Drug therapy for a patient who presents with MDD and a history of alcohol abuse

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• 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 depressive 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.

Sample Solution

The appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse will depend on the severity of the depression, the patient’s individual risk factors, and the patient’s preferences. However, some general guidelines include:

  • Selecting medications that are less likely to interact with alcohol. Some examples of these medications include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).
  • Starting with a low dose of medication and gradually increasing the dose as needed. This is important to do in order to minimize the risk of side effects.
  • Monitoring the patient closely for signs of alcohol use or abuse. This is important to do in order to ensure that the patient is not using alcohol to self-medicate the depression.
  1. Contraindicated drugs for a patient with MDD and a history of alcohol abuse

Some drugs that are contraindicated for a patient with MDD and a history of alcohol abuse include:

  • Monoamine oxidase inhibitors (MAOIs). MAOIs can interact with alcohol to cause a serious reaction called serotonin syndrome.
  • Tricyclic antidepressants (TCAs). TCAs can also interact with alcohol to cause serious side effects.
  • Obviously, alcohol should be avoided by patients with MDD and a history of alcohol abuse.
  1. Timeframe for resolution of depressive symptoms

The timeframe for resolution of depressive symptoms will vary depending on the severity of the depression and the patient’s individual response to treatment. However, in general, most patients will see a significant improvement in their symptoms within 4-6 weeks of starting treatment.

  1. Predictors of late onset generalized anxiety disorder (GAD)

There are a number of factors that can predict late onset GAD, including:

  • GAD is more likely to develop in people over the age of 65.
  • Women are more likely to develop GAD than men.
  • Family history. People with a family history of anxiety disorders are more likely to develop GAD.
  • Medical conditions. Some medical conditions, such as thyroid problems and heart disease, can increase the risk of developing GAD.
  • Lifestyle factors. Stressful life events, such as the death of a loved one or a job loss, can increase the risk of developing GAD.
  1. Potential neurobiology causes of psychotic major depression

There are a number of potential neurobiology causes of psychotic major depression, including:

  • Abnormalities in the neurotransmitters serotonin, norepinephrine, and dopamine. These neurotransmitters play a role in mood regulation and psychosis.
  • Abnormalities in the brain’s stress response system. The brain’s stress response system is involved in the development of both depression and psychosis.
  • Inflammation can damage the brain and contribute to the development of both depression and psychosis.

Genetic factors. There is a genetic component to psychotic major depression.

 

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