Decision Point One
Begin Effexor XR 37.5 mg orally daily
RESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Client reports that there is no change in depressive symptoms at all
RESULTS OF DECISION POINT ONE
- Client returns to clinic in four weeks
- Client reports that there is no change in depressive symptoms at all
Decision Point Two
Increase dose to 75 mg of Effexor XR orally daily
RESULTS OF DECISION POINT TWO
- Client returns to clinic in four weeks
- Client reports an improvement in depressive symptoms
- Montgomery- Asberg Depression Rating Scale (MADRS) decreased from 51 to 38 (25% reduction)
Decision Point Three
Increase dose to 112.5 mg orally daily
Guidance to Student
At this point, the PMHNP would have two choices to discuss with the client- the current dose of drug can be maintained if the client is feeling better and is not offering any complaints of side effects. The dose can also be increased at this point, but the PMHNP must counsel client regarding the possibility of side effects. The use of an augmenting agent is not appropriate at this time as we have not reached a maximum dose with Effexor (in fact, 75 mg is still a relatively small dose), displaying primarily SSRI properties only (recall that at lower doses, Effexor exerts a greater effect on serotonergic receptors than norepinephrine at low doses).