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Drug Therapy For A Patient Who Presents With Major Depressive Disorder And A History Of Alcohol Abuse Assignment

Drug Therapy For A Patient Who Presents With Major Depressive Disorder And A History Of Alcohol Abuse Assignment

Assignment 1: Short Answer Assessment

In 3 to 4 sentences, explain the appropriate drug therapy for a patient who presents with Major Depressive Disorder (MDD) and a history of alcohol abuse. Which drugs are contraindicated, if any, and why? What is the timeframe that the patient should see resolution of symptoms?

The co-occurrence of alcohol use disorder and major depression is associated with worse outcomes than when they occur in isolation. The most effective treatment option for these patients is the use of antidepressants (DeVido & Weiss, 2012). The antidepressants noted to have the most significant effects of reducing depressive symptoms in patients with such co-morbidity were nefazodone, desipramine, and imipramine (DeVido & Weiss, 2012). Selective Serotonin Reuptake Inhibitors (SSRIs) at higher doses than dose used for depression have been shown to be more effective in impacting drinking patterns in patients with comorbid alcohol use disorder and MDD (DeVido & Weiss, 2012). However, this class of drugs has selective proven efficacy in Type A alcoholics, who have less severe depression and late-onset alcohol dependence (DeVido & Weiss, 2012). However, these drugs require a treatment course ofat least six to eight weeks for symptoms relief to be noted Drug Therapy For A Patient Who Presents With Major Depressive Disorder And A History Of Alcohol Abuse Assignment.

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The antidepressant medication could be combined with drugs used for alcohol use disorder such as naltrexone, an opioid antagonist for higher rates of abstinence from alcohol, longer time to drinking relapse, and improvement in mood (DeVido & Weiss, 2012). Current evidence regarding the use of antidepressants alone support the need for combination therapies to reduce rates of readmission in these patients compared to the use of antidepressants alone which were shown to demonstrate lack of associated reduction in future readmission or increase in the number of days to readmission (Chan et al., 2015). Therefore, combination therapy is always better after making consideration and taking caution against potential drug interaction and side effects.

The antidepressant drugs that should be avoided in a patient with alcohol use disorder due to the risk of adverse side effects include bupropion which may precipitate seizures in patients experiencing withdrawal symptoms from alcohol by lowering seizure thresholds (DeVido & Weiss, 2012). The other drug is duloxetine which is hepatotoxic and hence it should be avoided in patients with comorbid liver disease such as hepatitis due to chronic use of alcohol (DeVido & Weiss, 2012).

List 4 predictors of late onset generalized anxiety disorder (GAD).

  1. Female gender,
  2. Recent adverse life events,
  3. Having chronic physical (respiratory and cardiovascular disorders like arrhythmias, and cognitive impairement) health disorders, and
  4. Having chronic mental (depression, phobia, and past GAD) heath disorder (Zhang et al., 2015).

Other include parental loss or separation, low affective support during childhood, and history of mental problems in the parents (Zhang et al., 2015). The conclusion is that GAD appears to be a multifactorial stress-related affective disorder of both current and past issues, some of which can be modified using healthcare interventions (Zhang et al., 2015).

List 4 potential neurobiology causes of psychotic major depression

  1. Electrical stimulation of the vagus nerve,
  2. Electrical stimulation of the subgenual cingulate or the ventral straitum,
  3. Transcranial magnetic stimulation of the prefrontal cortex,
  4. Reduced levels of brain-derived neurotrophic factor, and
  5. Serotonin-norepinephrine decrease in the brain – monoamine hypothesis (Rot, Mathew, & Charney, 2009).

List at least 5 symptoms required for an episode of major depression to occur.

  1. Depressed mood,
  2. Loss of interest/pleasure,
  3. Weight loss/gain,
  4. Insomnia/hyperinsomnia,
  5. Fatigue,
  6. Psychomotor agitation or retardation,
  7. Feeling worthless or excessive/inappropriate guilt,
  8. Decreased concentration, and
  9. Thoughts of death/suicide (MD CALC, 2022).

The other criteria for diagnosis of major depression is that the symptoms should cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The episode should not be attributed to physiological effects of a substance or another medical or psychiatric condition such as schizophrenia. Lastly, the patient should not have any history of manic or hypomanic episode (MD CALC, 2022).

List 3 classes of drugs, with a corresponding example for each class, that precipitate insomnia.

  1. SSRI antidepressants such as escitalopram
  2. Alpha- or beta-adrenergic blocker such as Metoprolol
  3. Cholinesterase inhibitors such as rivastigmine and donepezil.

As a psychiatric nurse practitioner, you will likely encounter patients who suffer from various mental health disorders. Not surprisingly, ensuring that your patients have the appropriate psychopharmacologic treatments will be essential for their overall health and well-being. The psychopharmacologic treatments you might recommend for patients may have potential impacts on other mental health conditions and, therefore, require additional consideration for positive patient outcomes. For this Assignment, you will review and apply your understanding of psychopharmacologic treatments for patients with multiple mental health disorders Drug Therapy For A Patient Who Presents With Major Depressive Disorder And A History Of Alcohol Abuse Assignment.

To Prepare
Review the Learning Resources for this week.
Reflect on the psychopharmacologic treatments that you have covered up to this point that may be available to treat patients with mental health disorders.
Consider the potential effects these psychopharmacologic treatments may have on co-existing mental health conditions and/or their potential effects on your patient’s overall health.
To complete:

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

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?
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.

PLEASE USE THESE REFERENCES IN YOUR SOURCES

https://www.proquest.com/docview/2422903356?accountid=14872

Winkelman, J. W. (2015). Insomnia Disorder. The New England Journal of Medicine, 373(15), 1437-1444. https://doi.org/10.1056/NEJMcp1412740

https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf

https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470

https://www.proquest.com/docview/1720529955?accountid=14872

References

Chen, P., Yomen, K., Turcios, J., & Richman, M. (2015). Prescription for antidepressants in reducing future alcohol-related readmission in patients suffering from depression and alcohol use disorder: a retrospective medical record review. Substance Abuse Treatment, Prevention, and Policy, 10(48). https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-015-0045-y

DeVido, J., & Weiss, R. (2012). Treatment of the Depressed Alcoholic Patient. Current Psychiatry Reports, 14(6), 610-618. https://doi.org/10.1007%2Fs11920-012-0314-7

MD CALC (2022). DSM-5 Criteria for Major Depressive Disorder. MD CALC. https://www.mdcalc.com/calc/10195/dsm-5-criteria-major-depressive-disorder

Rot, M., Mathew, S., & Charney, D. (2009). Neurobiological mechanisms in major depressive disorder. Canadian Medical Association Journal, 180(3), 305-313. https://doi.org/10.1503%2Fcmaj.080697

Zhang, X., Norton, J., Carriere, I., Ritchie, K., Chaudieu, I., & Ancelin, M. (2015). Risk factors for late-onset generalized anxiety disorder: results from a 12-year prospective cohort (The ESPRIT study). Translational Psychiatry, 5(3), e536. https://doi.org/10.1038%2Ftp.2015.31 Drug Therapy For A Patient Who Presents With Major Depressive Disorder And A History Of Alcohol Abuse Assignment