Drug therapy for a patient who presents with MDD

Sample Solution

The appropriate drug therapy for a patient with MDD and a history of alcohol abuse is a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI). SSRIs and SNRIs are generally safe and effective for treating MDD, and they have a lower risk of abuse and dependence than other types of antidepressants. Some specific SSRIs and SNRIs that are appropriate for treating MDD in patients with a history of alcohol abuse include:

• SSRIs: sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro)
• SNRIs: venlafaxine (Effexor), duloxetine (Cymbalta)

Contraindicated drugs Tricyclic antidepressants (TCAs) are contraindicated in patients with a history of alcohol abuse due to their increased risk of side effects, including seizures and heart problems. Atypical antidepressants, such as bupropion (Wellbutrin) and mirtazapine (Remeron), are also contraindicated in some patients with a history of alcohol abuse due to their potential to increase alcohol consumption. Timeframe for resolution of symptoms It is important to note that antidepressants take time to work. Most patients will not experience significant relief from their symptoms until after 2-4 weeks of treatment. Some patients may need to take antidepressants for several months or even years to maintain their mood stability. Predictors of late onset generalized anxiety disorder The following are four predictors of late onset generalized anxiety disorder:

• Family history of anxiety disorders: People with a family history of anxiety disorders are more likely to develop the disorder themselves.
• Childhood trauma: People who have experienced childhood trauma, such as abuse or neglect, are more likely to develop anxiety disorders.
• Major life stressors: Major life stressors, such as job loss, divorce, or the death of a loved one, can trigger the onset of anxiety disorders.
• Certain medical conditions: Certain medical conditions, such as hyperthyroidism and heart disease, can increase the risk of developing anxiety disorders.

Potential neurobiology causes of psychotic major depression The following are four potential neurobiology causes of psychotic major depression:

• Brain chemistry: Psychotic major depression may be caused by an imbalance in certain brain chemicals, such as serotonin, dopamine, and norepinephrine.
• Brain structure and function: Psychotic major depression may also be caused by changes in the structure and function of the brain, such as changes in the hippocampus and amygdala.
• Genetics: Genetics may also play a role in the development of psychotic major depression.
• Medical conditions: Certain medical conditions, such as brain tumors and Parkinson's disease, can increase the risk of developing psychotic major depression.

Symptoms required for a major depressive episode The following are at least five symptoms required for a major depressive episode:

• Depressed mood: A depressed mood is the most important symptom of major depression.
• Loss of interest or pleasure in activities: People with major depression often lose interest in activities that they used to enjoy.
• Changes in appetite and weight: People with major depression may experience changes in their appetite and weight, such as overeating or undereating.
• Sleep disturbances: People with major depression may experience sleep disturbances, such as insomnia or hypersomnia.
• Psychomotor changes: People with major depression may experience psychomotor changes, such as agitation or slowing down.
• Fatigue and loss of energy: People with major depression often feel tired and have a lack of energy.
• Feelings of worthlessness or guilt: People with major depression often have feelings of worthlessness or guilt.
• Difficulty concentrating: People with major depression may have difficulty concentrating or making decisions.
• Thoughts of death or suicide: People with major depression may have thoughts of death or suicide.

Classes of drugs that precipitate insomnia, with an example for each class The following are three classes of drugs, with a corresponding example for each class, that precipitate insomnia:

• Stimulants: methylphenidate (Ritalin), amphetamine (Adderall)
• Corticosteroids: prednisone, dexamethasone
• Antidepressants: bupropion (Wellbutrin), mirtazapine (Remeron)

It is important to note that this is not an exhaustive list of all drugs that can precipitate insomnia. Many other types of drugs can cause insomnia, including over-the-counter medications, herbal supplements, and illicit drugs.