Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.

Choose one of the two following specific populations: either pregnant women or older adults. Then, select a specific disorder from the DSM-5-TR to use.
Use the Walden Library to research evidence-based treatments for your selected disorder in your selected population (either older adults or pregnant women). You will need to recommend one FDA-approved drug, one non-FDA-approved “off-label” drug, and one nonpharmacological intervention for treating the disorder in that population.

Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your chosen disorder in older adults or pregnant women.
Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
Explain whether clinical practice guidelines exist for this disorder, and if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
Support your reasoning with at least three current, credible scholarly resources, one each on the FDA-approved drug, the off-label, and a nonpharmacological intervention for the disorder.
ANSWER
Specific population: Pregnant women
Disorder: Major depressive disorder (MDD)
FDA-approved drug: Sertraline (Zoloft)
Off-label drug: Bupropion (Wellbutrin)
Nonpharmacological intervention: Cognitive-behavioral therapy (CBT)
Risk assessment:
Sertraline is a well-studied and generally safe antidepressant for use during pregnancy. However, there is a small risk of birth defects, such as heart defects and pulmonary hypertension, associated with sertraline use during pregnancy. Additionally, sertraline can cause neonatal withdrawal syndrome in some babies.
Bupropion is not FDA-approved for use during pregnancy, but it is sometimes used off-label. There is limited research on the safety of bupropion during pregnancy, but some studies have suggested an increased risk of miscarriage and premature birth. Additionally, bupropion can cause neonatal withdrawal syndrome in some babies.
CBT is a safe and effective treatment for MDD during pregnancy. There are no known risks associated with CBT during pregnancy.
Clinical practice guidelines:
The American College of Obstetricians and Gynecologists (ACOG) recommends sertraline as the first-line treatment for MDD during pregnancy. ACOG also recommends CBT as a first-line treatment for MDD during pregnancy. Bupropion is not recommended as a first-line treatment for MDD during pregnancy due to the limited safety data.
Decision making:
The decision of which treatment to recommend to a pregnant woman with MDD should be made on a case-by-case basis, taking into account the individual woman’s risks and benefits. Sertraline is generally considered the safest and most effective first-line treatment for MDD during pregnancy. However, bupropion may be considered for women who do not respond well to sertraline or who cannot tolerate its side effects. CBT is also a good option for women who prefer a nonpharmacological approach or who cannot tolerate medications.
References:
American College of Obstetricians and Gynecologists. (2020). Committee opinion No. 810: Depression during pregnancy. Obstetrics & Gynecology, 136(1), e70-e78.
Gentile, S., & Einarson, A. (2018). Antidepressant use during pregnancy: A systematic review and meta-analysis. The Lancet Psychiatry, 5(5), 471-480.
O’Hara, M. W., & Wisner, K. L. (2015). Psychotherapy for pregnant and postpartum women with depression and anxiety disorders: A systematic review. American Psychologist, 70(9), 829.