Case Study: Evaluating Antidepressants for Anxiety and Depression

This case study discusses pharmacological treatments for depression and anxiety in different patient scenarios. It examines the use of Monoamine oxidase inhibitors (MAO) like phenelzine for a 35-year-old female with panic disorder, Selective serotonin reuptake inhibitors (SSRIs) like Prozac for a 12-year-old male with anxiety, and Sertraline (Zoloft), another SSRI, for a 22-year-old pregnant female in her 28th week of pregnancy. The study details the mode of action, dosages, and potential side effects of each medication. Furthermore, it outlines the three phases of depression and anxiety management: acute, continuation, and maintenance, emphasizing the importance of careful monitoring and dosage adjustments based on patient response and side effects. The study emphasizes the need for tailored treatment approaches considering individual patient profiles and preferences.

Running head: DEPRESSION AND ANXIETY
Depression and anxiety
Name of the Student
Name of the University
Author note

1DEPRESSION AND ANXIETY
Part 1
For the 35-year-old female with panic disorder and intolerance to SSRI or SNRI,
Monoamine oxidase inhibitor (MAO) class of drug can be given for panic disorder treatment.
Under MAO, phenelzine (Nardil) can be used that can help in balancing chemicals in
neurotransmitters (brain) for relieving symptoms of anxiety that is associated with panic
disorder. This class of drug can be recommended for this patient, as she is intolerant to other
antidepressant treatment medications like SSRI or SNRI. The mode of action of this drug is that
it inhibits the action of monoamine oxidase enzyme that results in accumulation of
neurotransmitters like serotonin, norepinephrine and dopamine in the body (Shulman, Herrmann
& Walker, 2013). The therapeutic effect of this drug is that it improves the mood in depressed
patients. The route or dosage for this drug is 15 mg, three times daily with a range of 60-90
mg/day into divided dosages. After achievement of maximal benefit, the dosage is reduced to
15mg/day. The side effects include dizziness, fatigue, drowsiness, hyperreflexia, headache,
twitching, tremor, insomnia and weakness in CNS. Orthostatic hypotension, oedema, dry mouth,
constipation are also adverse reactions. It can cause drug interactions with SSRI, SNRI and
other anti-depressants. Hypertensive crisis may also occur when this drug is used with
methyldopa, phetamines, epinephrine, reserpine or norepinephrine. Hypo- or hypertension,
seizures, coma, respiratory depression or even death can also occur (Krishnan, 2017).
For the 12-year-old male with anxiety, the best antidepressant is SSRIs like Prozac.
Selective serotonin reuptake inhibitor (SSRI) is a class of drugs that is used as antidepressants
for the treatment of anxiety disorder. Under SSRI, Prozac can be recommended as it selectively
inhibits the serotonin reuptake in CNS and this helps in decreasing behaviors associated with
anxiety being the mode of action. The recommended dosage is 20 mg/day that can increase to 50

2DEPRESSION AND ANXIETY
mg/day depending upon the maximal benefit required (Mandrioli et al., 2012). The side effects
include anxiety, headache, drowsiness, nervousness, insomnia in CNS. It can also cause diarroea
in GIT tract, sexual dysfunction, increase in pruritus and sweating, rashes, dizziness, weakness
and fatigue. The drug can be contraindicated in concurrent use of MAO inhibitors, pimozide,
thioridazine therapy and can cause hypersensitivity and therefore, Prozac should be discontinued
prior to these drug use.
For the 22-year-old depressed female in her 28th week of pregnancy, SSRI
antidepressants can be recommended. Sertraline (Zoloft) can be recommended for the woman,
as SSRI are not associated with any sort of birth defect. The mode of action is that it inhibits the
serotonin neuronal uptake in the CNS and thus potentiates the activity of serotonin having little
effect on dopamine or norepinephrine. It has an antidepressant action with decreased feelings of
helplessness, intense fear or horror (Kaplan & Zhang, 2012). The dosage is 50 mg single dose
per day in the morning or evening initially and after several weeks, the dose may be increased to
200mg/day weekly depending upon response. The side effects include drowsiness, dizziness,
headache, fatigue, agitation, anxiety and insomnia. There might also be increase in sweating,
rash or sexual dysfunction, tremor, twitching, hypertonia or fever as miscellaneous effects. The
drug-drug interactions include potentially serious and fatal reactions like rigidity, hyperthermia,
autonomic instability, myoclonus, extreme agitation, fluctuating vital signs that may cause
delirium and coma that may occur with MAO inhibitors. It can also increase the risk of life-
threatening cardiovascular reactions (Reefhuis et al., 2015).

3DEPRESSION AND ANXIETY
Part 2
Management of depression or anxiety is divided into three phases: acute, continuous and
maintenance phase. During acute phase, medication is given to patients by psychiatrist that is
influenced by clinical symptoms and patient preferences. During this phase, the initial
antidepressant medication selection is based on the anticipated side effects, tolerability or safety
of side effects for the patient, co morbid conditions and patient preferences. After antidepressant
selection, it is given at lower doses and there is careful monitoring in response to emergence of
side effects and pharmacotherapy. In addition, there is modification of drug therapy depending
upon the severity of side effects or symptoms witnessed in the patient (Gautam et al., 2017).
During the continuation phase, there is maintenance of acute treatment phase and
prevention of relapse of symptoms. The antidepressants dosage given during acute phase is
maintained in this phase if there is no relapse of symptoms or side effects. There might be failure
of maintenance of stability during this phase and therefore, requires careful monitoring of
patient’s clinical condition. The goal of maintenance phase is to prevent the recurrence of
episodes of anxiety and depression. Patients with depression or anxiety may experience more
than one episode and it is important to prevent recurrence during this phase. After this phase,
there is discontinuation of treatment based on probability of relapse, past episodes and
persistence of symptoms after recovery (Gautam et al., 2017).

4DEPRESSION AND ANXIETY
References
Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical practice guidelines
for the management of depression. Indian journal of psychiatry, 59(Suppl 1), S34.
Kaplan, C., & Zhang, Y. (2012). Assessing the comparative-effectiveness of antidepressants
commonly prescribed for depression in the US Medicare population. The journal of
mental health policy and economics, 15(4), 171.
Krishnan, K. R. R. (2017). Monoamine oxidase inhibitors. The American Psychiatric Association
Publishing Textbook of Psychopharmacology, 283.
Mandrioli, R., Mercolini, L., A Saracino, M., & A Raggi, M. (2012). Selective serotonin
reuptake inhibitors (SSRIs): therapeutic drug monitoring and pharmacological
interactions. Current medicinal chemistry, 19(12), 1846-1863.
Reefhuis, J., Devine, O., Friedman, J. M., Louik, C., & Honein, M. A. (2015). Specific SSRIs
and birth defects: bayesian analysis to interpret new data in the context of previous
reports. bmj, 351, h3190.
Shulman, K. I., Herrmann, N., & Walker, S. E. (2013). Current place of monoamine oxidase
inhibitors in the treatment of depression. CNS drugs, 27(10), 789-797.