Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes

Pharmacotherapy of Anxiety Disorders

Introduction

This report focuses on a 46-year-old who presents with symptoms similar to the ones seen in an anxiety disorder. These symptoms included the feeling of impending doom, shortness of breath, and chest tightness. An EKG was done to rule out a myocardial infarction. No anomalies were detected on the EKG. The patient reports occasional feelings of impending doom. On the mental state exam, the patient admits to having feelings of nervousness. His effect appears blunted occasionally. A HAM-A test administered yields a score of 26. Based on these symptoms and findings, a diagnosis of generalized anxiety disorder (GAD) is made. Do you need help with your assignment ? Contact us at eminencepapers.com.

After the diagnosis, a series of decisions will be made with regard to the best treatment regimen most appropriate for this patient. A rationale for each decision will be provided, and this will be supported by clinical evidence. Of note is that the patient uses alcohol and consumes about 3-4 beers a night. This is relevant as it may impact the choice of the preferred drug. Alcohol also has effects on the pharmacokinetics and pharmacodynamics of the drugs used for the management of mental disorders (Bhatt et al., 2019). The ethical considerations that are likely to have an impact on the patient’s treatment plan will also be discussed.

Decision 1

Several drugs have been developed over the years for the treatment of anxiety disorders. The treatment of anxiety disorders usually involves the use of antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are the preferred first-line treatment for General anxiety disorder. For this patient, my decision would, therefore, be to use Sertraline (Zoloft), being that it is an SSRI. The starting dose would be 50mg PO daily. The mechanism of action of SSRIs is that they inhibit the reuptake of serotonin in the brain. This increases the concentration of serotonin in the brain and enhances serotonin activity. SSRIs have little to no effect on other brain neurotransmitters, such as norepinephrine and dopamine. Anxiety depletes the levels of serotonin in the brain. SSRIs counter this effect by exerting their action on the concentrations of serotonin. SSRIs replace the depleted levels of serotonin in the brain (Bhatt et al., 2019). This greatly improves the symptoms of anxiety.

Imipramine and buspirone were not selected because these two medications are not as well tolerated as sertraline. Imipramine is one of the traditional tricyclic antidepressants (TCAs) which is effective for the treatment of anxiety disorders. The frequency of adverse effects is, however, much higher than in SSRIs. This disqualifies it as the first choice.

Buspirone also is an antidepressant that has been shown to be effective in the treatment of GAD. Studies have, however, shown that it is not always effective in the treatment of GAD (Bandelow et al., 2017)

With Zoloft 50 mg, it is expected that the symptoms manifested by the patient will gradually clear away. It is also expected that the HAM-A score would significantly reduce. This would indicate an improvement in the symptoms. Zoloft has been shown to be effective in the treatment of GAD (Patel et al., 2018). It is also expected that Zoloft should have minimal side effects, and evidence shows that SSRIs are well tolerated (Locher et al., 2017). The expected outcome isn’t that different because when the patient comes back for a review, he manifests some improvement in the symptoms. This shows that even though it is just a partial improvement, the patient is still responding to treatment.

Decision 2

The second chosen decision is to maintain the patient on Zoloft but to increase the dose to 75mg PO daily. This is mainly due to the fact that the patient shows some improvement on this medication, as evidenced by the reduction in the HAM-A score. Even though it is only a partial reduction, it is still a positive sign that the medication works. The logical next step would be to increase the dose from 50 mg to 75 mg. This will lead to a further improvement in symptoms as it will increase the availability of serotonin. Evidence supports the increase of the dosage if the initial response to treatment is not satisfactory (Patel et al., 2018).

With the increase in dosage, I expect that the symptoms will reduce further (Clevenger et al., 2018). The HAM-A score should also drop significantly. The patient returns in four weeks with reports of further reduction in symptoms and a reduced HAM-A score. The HAM-A score is now at 10.

Increasing the dosage of Zoloft from 50mg to 100mg was not chosen because it is recommended that Zoloft should be t