DRUG MANAGEMENT OF MAJOR DEPRESSIVE DISORDER CO-OCCURING WITH ALCOHOL ABUSE NURS 6630
Alcohol abuse and major depressive disorders occur commonly in the population. These disorders, from time to time occur together. When they occur together, they display a dreadful outcome (Baranyi et al., 2022). An integrated approach to the treatment of these patients is paramount. The purpose of this paper is to discuss the neurobiology, symptoms, and the appropriate drug therapy for patients with Major Depressive Disorder co-occurring with Alcohol Abuse.
Explain the Appropriate Drug therapy for Major Depressive Disorder co-occurring with Alcohol Abuse
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A combination of naltrexone and sertraline has been proven ideal for the treatment of co-occurrence of alcohol abuse and major depressive disorder. This combination delays the reversion to alcohol abuse, is highly efficacious, marked improvement in mood in comparison to other drug therapies, and had fewer side effects (Stubbs et al., 2022).
Which Drugs are contraindicated
Benzodiazepines- such as diazepam- are contraindicated as they lower the seizure threshold hence the patient is at an increased risk of falls, intellectual impairment, increased risk aspiration, and low efficacy, in the long run, cross-tolerance of the benzodiazepines and alcohol hence propensity to abuse the drugs, and withdrawal effects after stoppage of the drug.
Bupropion lowers the seizure threshold. Mirtazapine and tricyclic antidepressants when used in the setting of alcohol abuse, they act synergistically to increase the sedative effects of alcohol. Duloxetine is hepatotoxic and may propel liver disease in the setting of chronic alcohol abuse.
What is the Timeframe that the Patient should see the Resolution of symptoms
- With adherence to medication and abstinence from alcohol, symptoms abate starting from two weeks post initiation of therapy (Close, 2019).
List four Predictors of Late Onset Generalized Anxiety Disorder
- They include chronic disease conditions like COPD, mental retardation, presence of other mental illnesses like depression, lack of support and affection during childhood, poverty, unpropitious events in life, and separation.
List four Potential Neurobiological causes of Psychotic Major Depression
- They include hypersensitized response to stress, serotonin dysfunction, disrupted dopamine feedback system in the nigrostriatal pathway, and noradrenaline dysfunction.
List at least five Symptoms of Major Depression
- The presence of all three of a low mood, anhedonia, and anergia plus at least any three of disturbed sleep, lack of appetite, ideations of self-harm, worthlessness, reduced self-esteem, reduced attention and pessimism about the future.
List three Classes of Drugs that Precipitate Insomnia with a corresponding example for each class, be specific
- Selective Serotonin Reuptake Inhibitors such as fluoxetine.
- Dopamine receptor agonists such as pramipexole.
- Alpha-blockers such as alfuzosin.
Baranyi, G., Fazel, S., Langerfeldt, S. D., & Mundt, A. P. (2022). The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis. The Lancet Public Health, 7(6), e557–e568. https://doi.org/10.1016/s2468-2667(22)00093-7
Close, L. (2019). Depression & Substance Abuse Treatment Plans, Medication, Therapy. American Addiction Centers. https://americanaddictioncenters.org/treating-depression-substance-abuse
Stubbs, K. R., Van Bezooyen, J., & Tang, Y. (2022, January 1). Chapter 31 – Managing treatment-resistant depression with comorbid substance use disorders (J. Quevedo, P. Riva-Posse, & W. V. Bobo, Eds.). ScienceDirect; Academic Press. https://www.sciencedirect.com/science/article/pii/B9780128240670000311
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