| Course | NU675 PMHNP Diagnosis and Management Across the Lifespan II |
|---|---|
| Unit | Unit 8 |
| Paper type | Discontinuation case analysis |
| Length | About 1,090 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU675 Unit 8
Two Days, Then Six Weeks: A Discontinuation Case Analysis Separating Withdrawal From Relapse After a 67-Year-Old Stopped Desvenlafaxine
[Student Name]
Purdue University Global
NU675: PMHNP Diagnosis and Management Across the Lifespan II
Unit 8 Discontinuation Case Analysis
[Instructor Name]
[Date]
The patient is composite; doses, dates and scores are bracketed.
The Patient and the Taper
Mrs. [V.] is a [67]-year-old retired tax preparer with recurrent major depressive disorder, two previous episodes at [48] and [59]. Her most recent episode, three years ago, responded to desvenlafaxine [50] mg daily. After [two] years in remission she asked to stop, and she and her prescriber agreed on a taper: [25] mg daily for [two] weeks, then alternate days for a further fortnight, then stop. She did not have a relapse plan written down.
Event One: Days 2 to 16 After the Last Dose
Two days after her last dose she developed dizziness, nausea, poor sleep with vivid dreams, irritability, and brief electric jolts behind her eyes when she moved them quickly to the side. She felt "hungover and on edge." She called the clinic on day [four]. The symptoms eased over about two weeks and were gone by day [16].
Analysis. The timing, within days of stopping, and the nature of the symptoms point to withdrawal. Dizziness, nausea, sleep disturbance, vivid dreams and sensory disturbances described as electric shocks are characteristic features of antidepressant withdrawal, which reviews describe as typically beginning within a few days of stopping and lasting a few weeks, though sometimes longer (Fava et al., 2015). A systematic review of withdrawal effects across antidepressants found that they are more common, severe and long-lasting than earlier guidelines suggested, and warned that they are frequently misdiagnosed as relapse (Davies & Read, 2019). None of her symptoms were typical of her previous depressive episodes, which had begun with early waking and withdrawal from people.
What was done. She was reassured, told the symptoms were expected and likely to pass, and advised on hydration and rest. Restarting was offered but she declined. The clinic did not treat the event as relapse, and it was right not to.
Event Two: Weeks 6 to 8 After the Last Dose
Six weeks after stopping, well after the withdrawal symptoms had resolved, she began waking at [4:15 a.m.] and lying awake. Over two weeks she lost interest in her garden, stopped calling her sister, felt guilty about "being a burden" and dreaded her grandchildren's weekend visits, which she had always loved. Her PHQ-9 rose from [3] to [15].
Analysis. These symptoms began after a symptom-free interval, matched her previous depressive episodes almost exactly and included no dizziness, nausea or sensory jolts; that is the pattern of relapse, not withdrawal. Recurrence after stopping maintenance treatment is common in people with recurrent depression; pooled relapse prevention trials show clearly that staying on an antidepressant protects against relapse compared with switching to placebo (Geddes et al., 2003). Her history of three episodes placed her at high risk.
What was done. Desvenlafaxine was restarted at [50] mg daily, and she returned to remission over [eight] weeks.
How She Described the Difference
When asked afterward to compare the two periods, Mrs. [V.] put it in her own terms. The first, she said, "was in my body. I felt seasick and my head buzzed, but I still wanted to see people." The second "was in my mind. I felt fine physically and wanted nobody near me." She added that during the first period she had been frightened that the depression was returning, and that the clinic's explanation had helped her wait. During the second she had not called for almost two weeks, because she assumed it was more of the same and did not want to seem to be complaining. Her account supports the distinction, and it also shows a risk in it: a patient reassured once that her symptoms are withdrawal may assume the same about a later relapse and delay seeking help.
The Relapse Plan She Now Has
Her plan, written after she recovered, lists her personal early warning signs in the order they appeared: waking before five, stopping calls to her sister, and dreading family visits. If two of these last more than a week, she calls the clinic, and she has agreed that her sister may call on her behalf. The plan also records what withdrawal felt like for her, so that if she ever tapers again she and the clinic can compare new symptoms with both lists. She and her prescriber agreed that, with three episodes, continuing treatment long term is the sounder choice for now, and that any future attempt to stop will use smaller final steps over a longer period.
Why the Distinction Mattered
If the first event had been read as relapse, she would likely have restarted within days and concluded that she could never stop, when her symptoms were in fact withdrawal. If the second event had been read as lingering withdrawal, her relapse would have been left untreated for weeks. The list below summarizes the difference as it was recorded.
1. Onset: withdrawal within days of the last dose; relapse after a six-week symptom-free interval.
2. Symptoms: withdrawal physical and sensory, including dizziness and jolts; relapse the core symptoms of her earlier episodes.
3. Course: withdrawal eased over about two weeks; relapse worsened over two weeks.
4. Resemblance to previous episodes: none for withdrawal; close for relapse.
What Could Have Been Done Better
Two things would have improved her care. First, the taper was fairly quick for someone on long-term treatment; the argument for proportional tapering, with smaller reductions at lower doses, was developed for serotonin reuptake inhibitors but may apply to related drugs (Horowitz & Taylor, 2019), and a slower final step might have reduced the withdrawal. Second, with three previous episodes, a written relapse plan, including her personal early warning signs and a plan to restart promptly, should have been in place before the taper started. She now has one.
Lessons
When a patient develops symptoms after stopping an antidepressant, the clinician should ask when they began, what they are, and whether they resemble the patient's previous episodes. Symptoms within days that are physical, sensory and unlike past episodes suggest withdrawal. Symptoms that return after a symptom-free interval and match past episodes suggest relapse. Writing the answers down at each call makes the difference visible. It also protects the patient from two opposite mistakes: restarting a drug she did not need, and waiting out a relapse she did.
References
Davies, J., & Read, J. (2019). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, 97, 111-121. https://doi.org/10.1016/j.addbeh.2018.08.027
Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E. (2015). Withdrawal symptoms after selective serotonin reuptake inhibitor discontinuation: A systematic review. Psychotherapy and Psychosomatics, 84(2), 72-81. https://doi.org/10.1159/000370338
Geddes, J. R., Carney, S. M., Davies, C., Furukawa, T. A., Kupfer, D. J., Frank, E., & Goodwin, G. M. (2003). Relapse prevention with antidepressant drug treatment in depressive disorders: A systematic review. The Lancet, 361(9358), 653-661. https://doi.org/10.1016/S0140-6736(03)12599-8
Horowitz, M. A., & Taylor, D. (2019). Tapering of SSRI treatment to mitigate withdrawal symptoms. The Lancet Psychiatry, 6(6), 538-546. https://doi.org/10.1016/S2215-0366(19)30032-X
NU675 Unit 8 instructions, in plain terms
For Unit 8 you analyze a case in which symptoms appeared after a medication was stopped, and decide what they were. Prompts usually ask for the history and taper, a description of each symptom period, an analysis using clear criteria, the actions taken and whether they were right, and what could have been done better. This paper often runs four to six pages. Strong grades follow when the writer separate withdrawal from relapse by explicit features, such as timing and type of symptoms, rather than by impression, and that cite evidence on both. Including the patient's own description of the difference, and the relapse plan she now has, turns the analysis into something a clinician can use at the next call.
How the NU 675 Unit 8 example is put together
The case opens with her history of three episodes and a quick taper with no written relapse plan. Event one is described day by day and analyzed with the Fava and Davies and Read reviews on withdrawal. Event two is described with her PHQ-9 rising to 15, and a highlighted sentence explains why it matches relapse, with the Geddes meta-analysis on relapse risk. Her own comparison of the two periods follows, then her new relapse plan. A four-line list sets out onset, symptoms, course and resemblance for each event. A section on what could have been done better cites proportional tapering, and three questions for any phone call close the case.
Where the points sit in the NU675 Unit 8 rubric
Graders look first at how clearly the criteria are stated, then at accurate description of each period, use of evidence, judgment about the actions taken and lessons for practice. Criteria earn full points when timing, symptom type and resemblance to past episodes are stated and applied to both events. Description rewards specific symptoms and dates. Evidence points go to reviews of withdrawal and trials of relapse prevention, each used for the event it explains. Judgment is scored on whether the analysis says which responses were right and why. Lessons for practice earn credit when they are simple enough for a clinician to apply on the phone.
Common NU675 Unit 8 mistakes, and how to avoid them
The most frequent error is treating every symptom after stopping an antidepressant as relapse, which leads to unnecessary restarting. The opposite error, treating a later relapse as prolonged withdrawal, delays needed treatment. Students often skip the patient's history of previous episodes, which shapes the risk. Some analyses describe the taper without judging whether it was too fast. Others omit the relapse plan that should have been in place. And an analysis that never asks the patient how the two periods felt misses the evidence that often distinguishes them most clearly, and that she will use herself next time. Write down what the patient says each time she calls.
Get an NU675 Unit 8 example written to your instructions
Put every date your NU675 Unit 8 case gives into what you send: each taper step, the day each symptom began and any record of past episodes, plus the rubric. Expect the first custom analysis back within 24-48h, free, testing each cluster against onset, novelty and resemblance, then pairing each with its response. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU675 Unit 8 questions, answered
Can withdrawal and relapse happen in the same patient?
Yes, and a strong analysis allows for it. One set of symptoms can start soon after a dose step and fade, while a return of the original illness emerges later. Separate them by onset, by whether the symptoms were part of the illness before, and by resemblance to past episodes, and flag any symptom that could belong to either.
How long can antidepressant withdrawal last?
Typically days to a few weeks, but some people report symptoms for considerably longer, and guidance has shifted to acknowledge this. NICE revised its advice in 2019 after reviews suggested withdrawal was more common and longer-lasting than earlier guidance stated. Cite the source you rely on and avoid presenting a fixed duration as certain.
Should the analysis recommend restarting the antidepressant?
It can discuss restarting where the evidence points to relapse, with the reasoning shown and every amount bracketed. For withdrawal alone, the options include waiting, or resuming and then tapering more slowly. Present the choices with their rationale and treat the final call as one for the prescriber and patient together, since a coursework analysis is not a prescribing document for anyone.
Where can I find a free NU675 Unit 8 sample paper?
This page gives the full NU675 Unit 8 discontinuation case analysis, with both symptom periods, the criteria that separate them, her own account, her new relapse plan and what could be improved, plus four references. Send the details of your own discontinuation case and an analysis can be prepared.
How is withdrawal told apart from relapse in NU675 Unit 8?
By timing, symptom type and resemblance to past episodes. Withdrawal began within days, was physical and sensory and unlike her depressions; relapse came after a symptom-free interval and matched her earlier episodes almost exactly.