Appropriate Drug Therapy for MDD and Alcohol Abuse

Appropriate Drug Therapy for MDD and Alcohol Abuse

Question One

Patients presenting with MDD and a history of alcohol abuse pose a unique challenge for psychiatric nurse practitioners. The selection of appropriate drug therapy is crucial for positive patient outcomes. SSRIs such as sertraline or fluoxetine are often considered the first-line treatment due to their effectiveness in treating MDD and a relatively favorable side effect profile (Chhetri et al., 2023; McHugh & Weiss, 2019). SSRIs work by increasing the levels of serotonin in the brain, which is implicated in mood regulation. Conversely, TCAs and MAOIs are generally contraindicated in this population. TCAs, such as amitriptyline, may have adverse interactions with alcohol, potentially increasing sedation and respiratory depression. MAOIs, like phenelzine, can cause hypertensive crises when combined with alcohol. These interactions underscore the importance of choosing medications with a safer side effect profile.

Each person experiences depression symptoms differently. The entire therapeutic benefit of SSRIs may take four to six weeks. However, some patients may show improvement in the first few weeks. Monitoring the patient closely for signs of improvement and adjusting the treatment plan accordingly is essential. Additionally, ongoing support for alcohol cessation is crucial, possibly involving collaboration with addiction specialists.

Question Two

Various factors can influence late-onset generalized anxiety disorder (GAD) in older adults. Chronic medical conditions, such as cardiovascular diseases or chronic pain, may contribute to heightened anxiety levels. Major life stressors, like the loss of a loved one or retirement, might cause late-onset GAD (Hellwig & Domschke, 2019; Lenze & Wetherell, 2022). A family history of anxiety disorders suggests a genetic predisposition, and the prevalence of GAD is higher in females, potentially due to hormonal fluctuations.

Chronic health issues, often prevalent in older adults, can lead to increased worry about one’s health, contributing to the development of GAD (Hellwig & Domschke, 2019; Lenze & Wetherell, 2022). Major life transitions, such as retirement, may result in losing identity and increased leisure time, leading to excessive rumination and worry. Understanding these predictors is vital for early identification and intervention.

Question Three

According to Stahl (2021), psychotic major depression is a severe kind of depression marked by the existence of psychotic symptoms like delusions or hallucinations. The neurological basis of this illness entails intricate interactions in the central nervous system. The etiology of psychotic major depression is linked to abnormalities in the dopamine and serotonin systems. The dysregulation of these neurotransmitters may exacerbate perception errors and mood disorders. Disruption in the HPA axis, which is connected to high cortisol levels and plays a crucial role in the stress response, may also worsen depressive symptoms. Alterations in neuroplasticity, the brain’s ability to reorganize and adapt, are also observed in psychotic major depression. Reduced neuroplasticity may contribute to the persistence of negative thought patterns and cognitive distortions (Stahl, 2021). Furthermore, inflammation in the central nervous system has been linked to depressive disorders, including those with psychotic features.

Question Four

At least five of the following symptoms must be present for two weeks in order to identify a severe depressive episode: depressed mood, a diminished sense of enjoyment or interest in activities, noticeable weight loss or increase, sleeplessness or excessive sleep, psychomotor retardation or agitation, fatigue or low energy, overwhelming guilt or feelings of unworthiness, trouble focusing, and repeated thoughts of death or suicide (American Psychiatric Association, 2021).

Question Five

• Stimulants: Medications like amphetamines or methylphenidate used for attention deficit hyperactivity disorder (ADHD) (Katzung et al., 2021).
• Corticosteroids: Drugs such as prednisone are often prescribed for inflammatory conditions.
• Antidepressants: Some people may get insomnia as a side effect of taking drugs such as venlafaxine or fluoxetine (Katzung et al., 2021).

References

American Psychiatric Association. (2021). Diagnostic and statistical manual of mental disorders (DSM-5). Booksmith Publishing LLC.

Chhetri, B., Dem, U., Letho, Z., Tshering, K., & Škodlar, B. (2023). Prevalence of major depressive disorder in adult patients with alcohol use disorder admitted in the psychiatric ward at the Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan. Population Medicine, 5(May), 1–8. https://doi.org/10.18332/popmed/166187

Hellwig, S., & Domschke, K. (2019). Anxiety in late life: An update on pathomechanisms. Gerontology, 65(5), 465–473. https://doi.org/10.1159/000500306

Katzung, B. G., Kruidering-Hall, M., Tuan, R. L., Vanderah, T. W., & Trevor, A. J. (2021). Katzung & Trevor’s pharmacology examination and board review (13th ed.). McGraw Hill Professional.

Lenze, E. J., & Wetherell, J. L. (2022). A lifespan view of anxiety disorders. Anxiety, 13(4), 381–399. https://doi.org/10.31887/dcns.2011.13.4/elenze

McHugh, R. K., & Weiss, R. D. (2019). Alcohol use disorder and depressive disorders. Alcohol Research: Current Reviews, 40(1). https://doi.org/10.35946/arcr.v40.1.01

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. Cambridge University Press.

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Appropriate Drug Therapy for MDD and Alcohol Abuse

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 the resolution of symptoms?
List 4 predictors of late-onset generalized anxiety disorder.
List 4 potential neurobiology causes of psychotic major depression.
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.
List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia. Be specific.