomes (Dooley et al., 2021). Often, adolescents under benzodiazepines and antidepressants may be socially isolated by their peers, which further affects their results and contribute to their feelings(Dooley et al., 2021). Different scholars have conceptualized loneliness. Previous studies by Katzung & Trevor (2012) that address the concern highlight that loneliness and isolation impact an individual’s social network, including interaction. The concern affects their ability to focus on essential elements in their daily existence.
Teaching Strategies
Psychotropic drugs may cause dizziness, drowsiness, and impaired judgment, including blurred vision (Yang et al., 2018). Nurses play a critical role in patient education; they ensure patients understand different aspects of their treatment, which is vital in reducing factors that predispose them to adverse effects (Smogur et al., 2021). The nurse should advise the patient to take the drugs on the same day and not double dose or discontinue the medications without consulting with their health professionals (Yang et al., 2018). Patient teaching will include taking medicine in the evening to enhance concentration during daytime activities (Yang et al., 2018).
The relatives and family should be prepared to immediately inform the care providers in case of any suicide behaviors, restlessness, and irritability in the patient that signals serotonin syndromes (Yang et al., 2018). Therefore, the nurse should teach Lola’s parents to look out for any elements of suicidality and suicide ideations. Also, the patient, including the family, should be taught about a gradual change in position to minimize dizziness (Smogur et al., 2021). The patient should be prepared to notify care providers of sensitivity reactions, including the presentation of nausea, vomiting, anxiety, and anorexia (Yang et al., 2018). The patient should emphasize the importance of follow-up to ascertain the drug’s effectiveness.
Patient and family education on the expectation of desired outcomes helps them track improvements or poor responses to the drugs, which remain critical in dose adjustments and alternative interventions to improve health outcomes (Dooley et al., 2021). With continued diazepam and fluoxetine, the patient should demonstrate an increased sense of wellness (Yang et al., 2018). Lola will show a renewed interest in the surroundings. Patients’ awareness about the duration of therapy, i.e., about one to four weeks before antidepressant effects can be elicited and mood alteration declines, including the frequency of panic attacks, remain critical (Smogur et al., 2022). Overall, the consumer’s education will also focus on the use of the drugs and the side effects linked to the regimen to monitor their outcomes effectively.
Nurses are the frontline providers who advocate for patients to ensure they receive the best high-quality care. Nursing considerations in client education will include the likelihood of poor response to antidepressants (Smogur et al., 2022). The aspects that suggest an inadequate response to psychotropic drugs include worsening depressive manifestations, including increased incidences of side effects. The increased onset of new behaviors and new suicidal thoughts suggests a poor reaction to the drugs. Research by Smogur et al. (2022) aimed to examine the different dimensions related to antidepressants. The study found that antidepressant-induced risks such as suicidal behaviors, hopelessness, anxiety, and suicide attempts suggest a poor response to antipsychotic treatment.
Conclusion
Conclusively, Lola has been under cognitive behavior therapy for a diagnosis of major depression. Given that the intervention had no significant effect on Lola, a prescription of Prozac and low dose diazepam to settle down the condition. As highlighted in the study, the physiological impacts of antidepressants and anxiolytics include nausea, vomiting, and shortness of breath. Nurses play a critical role in teaching the patients about the occurrences that suggest positive compliance. It allows for a prompt intervention to improve the outcomes for patients. Nursing consideration in client education will include the likelihood of poor response to antidepressants.
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