Alcohol Use Disorder And Depressive Disorders Discussion Paper

Appropriate Drug Therapy to Manage MDD Patient with a History of Alcohol Abuse

Selective serotonin reuptake inhibitors (SSRIs) and naltrexone are the appropriate drugs to manage co-occurring alcohol use disorder and major depression (Alsheikh, Elemam, & El-Bahnasawi, 2020). Thus a patient with MDD and a history of alcohol abuse would require treatment with SSRIs such as Sertraline and naltrexone. Studies reveal that the combination of sertraline management of MDD and naltrexone for managing alcohol use disorder can enhance alcohol abstinence among people with depression and a history of alcohol abuse. (McHugh & Weiss, 2019). Benzodiazepines such as alprazolam and diazepam, stimulants such as methylphenidate, and anticonvulsants such as carbamazepine are contraindicated from managing MDD because they trigger depressive symptoms. The timeframe that the patient should experience resolution of symptoms is four to 8 weeks after commencing therapy. Complete remission can require a few months, depending on whether the patient is managed on the appropriate drugs.  Alcohol Use Disorder And Depressive Disorders Discussion Paper

Four Predictors of Late Onset Generalized Anxiety Disorder

1. Family history of anxiety or other mental disorders
2. Being a female: The female gender is more afflicted by late-onset GAD.  (Arch et al., 2020)
3. Preexisting anxiety disorders (Agyapong et al., 2018).
4. History of trauma or abuse and stress: having a history of trauma such as eviction from own home or settlement predicts late-onset of GAD (Koukourikos 2021).
   

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Four Potential Neurobiology Causes of Psychotic Major Depression

1. Abnormalities in the levels of certain neurotransmitters, such as dopamine and serotonin, have been linked to psychotic depression (Filatova, Shadrina & Slominsky, 2021).
2. Research suggests that there may be a link between psychotic depression and abnormalities in the functioning of the brain’s frontal lobe.
3. Studies have also shown that people with psychotic depression are more likely to experience changes in their brain chemistry, including an increase in inflammation and a decrease in the level of serotonin.
4. Other possible causes of psychotic depression include chronic stress, traumatic experiences, and a history of psychiatric illness. Chronic stress interferes with appropriate responses in the brain in to stress stimuli (Filatova et al., 2021).

Symptoms required For an Episode of Major Depression to Occur

1. A depressed mood most of the day, nearly every day; can be reported by the patient or objectively as an irritable mood (Christensen, Wong & Baune, 2020).
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
3. Significant weight loss or gain, despite unchanged eating habits or increased exercise Alcohol Use Disorder And Depressive Disorders Discussion Paper
4. Psychomotor agitation or irritability, restlessness
5. Fatigue or loss of energy, even after very little sleep (Christensen et al., 2020).
6. Insomnia or hypersomnia nearly every night
7. Recurring thoughts of death or suicide, particularly when upset or stressed
8. Feeling persistently sad, hopeless, or anxious
9. Changes in appetite (an increased or decreased appetite)
10. Difficulty concentrating or making decisions
11. Feelings of worthlessness or guilt

3 Classes of Drugs That Precipitate Insomnia

1. Central nervous system stimulants: caffeine, nicotine, amphetamines such as dextroamphetamine
2. Sympathomimetics such as pseudoephedrine or phenylephrine used as a decongestant can induce insomnia and restlessness or phenylephrine; Xanthines such as theophylline used as a decongestant can also precipitate insomnia (Krystal, Prather & Ashbrook, 2019).
3. Beta blockers used in management of hypertension such as can reduce melatonin levels and precipitate insomnia Alcohol Use Disorder And Depressive Disorders Discussion Paper

References

Alsheikh, A. M., Elemam, M. O., & El-Bahnasawi, M. (2020). Treatment of Depression With Alcohol and Substance Dependence: A Systematic Review. Cureus, 12(10), e11168. https://doi.org/10.7759/cureus.11168

Agyapong, V. I., Hrabok, M., Juhas, M., Omeje, J., Denga, E., Nwaka, B., … & Li, X. M. (2018). Prevalence rates and predictors of generalized anxiety disorder symptoms in residents of Fort McMurray six months after a wildfire. Frontiers in psychiatry, 9, 345.  https://doi.org/10.3389/fpsyt.2018.00345

Arch, J. J., Genung, S. R., Ferris, M. C., Kirk, A., Slivjak, E. T., Fishbein, J. N., Schneider, R. L., & Stanton, A. L. (2020). Presence and predictors of anxiety disorder onset following cancer diagnosis among anxious cancer survivors. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 28(9), 4425–4433. https://doi.org/10.1007/s00520-020-05297-0

Christensen, M. C., Wong, C., & Baune, B. T. (2020). Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ?. Frontiers in psychiatry, 11, 280. https://doi.org/10.3389/fpsyt.2020.00280

Filatova, E. V., Shadrina, M. I., & Slominsky, P. A. (2021). Major Depression: One Brain, One Disease, One Set of Intertwined Processes. Cells, 10(6), 1283. https://doi.org/10.3390/cells10061283

Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World psychiatry : official journal of the World Psychiatric Association (WPA), 18(3), 337–352. https://doi.org/10.1002/wps.20674

McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol research : current reviews, 40(1), arcr.v40.1.01. https://doi.org/10.35946/arcr.v40.1.01

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. Alcohol Use Disorder And Depressive Disorders Discussion Paper
To complete:
Address the following Short Answer prompts for your Assignment. Be sure to include references to the Learning Resources for this week.

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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 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.

In week 8 you will consider the treatment of sleep / wake disorders.

You will have a short-answer assignment, in addition to the decision tree assignment. This week’s decision tree will address the treatment of insomnia in a younger adult.

It is important that you describe the pharmacology of the medications that you choose, as well as those that you did not choose. It is vital that a practitioner understand the pharmacology, indications, side effects and monitoring considerations for all medications in order to make an informed decision on the most appropriate therapy. Alcohol Use Disorder And Depressive Disorders Discussion Paper