NURS 6630- Week 8

1). In 3 or 4 sentences, explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? Be specific. What is the timeframe that the patient should see resolution of symptoms? The appropriate drug therapy for Major Depressive Disorder (MDD) is Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are considered as the first line treatment therapy for patients having MDD. Considering this, the specific drug for a patient with MDD is Zoloft (also known as Sertraline Hydrochloride). However, it is important to ensure that the patient is not currently addicted to alcohol. Consumption of alcohol while on antidepressants can reduce the efficacy of therapy and can worsen the symptoms of depression. It is because alcohol can increase the severity of side effects of antidepressants as the patient will become more drowsy and dizzy. Therefore, patient needs to be educated that he/she should avoid alcohol consumption because if he/she will continue alcoholism then it can worsen the symptoms of depression and can reduce the efficacy of treatment. Zoloft is also recommended for such patients because Zoloft maintains the serotonin’s optimal levels and therefore enhances the serotonergic activities in central nervous system. This drug is also recommended because of its milder side effects and less toxic profile in overdose as compared to other tricyclic antidepressants. The initial therapeutic dosage will be recommended which is 50mg PO once daily. If the patient failed to respond to this dose, then the dose could be increased up to 150 mg PO once daily (Tolliver & Anton, 2015). Majority of the antidepressants are not recommended if the patient is consuming alcohol because alcohol can further worsen the symptoms of depression. However, drugs like Paroxetine, Fluoxetine and Lexapro would be avoided because these drugs can cause increased sedation with alcohol. Moreover, these three drugs with Zoloft can cause life threatening complications due to Serotonin Syndrome. The time frame that the patient should see resolution of symptoms is two weeks minimum. However, it is recommended to evaluate the efficacy of any antidepressant drug for at least 4 weeks (Tolliver & Anton, 2015). 2). List 4 predictors of late onset generalized anxiety disorder. • If the patient is woman • If the patient has experienced any recent traumatic incident • Is the patient is suffering from a chronic cardiovascular or respiratory disorder • If the patient has cognitive impairment and phobia. 3). List 4 potential neurobiology causes of psychotic major depression. • Interactions that occur between the genes of a person and environment • Recent or ongoing stress • Traumatic/ abusive incidents experienced during childhood • The cumulative impacts of genetics. 4). An episode of major depression is defined as a period of time lasting at least 2 weeks. List at least 5 symptoms required for the