Introduction
An investigation and treatment will be carried out on a 46-year-old individual who works as a welder at an adjacent steel production firm. Previously, he had been admitted to the emergency room for what he thought was a heart attack. Throughout the event, he had symptoms compatible with a heart attack. Shortness of breath, chest aches, and an overpowering feeling of dread was all symptoms he was experiencing. A normal electrocardiogram (EKG) was performed during his visit, which ruled out myocardial infarction (MI). A physical check also turned up nothing unusual. An evaluation by a psychiatrist led to his being transferred for further treatment. As a consequence of his desire to “leave,” he’s experienced cardiac and respiratory issues in the past, and he says he’s had comparable experiences in the past. The term “anxiety attacks” was invented by him to describe these bouts of anxiety.
As a result of his mild hypertension, he is also fat, which he controls by eating less sodium. He hasn’t provided further information about his medical history or mentioned any drugs or herbs. He’s a widower who takes care of his aging parents out of pocket. He admitted to downing three to four beers a night to deal with the pressures of his job and the stress it caused him. According to him, his employer was severe, and he was afraid for his job’s safety. He claimed.
In addition to being up and alert, he had exceptional communication skills and a natural ability to express himself. He was afraid, and he admitted it. The effect is minimal in the majority of cases. When confronted with the evidence, he said he was not suffering from mental illness. At this time, there is no known history of suicidal or homicidal tendencies. When the patient was interviewed, he was administered the Hamilton Anxiety Rating Scale (HAM-A), scoring 26. He was diagnosed with Generalized Anxiety Disorder (GAD).
Decision One
I would start the patient on Zoloft 50 mg daily, Imipramine 25 mg twice daily, or Buspirone 10 mg twice daily from a list of three medicines as a Psychiatric Mental Health Nurse Practitioner (PMHNP). Taking 300 mg of Zoloft per day is the maximum recommended dose. There is a 50-150 mg dose recommendation. It is best to start with the lowest dose feasible and observe the patient’s reaction to it for ethical reasons. If he does have an adverse reaction, at least it will be mild.
Selective serotonin reuptake inhibitors (SSRIs) include Zoloft, Lexapro, and Prozac (SSRIs). In the brain, SSRIs raise serotonin levels. In treating depression, OCD, panic disorder, PTSD and anxiety disorders, Zoloft is a prescription drug. It is available only via prescription. As a result of Zoloft’s ability to block serotonin resorption in the brain, more serotonin is accessible. Anxiety, pleasure, and mood regulation are linked to the neurotransmitter serotonin. The medication causes suicidal thoughts as a side effect. Screening for suicidal ideation or previous suicide attempts in a patient is essential (Allgulander et al., 2015). There is little possibility of these patients harming themselves. He’s not depressed, and he’s never voiced thoughts of taking his own life.
A tricyclic antidepressant, imipramine is used for a wide range of ailments. For example, tricyclic antidepressants are not as well tolerated as second-generation antidepressants. Compared to other GAD medications, tricyclics have more side effects and target more receptors in the body. Thus they are not suggested as a first-line therapy option because of the potential for cardiovascular problems (Zohar & Westenberg, 2000). Anti-anxiety medication Buspirone is used to treat long-term anxiety. As a second-line therapy, it is taken alongside SSRIs. Only when the side effects of SSRIs are judged unacceptable will it be prescribed as an alternative. It is not prescribed as an acute anxiolytic or a long-term anxiety reliever. Four weeks later, he returned to the clinic, his HAM-S score down, no longer experiencing any cardiac or respiratory issues. A partial answer is one with a score ranging from 26 to 18 points.
Decision Two
Increasing my daily Zoloft dosage to 75 mg orally, 100 mg orally, or keeping it the same are my options. As a PMHNP, I’d recommend increasing the daily dosage of Zoloft to 75 mg. If he hasn’t had any significant side effects, I’d want to increase the dosage. He saw a difference after only four weeks. You may prevent unpleasant side effects by gradually increasing the dosage. Start gently because of the positive effects of this medication on this patient.
It’s possible that the patient may become less agreeable with the drug if the dosage is increased to 100 mg orally daily. If a patient stops taking their prescription because they are afraid of the side effects, they are less likely to experiment with other drugs or lessen their dose. Gradual dose increases are preferable from an ethical standpoint. Also, if I want to see further progress, I don’t think I should keep taking the same dosage. It seems that the medication is working, so I plan to gradually raise the dosage to observe if the patient’s symptoms improve. A decrease in symptoms may not be seen in the following four weeks if current dosing levels are not altered. Patients may get discouraged as a result.
Patients who take 75 mg orally daily for four weeks show even better improvement in their symptoms and an improved HAM-A score of 10. In comparison to his previous symptoms, this represents a 61% improvement.
Decision Three
Maintaining the present Zoloft dosage of 75 mg orally daily or boosting it to 100 mg orally daily is now up to the PMHNP. BuSpar may also be used as an augmentation drug (buspirone). If feasible, I’d want to keep my daily dosage of 75 mg by mouth. This is because the patient’s symptoms have decreased by more than 50%, and he has seen no bad side effects due to his treatment so far. Increasing the quantity of medicine you take might cause unwanted side effects. If you’re acting ethically, you should discuss numerous treatment options with the patient. He could feel better if he takes a bigger dose, or he might feel worse and want to stop taking his medicine altogether.
Since the patient’s current treatment has been helpful, you don’t want to add extra medications unless required. For patients on just 50mg of Zoloft, I would usually consider adding another drug to help alleviate their problems. As an alternative, this person responds well to Zoloft and reports an improvement in his symptoms. When used as part of a therapy plan, buspirone may have unwanted side effects. Use the fewest number of medications and the lowest dosage possible to achieve the desired treatment effect. The chance of drug interactions rises directly to prescription volume (Cascorbi, 2012). This is the right thing to do from an ethical sense for the patient. After 12 weeks, you’ll know whether the medication works and if the patient’s symptoms have improved if the patient continues to take it.
Conclusion
Even if you’ve experienced anxiety before, it may be difficult to live and function normally if it persists and gets in the way of routine tasks. Generalized anxiety disorder (GAD) may be helped with medication, though. Drugs for treating generalized anxiety disorder are available in various forms (GAD). As a doctor, you may wish to start the patient on various medications depending on the patient’s age, gender, and ethnicity. Consider their current medications and lifestyle habits, such as drinking and smoking, that may interfere with the medication.
As an SSRI, Zoloft is considered the first-line therapy for generalized anxiety disorder (GAD). Given that he was doing well, I decided to keep him on his medication and only increase the dose by 25mg per day. There were no significant side effects, so I decided to retain him on the 75mg Zoloft dosage. As a test, he plans to continue taking that amount for another 12 weeks to see how well he tolerates it.
Educating patients on the risks and benefits of psychotropic medications is essential when starting them. Adverse reactions from these medications should be reported immediately. While it’s important to stick with working treatment, certain medications need to be gradually weaned off to avoid unpleasant side effects. Patient participation in decision-making is essential so that they may be more actively involved in their care. Patients who feel like they have a say in the therapy they get are more likely to be forthcoming and cooperative throughout their treatment.
References
Allgulander, C., Dahl, A., Austin, C., Morris, P., Sogaard, J., Fayyad, R., Rynn, M. (2015, January 24). Efficacy of Sertraline in a 12-Week Trial for Generalized Anxiety Disorder. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.161.9.1642#:~:text=In%20conclusion%2C%20the%20results%20of,psychic%20and%20somatic%20anxiety%20symptoms.
Cascorbi I. (2012). Drug interactions–principles, examples and clinical consequences. Deutsches Arzteblatt international, 109(33-34), 546–556. https://doi.org/10.3238/arztebl.2012.0546
Zohar, J., & Westenberg, H. G. (2000). Anxiety disorders: a review of tricyclic antidepressants and selective serotonin reuptake inhibitors. Acta psychiatrica Scandinavica. Supplementum, 403, 39–49. https://doi.org/10.1111/j.1600-0447.2000.tb10947.x
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