What medication would you first prescribe to this patient?
Angela has presented key medical concerns with the main issue being ranging insomnia depression of unknown cause to emotional dysregulation disorder having a feeling of senseless life. The patient will need mood fixation medication. The best medication to prescribe for Angela is coupling an antidepressant medicinal drug with psychotherapy (counseling and talk therapy). The antidepressant of choice is selective serotonin reuptake inhibitors more specifically sertraline (Zoloft) When this is combined with ramelteon (Rozerem); a drug that mimics the action of melatonin, treatment of insomnia would be achieved (Chew et al., 2016). However, before deciding to use the combination of the drugs, effective drug interaction should be observed. Two drugs can be used for the treatment of different symptoms in a patient, but the two drugs may combine to produce unusual side effects, therefore, worsening the health condition of the patient.
Selective serotonin reuptake inhibitors such as fluvoxamine should not be taken together with ramelteon to manage depression symptoms (Levin, 2019). The medication sertraline will be taken as 25 mg PO qDay for social anxiety disorder. Alongside the medication, psychotherapy which is a talk therapy that targets clinical depression will be used to help her restore the mental issue from the social and medical problems cutting across cognitive therapy, behavioral therapy, and cognitive behavioral therapy and helping in the primary focus of the patient. a combination of the therapy and medication should help her gain her emotional balance including engaging in physical exercise.
She comes back in 2 weeks and states she has not noticed a change in her mood since starting on the medication. What would be your response?
The drug selective serotonin reuptake inhibitors are effective after a dosage duration of between 2 to 4 weeks (Hieronymus et al., 2016) The duration of drug efficacy is fluid, it varies depending on natural physiological responsiveness to a drug that is specific to a given individual. Some people will take a shorter duration to start noticing health beneficial changes attributed to the drug use while others will take a longer period. Sertraline is contraindicated in patients with documented hypersensitivity to the drug or its components (Rauch et al., 2019). The coadministration of sertraline with thioridazine, pimozide, or monoamine oxidase inhibitors, including linezolid or methylene blue, is also contraindicated. Patients who are taking other serotonergic medications should receive education regarding the risks of coadministration with sertraline. The advice is to encourage Angela to be strict with her medication as the medication combination takes time to restore normality and ease the major symptoms. Angela should not rule out the drug effectiveness since she is within the standard range for the drug efficacy duration. She needs to have the drugs alongside taking her therapy sessions seriously and getting socially engaged including being physically active to help her restore her mental health.
What are the possible problem with the medication you prescribed?
A drug is a foreign substance to the body; the body will perceive it and generate the counter antibody to its effect. When the body counteracts the effect of the drug in the system, the effect of this counteraction is manifested in terms of signs and symptoms and is described as the possible side effects. Again, individuals have specific genetic makeup, and their physiology is different. This fact will explain why it is not universal for a side of a drug to be attributed to a specific sign and symptom. In other word perception of a drug in the body differ from one person to another.
However, in medical professionalism, it is required to list to a patient some of the possible abnormalities that she/he might feel during the use of a given drug. The case Angela: an adult, sertraline (Zoloft) usage might result in the side effects such as nausea, loss of appetite, diarrhea, increased sweating, decreased sex drive, shaking, agitation, tiredness, and fatigue (Poweleit et al., 2019). Another medication that has been used in the treatment ramelteon (Rozerem) to facilitate sleeping might result in side effects such as severe allergic reaction; difficulty in breathing; nausea and vomiting; swelling of face, lips, tongue, or (Asnis et al., 2016).
How long should you continue the treatment regimen?
Treatment is best achieved by a combination of effective drug use and clinical monitoring. The health caregiver will proceed with the selected treatment regimen as long the side effects of the drug are outweighed by the clinical manifestation of the patient, when the sides are not life-threatening, and when the set dosage duration has not been reached. In the case of Angela, the treatment is expected to continue for up to 4 to 6 weeks with thorough and close clinical monitoring. The estimated dose efficacy duration for sertraline is between 2 to 4 weeks but an allowance of another two more weeks will help to eliminate the possibility of slow response to the drug as may be indicated by some individuals. The patient will also need to have a lifetime of exercise therapy to help her control the depression disorder.
Asnis, G. M., Thomas, M., & Henderson, M. A. (2016). Pharmacotherapy treatment options for insomnia: a primer for clinicians. International journal of molecular sciences, 17(1), 50.
Chew, R. H., Hales, R. E., & Yudofsky, S. C. (2016). What your patients need to know about psychiatric medications. American Psychiatric Pub.
Hieronymus, F., Nilsson, S., & Eriksson, E. (2016). A mega-analysis of fixed-dose trials reveals dose-dependency and a rapid onset of action for the antidepressant effect of three selective serotonin reuptake inhibitors. Translational psychiatry, 6(6), e834-e834.
Levin, J. (2019). Mental health care for survivors and healthcare workers in the aftermath of an outbreak. In Psychiatry of pandemics (pp. 127-141). Springer, Cham.
Poweleit, E. A., Aldrich, S. L., Martin, L. J., Hahn, D., Strawn, J. R., & Ramsey, L. B. (2019). Pharmacogenetics of sertraline tolerability and response in pediatric anxiety and depressive disorders. Journal of child and adolescent psychopharmacology, 29(5), 348-361.
Rauch, S. A., Kim, H. M., Powell, C., Tuerk, P. W., Simon, N. M., Acierno, R., … & Hoge, C. W. (2019). Efficacy of prolonged exposure therapy, sertraline hydrochloride, and their combination among combat veterans with posttraumatic stress disorder: a randomized clinical trial. JAMA psychiatry, 76(2), 117-126.
The medication that should be offered to the patent who is having mental issues having no signs of having a life and may significantly develop suicidal throughs of which she denies that she might have. The patient is having mild depression that has caused her to have a negative attitude towards life stating that the family members can easily do without her if she would not be there. Mild depression is a mental illness that is associated with sadness feeling having loss of interest and causing a range of behavioral changes and physical symptoms including sleep alteration, appetite alteration, and energy levels (Schröder et al., 2017). The medication for such an illness will include having a counseling session to help her restore her mental strength and identify the possible environmental or social source of her stress before developing an effective counseling session making her understand that the life challenges exist and can be overcome through various solutions.
The recommended medication for the patient would be Selective serotonin reuptake inhibitors (SSRIs) which are having few side effects when use and are effective in restoring the brain coordination responsible for the depression illness (Otto-Meyer et al., 2020) The dose would include taking a dose paroxetine 20 mg PO qDay before graduating to the increased content by 10 mg/day but should not be more than 50 mg qDay. The medication will be taken alongside the occasional therapy counseling the patient about the affected interests, work-related and the family that are the possible causes of the patient’s stress. The family should also be involved in the session to help her recover from the social problem and degenerate the social support.
She Comes Back in 2 Weeks and States She Has Not Noticed and Change in Her Mood Since Starting on The Medication. What Would Be Your Response?
Angela has not been able to see any remarkable change after taking the paroxetine as a Selective serotonin reuptake inhibitor for relieving the depression illness. The Selective serotonin reuptake inhibitors that have been applied in the patient work by having alterations to the normal functioning of the body organs with the expected side effects of paroxetine including having nausea, difficulty in falling asleep at night causing Insomnia, lack of energy, and may extend to dry mouth and dizziness (Hieronymus et al., 2018). The patient within the two weeks may therefore still feel the lack of energy that was a major symptom with insomnia cases and the future not noticing any major changes after using the medication for two weeks.
The information that I will give the patient is to continues with the doses that were previously prescribed with an additional 50 mg qDay of the Selective serotonin reuptake inhibitors paroxetine to help her get better. The other information that I would inquire about is to let her record the side effects noted to compare with the noted side effects to make the necessary adjustment that might include the change of the medication or using the medication alongside the other over-the-counter medications. The response will also include taking the therapy session alongside the medication for comprehensive treatment.
What Are the Possible Problems with The Medication You Prescribed?
The medications that are used to cure depression and mood disorders work differently with the common variable being to correct the hormonal balance in the brain responsible for the mood alteration (Sun et al., 2017) it is the balance that the antidepressant medication solves the mood of the patient, however, the medication that has been used in Angel’s case is specifically paroxetine with various side effects to the patient that are like the depression symptoms. The noted problem with the use of paroxetine as prescribed to Angela is that they are not able to restore the normality and controlling the symptoms within the shortest time as expected by the patient. the possible problem of using paroxetine is showing side effects including weakness, nausea, dry mouth, insomnia, headache, anxiety, and nervousness (Khushboo, & Sharma, 2017). The problem with the side effects will be experienced during the initial’s first two weeks as the body will be reacting to the medications. the continuous use of the medication however should at long last improve the mood of the patient and restore normality with great energy and proper sleeping pattern. The patient should be made aware of the expectations.
How Long Should You Continue the Treatment Regimen?
The treatment schedule for Angela will focus on controlling the major manifestations including insomnia, boredom, loss of interest, and getting tired most of the time. The use of the selective serotonin reuptake inhibitors paroxetine will be expected to be effective in controlling most of the symptoms within a month (Kantor et al., 2017). The therapy however should be done even after the symptoms have been controlled. The therapy session will include weeks of engaging the patient on the various possible lifestyle and social stressors and eliminating them or control them to get better. The patient will additionally need seasonal therapy sessions that might be done for a year to make the patient emotionally stable and have regular clinical checkups afterward.
Hieronymus, F., Lisinski, A., Nilsson, S., & Eriksson, E. (2018). Efficacy of selective serotonin reuptake inhibitors in the absence of side effects: a mega-analysis of citalopram and paroxetine in adult depression. Molecular Psychiatry, 23(8), 1731-1736.
Kantor, S., Varga, J., Kulkarni, S., & Morton, A. J. (2017). Chronic Paroxetine treatment prevents the emergence of abnormal electroencephalogram oscillations in Huntington’s disease mice. Neurotherapeutics, 14(4), 1120-1133.
Khushboo, S. B., & Sharma, B. (2017). Antidepressants: mechanism of action, toxicity and possible amelioration. J. Appl. Biotechnol. Bioeng, 3, 1-13.
Otto-Meyer, S., DeFaccio, R., Dussold, C., Ladomersky, E., Zhai, L., Lauing, K. L., … & Wainwright, D. A. (2020). A retrospective survival analysis of Glioblastoma patients treated with selective serotonin reuptake inhibitors. Brain, Behavior, & Immunity-Health, 2, 100025.
Schröder, J., Berger, T., Meyer, B., Lutz, W., Hautzinger, M., Späth, C., … & Moritz, S. (2017). Attitudes towards internet interventions among psychotherapists and individuals with mild to moderate depression symptoms. Cognitive therapy and research, 41(5), 745-756.
Sun, L., Sun, Q., & Qi, J. (2017). Adult hippocampal neurogenesis: an important target associated with antidepressant effects of exercise. Reviews in the Neurosciences, 28(7), 693-70
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