Assignment; Appropriate Drug Therapy for a Patient with Major Depressive disorder and History of Alcohol Abuse

Assignment; Appropriate Drug Therapy for a Patient with Major Depressive disorder and History of Alcohol Abuse

Short-Answer Assessment

The appropriate drug therapy for a patient with major depressive disorder and a history of alcohol abuse entails the use of antidepressants. Antidepressants such as selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have proven effective. The contraindicated drugs for use in such a patient include duloxetine, venlafaxine, bupropion, nortriptyline, and mirtazapine. These drugs have a high risk of overdose. The patient should also not be prescribed benzodiazepines because they are not used together with alcohol(Wang et al., 2020). Patients should expected resolution of symptoms within six to eight weeks of treatment, since antidepressants have a slow onset of action.

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Predictors of Late Onset Generalized Anxiety Disorder

Several risk factors or predictors increase the risk of individuals developing late onset generalized anxiety disorder. One of them is poverty. People from poor socioeconomic backgrounds have an increased risk of developing late onset generalized anxiety disorder as compared to those from affluent backgrounds. The second predictor is gender. Females are highly at risk of developing the disorder as compared to men. The third predictor is traumatic experiences. People that experiences trauma in forms such as loss of a loved one, lack of support during childhood, and parental separation increase the risk of late onset generalized anxiety disorder in the population. Lastly, a family history of mental health problems increases the risk of the disorder (Welzel et al., 2021). The risk is elevated if one is born to a family where parents have a history of mental health problems.

Potential Neurobiology Causes of Psychotic Major Depression

One of the potential neurobiology causes of major depression is the changes in the normal neuronal functions in the brain. Studies have shown that depressed patients have reductions in network functional connectivity in the bilateral insular, somato-motor, somatosensory, and auditory cortices. The reductions low the functional connectivity in the default mode network, hence the development of psychotic depression (Nemeroff, 2020). In this case, psychotic depression arises from poor regulation of emotions and thoughts.

The other neurobiological cause of psychotic depression is the structural brain changes. Changes in some brain areas such as subgenual cortex have been identified to be a common occurrence in most of the patients with psychotic depression. The changes alter the normal brain functioning and transmission of nerve impulses by increasing hyperactivity and hyper-connectivity between and among neuronal networks, hence, psychotic depression(Kamran et al., 2022).

The other neurobiological cause is imbalances in the neurotransmitters. Neurotransmitters such as dopamine, serotonin, and glutamate are crucial for the regulation of mood and emotions. An imbalance in these neurotransmitters results in altered mental status, including major depressive episodes (Kamran et al., 2022). As a result, this explains the use of antidepressants to increase the levels of these neurotransmitters in the brain.

The last neurobiological cause of psychotic depression is the deregulation of the HPA axis response. The HPA axis plays the role of responding to stress in a normal human being. However, persistent exposure to stressors causes hyper-stimulation and hypersensitivity of the axis to stress. There is also the dysregulation of the negative feedback regulation that is crucial for effective management of stress. These changes bring about neurobiological cascades that affect the normal functioning of the brain regions such as the hippocampus that facilitates adaptation to stress. In addition, there is the reduction in the dendritic complexity in the medial prefrontal cortex, which affects cognitive processing (Nemeroff, 2020). Overall, these changes precipitate the development of psychotic depression.

Symptoms of Major Depression

One of the symptoms of major depression is depressed mood. A patient should have depressed mood in most of the time almost every day. The second symptom is loss of interest or pleasure. The patient should report a loss of pleasure or interest in almost all the activities the client previously enjoyed. The third symptom is unintentional weight loss or gain. The patient should report more than five percent unintentional weight gain or loss in a month. The fourth symptom is sleep disturbance. The patient should report either hypersomnia or insomnia(Kim & Park, 2021). Lastly, there should be psychomotor changes such as retardation or agitation that others can observe.

Classes of Drugs

One of the classes of drugs that precipitate insomnia is selective serotonin reuptake inhibitors. Selective serotonin reuptake inhibitors such as sertraline cause insomnia. The other example is anticonvulsants. Anticonvulsants such as carbamazepine precipitate insomnia among patients. The last category is steroids such as dexamethasone.

References

Kamran, M., Bibi, F., ur. Rehman, A., & Morris, D. W. (2022). Major Depressive Disorder: Existing Hypotheses about Pathophysiological Mechanisms and New Genetic Findings. Genes, 13(4), Article 4. https://doi.org/10.3390/genes13040646

Kim, Y.-K., & Park, S.-C. (2021). An alternative approach to future diagnostic standards for major depressive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 105, 110133. https://doi.org/10.1016/j.pnpbp.2020.110133

Nemeroff, C. B. (2020). The state of our understanding of the pathophysiology and optimal treatment of depression: Glass half full or half empty? American Journal of Psychiatry, 177(8), 671–685.

Wang, S.-C., Chen, Y.-C., Chen, S.-J., Lee, C.-H., & Cheng, C.-M. (2020). Alcohol Addiction, Gut Microbiota, and Alcoholism Treatment: A Review. International Journal of Molecular Sciences, 21(17), Article 17. https://doi.org/10.3390/ijms21176413

Welzel, F. D., Luppa, M., Pabst, A., Pentzek, M., Fuchs, A., Weeg, D., Bickel, H., Weyerer, S., Werle, J., Wiese, B., Oey, A., Brettschneider, C., König, H.-H., Heser, K., van den Bussche, H., Eisele, M., Maier, W., Scherer, M., Wagner, M., & Riedel-Heller, S. G. (2021). Incidence of Anxiety in Latest Life and Risk Factors. Results of the AgeCoDe/AgeQualiDe Study. International Journal of Environmental Research and Public Health, 18(23), Article 23. https://doi.org/10.3390/ijerph182312786

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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.

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.

Resources:
Stahl, S. M. (2021). Stahls essential psychopharmacology: Neuroscientific basis and practical applications (5th Ed.) Cambridge University Press.
Chapter 10, Disorders of Sleep and Wakefulness and Their Treatment: Neurotransmitter Networks for Histamine and Orexin (pp. 401-448)
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787

Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health.

Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/
Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L., Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_Narcolepsy.pdf
Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B, Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-wpengine.netdna-ssl.com/wp-content/uploads/2017/07/PP_NightWakingsChildren.pdf
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470
Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740