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Appropriate Drug Therapy for MDD and Alcohol Abuse
The appropriate drug therapy for a patient with major depressive disorder and alcohol abuse is the use of antidepressants, which are effective in reducing symptoms associated with depression alongside having modest effect on the drinking outcomes in alcohol abuse disorder (McHugh & Weiss, 2019). Antidepressants also have positive effects on the severity of the depression, abstinence and number of alcoholic drinks consumed per day (Agabio et al., 2018). The resolution of symptoms with the use of antidepressants occur within two weeks. Contraindicated drugs include lithium, as it does not improve abstinence, severity of both conditions, and alcohol-related hospitalizations (Pary et al., 2017).
Predictors of Late Onset Generalized Anxiety Disorder
One of the predictors of late onset generalized anxiety disorder is a history of mental disorders. Patients with history of mental disorders such as depression have a high risk of late onset generalized anxiety disorder. A history of respiratory disorders also predicts the occurrence of late onset generalized anxiety disorder. Some of the identified predictors include bronchitis, asthma, and dyspnea. The third predictor is history of phobia. Patients with history of phobias such as social and agoraphobia have an increased risk of late onset generalized anxiety disorder. The last predictor is childhood exposure to adverse events. Individuals who were exposed to severe trauma at childhood have a high risk of developing late onset generalized anxiety disorder (Hellwig & Domschke, 2019).
Neurobiology Causes of Psychotic Major Depression
An imbalance in neurotransmitters is the first potential neurobiology cause of psychotic major depression. An imbalance of dopamine, norepinephrine and serotonin neurotransmitters causes major depression, hence, the target of antidepressants. The interaction between genetics and environment also potentiate psychotic major depression. Family history of psychotic major depression and environmental influence such as stressors increase the risk of major depressive disorder. Psychotic major depression is also attributed to arise due to depression of the neural circuitry of the brain. Abnormalities in the grey-matter volume, glial density, and nucleus accumbens volume increase the risk of depression due to decline in hippocampal function and dyregulation of the brain functions related to pleasurable stimuli. The last potential cause is hypercortisolemia. Chronic stress causes hyperactivity of the HPA axis, which affect the brain structures such as amygdala and hippocampus, which regulate mood (Fekadu et al., 2017).
Symptoms of Depression
One of the other symptoms of major depression is the symptoms that the patient experiences being not attributed to any other cause such as substance abuse (drug abuse) or medical disorders such as hypothyroidism. The second symptom is patients not having any history of hypomania or mania episodes. The third symptom is the patient experience excessive worthlessness or delusional guilt. The fourth symptom is the patient experiencing low energy levels as evidenced by tiredness, fatigue and reduced efficiency in undertaking social and occupational responsibilities. The last symptom is patients experiencing significant retardation or agitation that is enough for others to witness or report. Other symptoms include sleep disturbances, loss of interest in pleasurable things and unintentional changes in the body weight (Kim, 2018).
Drugs Precipitating Insomnia
One class of drugs that precipitate insomnia is beta-blockers. Beta-blockers such as atenolol induce insomnia through melatonin and interfering with REM sleep. The other class is serotonin stimulators such as ritanserin tht induce insomnia by interfering with REM sleep. The last class is stimulants such as theophylline that interfere with REM (Aaron, 2020).
References
Aaron, J. (2020). Pharmacology Student Graduation Gift Pharmacist Est. 2020: Appreciation Gift for Graduation, College, High School, Funny Congratulatory Diary for Graduate Students, Educational Gifts, 6×9 Notebook, 100 Pages Ruled. Independently Published.
Agabio, R., Trogu, E., & Pani, P. P. (2018). Antidepressants for the treatment of people with co‐occurring depression and alcohol dependence. Cochrane Database of Systematic Reviews, 4. https://doi.org/10.1002/14651858.CD008581.pub2
Fekadu, N., Shibeshi, W., & Engidawork, E. (2017). Major depressive disorder: Pathophysiology and clinical management. J Depress Anxiety, 6(1), 255–257.
Hellwig, S., & Domschke, K. (2019). Anxiety in Late Life: An Update on Pathomechanisms. Gerontology, 65(5), 465–473. https://doi.org/10.1159/000500306
Kim, Y.-K. (2018). Treatment Resistance in Psychiatry: Risk Factors, Biology, and Management. Springer.
McHugh, R. K., & Weiss, R. D. (2019). Alcohol use disorder and depressive disorders. Alcohol Research : Current Reviews, 40(1). https://doi.org/10.35946/arcr.v40.1.01
Pary, R., Patel, M., & Lippmann, S. (2017). Depression and bipolar disorders in patients with alcohol use disorders. Federal Practitioner, 34(Suppl 2), 37S-41S.
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