Assignment 1: Short Answer Assessment
Question 1: 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 the
resolution of symptoms?
The co-occurrence of psychiatric disorders, including major depressive disorder and
alcohol abuse, has been frequently studied in clinical and other settings to establish the best
treatment therapy. Together, the disorders are associated with worse functional and clinical
outcomes than when they occur individually (Fernandez-Mendoza & Vgontzas, 2013). A
patient presenting with major depressive disorder and comorbid or a history of alcohol abuse
can be treated with a combination of sertraline and naltrexone. Based on the severity of the
symptoms, the patient can be started with a Zoloft dose of 50 mg orally once daily taken in the
morning and naltrexone 50 mg orally once daily. The first prescription should go for four weeks
before the patient shows up for a follow up to monitor the symptoms and any possible side
effects of the medications. Within the first four weeks, a resolution of the symptoms should be
noticeable. However, the treatment should go for 12 weeks, and the daily dosage of each
medication should not exceed 150 mg daily for the patient (IBM Corporation, 2020). The
mechanism of action for naltrexone and sertraline includes blocking the ecstatic, soothing
effects of alcohol and inhibiting the brain’s serotonin levels to balance moods and behavior,
respectively.
The contraindication for sertraline includes patients taking pimozide, patients with
hypersensitivity to sertraline, anaphylaxis, and angioedema, and patients that are taking or
stopping taking Monoamine oxidase inhibitors (MAOIs) for the treatment of depression at least
3
14 days before the current prescription. Moreover, pharmacological and clinical findings have
established that Zoloft oral solution contains contain alcohol, which can cause a drug-drug
interaction with disulfiram. Therefore, it is contraindicated for patients taking this medication
(APA, 2013). Other medications used to treat alcohol addiction, such as Methadone and
Buprenorphine, interact with Zoloft to increase the risk of developing heart conditions and
serotonin syndrome, respectively. Serotonin syndrome causes further complications resulting in
symptoms, such as hallucinations, blood pressure alterations, and blurred vision, among other
minor symptoms that might require further pharmacological interventions.
Question 2: List 4 predictors of late-onset generalized anxiety disorder
A history of mental health illnesses
A history of physical health illnesses that interfere with cognitive functions
A history of recent adverse life events such as the loss of a close relative or job
Being a woman
Question 3: List 4 potential neurobiology causes of psychotic major depression
Polymorphisms
Reduced or depleted tryptophan
Reduced levels of serotonin and dopamine
Low synthesis of serotonin and dopamine
Question 4: List at least five symptoms required for the episode to occur. Be specific.
Loss of interest or pleasure
4
Decreased or increased weight or appetite
Thoughts of death, suicide attempts, or plans
Poor concentration or indecisiveness
Question 5: List 3 classes of drugs, with a corresponding example for each class, that
precipitate insomnia. Be specific.
Diuretics – alfuzosin (Uroxatral), doxazosin (Cardura), prazosin (Minipress)
Appetite suppressants – Saxenda
Steroids – Prednisone
5
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
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
IBM Corporation. (2020). IBM Micromedex.
https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLin
k&institution=SZMC%5ESZMC%5ET43537
