Question

A client has been taking imipramine (Tofranil), 125 mg by mouth daily, for 1 week. Now the client reports wanting to stop taking the medication because he still feels depressed. At this time, what is the nurse's best response?

1. "Imipramine may not be the most effective medication for you. You should call your physician for further evaluation."
2. "Because imipramine must build to a therapeutic level, it may take 2 to 3 weeks to reduce depression."
3. "The physician may need to increase the dosage for you to get the medication's maximum benefit."
4. "Don't stop taking the medication abruptly because you may develop serious adverse effects."

Answer 1

The patient's refusal to continue amitriptyline due to side effects and no immediate mood improvement aligns best with the nursing diagnosis 'Noncompliance (treatment regimen) related to treatment resistance.' The nurse's role includes managing side effects and informing about the typical delay in antidepressant effectiveness.

Step-by-step explanation:

The nurse is dealing with a client who refuses to continue with amitriptyline treatment due to experiencing side effects such as blurred vision, dry mouth, and constipation, without perceived improvement in mood. Given that amitriptyline is a tricyclic antidepressant which can lead to side effects and typically requires a period of two to three weeks before mood elevation is noticeable in patients, the most appropriate nursing diagnosis for this situation would be 1. Noncompliance (treatment regimen) related to treatment resistance. This diagnosis is due to the patient's refusal to take the medication as a result of the side effects experienced and the lack of immediate mood improvement. The nurse should address the side effects while educating the patient on the typical onset of beneficial effects of the medication, as antidepressants like amitriptyline require some time before their full therapeutic effects are felt.