Case Study Assignment: A Drug Therapy Appropriate for a Patient Presented with MDD and a History of Alcohol Abuse

Case Study Assignment: A Drug Therapy Appropriate for a Patient Presented with MDD and a History of Alcohol Abuse

Case Study Assignment: A Drug Therapy Appropriate for a Patient Presented with MDD and a History of Alcohol Abuse

Case Study

A Drug Therapy Appropriate for a Patient Presented with MDD and a History of Alcohol Abuse

This patient can be treated using various forms of antidepressants, including SSRIs, SNRIs), MAOIs, central alpha2-receptor antagonists, and dopamine reuptake inhibitors. These antidepressants have an impact on the overall balance of the three neurotransmitters found in the human brain. The medication relieves presented major depressive disorder symptoms since depression is associated with brain chemistry. However, tricyclic antidepressants (TCAs) should not be used in treating this client since sedation is likely to occur, increasing the risk of overdose if the patient has used an opioid, which might lead to death (Moraczewski & Kapil, 2020). A patient should see a resolution of MDD symptoms within 1–2 weeks. Nonetheless, it may take up to 3 months for the patient to experience all the benefits (Stein, 2020).

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Triggers for Late-Onset Generalized Anxiety Disorder

Several factors increase the risk of late-onset generalized anxiety disorder above 12 years. First, recent adverse life events increase the risk of late-onset GAD (Zhang et al., 2015). For instance, a person above 12 years is likely to develop generalized anxiety disorder following the death of a loved one. Additionally, multiple chronic physical and mental diseases trigger late-onset GAD. For instance, a person with heart failure is likely to develop GAD after 12 years (Zhang et al., 2015). Another major factor associated with late-onset GAD is genetics. According to Hellwig and Domschke (2019), genetic factors significantly impact the pathogenesis of anxiety disorders during adulthood. For example, a person might develop GAD after 12 years if his or her family has a history of GAD. Finally, late-life GAD is attributed to neuroendocrinology and hormones. Hypothalamic-pituitary-adrenal (HPA) axis function is altered by age-related hormones increasing the risk of late-onset GAD.

Potential Neurobiology Causes of Psychotic Major Depression

 Psychotic major depression is attributed to some neurobiological causes. The first cause is aberrant intra and internetwork patterns of connectivity. DMN hyperconnectivity and hyperactivity also increase the risk of this condition (Croarkin, 2018). Psychotic major depression is also caused by some subgenual cortex abnormalities and DMN functional connectivity. Finally, amygdala functional connectivity increases the risk of psychotic major depression.

Symptoms associated with an episode of Major Depression

The first symptom that characterizes an episode of major depression is a depressed mood. A person experiences a depressed mood on most of the days, almost daily within the two weeks. This condition is also characterized by a great loss of interest or pleasure in most activities that one liked before an episode of major depression. For instance, a person who enjoyed watching movies is no longer interested in watching those movies. Significant weight loss or weight gain is another major symptom. For example, a person can add or lose more than 20 pounds within a short period, such as a month. An episode of major depression is also characterized by fatigue or loss of energy. A person experiences fatigue even when at rest. Finally, this condition is associated with feelings of worthlessness. An individual feels that he or she does not have any value.

Classes of Drugs used in Treating Insomnia

 Multiple forms of pharmacological treatments are used in treating patients with insomnia. The first class consists of Nonbenzodiazepines, also known as “Z drugs,” such as zolpidem and zaleplon (Lie et al., 2015). These drugs facilitate GABAA receptors in the central nervous system, thereby preventing brain activity. The second class of drugs used in treating insomnia is Benzodiazepines such as lorazepam and oxazepam. Dual orexin receptor antagonists such as Suvorexant are also used in treating insomnia. Patients with insomnia are treated using melatonin receptor agonists such as Ramelteon (Rozerem). The last class of drugs used in treating insomnia is antidepressants such as Trazodone and Mirtazapine.

References

Croarkin, P, E. (2018). Indexing the neurobiology of psychotic depression with resting-state connectivity: Insights from the STOP-PD study. EBioMedicine; 37: 32–33. doi: 10.1016/j.ebiom.2018.10.010.

Hellwig, S & Domschke K. (2019). Anxiety in Late Life: An Update on Pathomechanisms. Gerontology; 65 (5): 465–473 https://doi.org/10.1159/000500306.

Lie, J, D., Tu, K, N., Shen, D, D., & Wong, B, M. (2015). Pharmacological Treatment of Insomnia. P & T; 40(11): 759-768, 771.

Moraczewski, J & Kapil, K, A. (2020). Tricyclic Antidepressants. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK557791/

Stein, S. (2020). Major Depressive Disorder (MDD) & Addiction. American Addiction Centers. https://americanaddictioncenters.org/treating-depression-substance-abuse/major

Zhang, X., Norton, J., Carrière, I., Ritchie, K., Chaudieu, I & Ancelin, M, L. (2015). Risk factors for a late-onset generalized anxiety disorder: Results from a 12-year prospective cohort. Translational Psychiatry; 5: 1-7. doi:10.1038/tp.2015.31.

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Address the following Short Answer prompts for this Assignment. Be sure to include references to the Learning Resources for this week.

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?
2. List 4 predictors of late onset generalized anxiety disorder.
3. List 4 potential neurobiology causes of psychotic major depression.
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 episode to occur. Be specific.
5. List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.