discussion response

pls respond to this 2 people. 1/2 a page each with 2 references each. thanks
this is an example An alternative treatment for ADHD would be the administration of concerta. Studies have shown the effectiveness of concerta in reducing symptoms of ADHD. Participants in the study were administered a mean dose of 20 mg PO daily (Kim et al., 2017). There are various formulations of concerta including immediate release as well as extended release. Among young children, the most common form prescribed is immediate release tablets (Briars & Todd, 2016). Concerta works on both norepinephrine and dopamine transporters, increasing norepinephrine and dopamine within the prefrontal cortex (Briars & Todd, 2016). Common side effects of concerta include nausea, headache, anorexia, vomiting, insomnia, and dizziness (Kim et al., 2017).

first post by ruth
A psychological disorder is an illness that affects an individual’s health, education, and career. Through time mental illness is increasing in numbers and underdiagnosed by the health care providers because of the overlapping of signs and symptoms which makes it difficult for health care providers to diagnose and treat psychologic disorders in a timely manner. It is very important for the wellbeing of the patient to have the right diagnosis and treatment of the psychological disorder (Umar & Qamar, 2019).

Generalized Anxiety Disorder

Generalized Anxiety Disorder is a complex psychological problem that affects a significant number of people in society. In the United States of America, the prevalence of the DSM-IV Generalized Anxiety Disorder is estimated to be 5% (Weisberg, 2009). It is also known that it presents up to 13% among people in the United States. Generalized Anxiety Disorder is one of the psychological disorders characterized by uncontrolled excessive anxiety which lasts for 6month and above. GAD usually present with poor focus, insomnia, muscle tension, increased heart rates, and nervousness. The mild form of GAD is managed by the non-pharmacological method which includes “cognitive behavioral therapy, biofeedback, and relaxation training” (Rosenthal, & Burchum, 2018).

Scenario

A 46-year-old male patient admitted to the emergency room with a chief complaint of chest pain and tightness. He does not have any significant medical history, cardiac disease ruled out and Hamilton Anxiety Rating (HAM) scale is 26 which is an indication of severe anxiety. The patient is diagnosed with GAD. As the provider for this patient I will start Zoloft 50 mg orally daily and follow up on the patient after 4 weeks. After 4 weeks the patient HAM scores 18, increase dose of Zoloft to 75 mg and schedule follow up appointment for 4 weeks. After 4 weeks HAM scores 10 and will schedule follow up in 4 weeks keeping the dose of Zoloft at 75 mg.

Zoloft

Zoloft one of selective serotonin reuptake inhibitors (SSRI), applies its antidepressant action by preventing the reuptake of 5-hydroxytryptamine (5-HT, serotonin) in the central nervous system. The most common side effect of Zoloft is cardiac toxicity. Patient cardiac activity must be check while on Zoloft (Hyang, Sang, & Bok, 2016). For example, in the above scenario that’s better to keep the patient on Zoloft 75 mg PO daily and also combine non-pharmaceutical methods to relieve anxiety. By doing this the toxicity and side effects of the drug will be lesser.

References

Hyang Mi Lee, Sang June Hahn, & Bok Hee Choi. (2016). Blockade of Kv1.5 channels by the antidepressant drug sertraline. Korean Journal of Physiology & Pharmacology, 20(2), 193–200. https://doi-org.ezp.waldenulibrary.org/10.4196/kjpp.2016.20.2.193

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Umar, A., & Qamar, U. (2019). Detection and Diagnosis of Psychological Disorders Through Decision Rule Set Formation. 2019 IEEE 17th International Conference on Software Engineering Research, Management and Applications (SERA), Software Engineering Research, Management and Applications (SERA), 2019 IEEE 17th International Conference On, 33–37. https://doiorg.ezp.waldenulibrary.org/10.1109/SERA.2019.8886786

Weisberg, R.B. (2009). Overview of Generalized Anxiety Disorder” Epidemiology, Presentation and course. J Clin Psychiatry.

2nd post by Abidemi
Depression is one of the most prevalent mental health issues encountered in care facilities and a major cause of disability worldwide encountered in primary care. It is the leading cause of disability worldwide, Unützer & Park (2012). Major depressive disorder (MDD) is a mood disturbance characterized by exaggerated feelings of sadness, despair, lowered self-esteem, loss of interest, and pessimistic thoughts. It is best managed like a chronic illness due to its recurring nature, What is Depression, (2017). Mood disorder or depression is best managed with medication. These medications must be properly managed and titrated or adjusted for therapeutic gains and to avoid side effects. Below are the classes of antidepressants that are available to treat patients with depressive disorder.

Selective serotonin reuptake inhibitors (SSRIs)
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Atypical agents.
Finding the right treatment for a mentally ill patient is key to recovery. The various categories of antidepressants work in different ways just as symptoms of illness may vary from patient to patient. Combined treatment with antidepressant medications and psychotherapy is fundamental to recovery. A collaborative effort of Mental health providers and a systematic approach that includes patient involvement will help in determining the effectiveness of the medication.

Antidepressants usually may not be the cure for depression but will reduce its symptoms to help the patient become functional. Providers must follow up with patients to determine whether a patient is getting the desired effect of the prescribed medication or to determine if dose adjustment is necessary or to discontinue the medication if a side effect is noted.

The patient in the case study was started with an initial dose of Effexor XR37.5mg, but he returned after four weeks stating there’s no change in his depressive symptoms. The decision in this situation was to increase his dose to 75mg orally daily. The patient again returned after four weeks and reported an improvement in the depressive symptoms. There was a 25% reduction in his depressive symptoms using the Montgomery – Asberg Depression Rating Scale (MADRS). Effexor has been shown to have good efficacy and tolerance, and also to have greater efficacy than SSRI in the treatment of severe depression Ivanets, N. N., Kinkul’kina, M. A., Tikhonova, Y. G., & Izyumina, T. A. (2016).

The goal here is to improve the patient’s quality of life by getting rid of the depressive symptoms to a certain level and also managing his symptoms. Also, it is often advisable to give medication enough time to work and not stopped abruptly, even when side effects are experienced. Stopping venlafaxine abruptly may result in one or more withdrawal symptoms like irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias, Campagne (2005). So, it is very important to educate patients on the need to ensure to talk to their healthcare provider before stopping a medication. Every medication has its side effects that need to be communicated to the patients so they have that understanding. Side effects may disappear with time because stopping the use of an SSRI medication may cause an undesirable effect. Combining pharmacotherapy with psychotherapy has shown to produce a desirable effect than just administering antidepressants. It is good to note that many side effects are dependent on the dose, so as the dose increases the side effects may increase, and the goal of treatment is complete remission of the current symptoms and the prevention of future relapses (Stahl, 2013).
References:

Campagne D. M. (2005). Venlafaxine and serious withdrawal symptoms: a warning to drivers. MedGenMed : Medscape general medicine, 7(3), 22.

Ivanets, N. N., Kinkul’kina, M. A., Tikhonova, Y. G., & Izyumina, T. A. (2016). Venlafaxine in the treatment of moderate and severe depression: Approaches to increasing treatment efficacy. Neuroscience And Behavioral Physiology, 46(5), 529-533. doi:10.1007/s11055016-0272-3

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Unützer, J., & Park, M. (2012). Strategies to improve the management of depression in primary care. Primary care, 39(2), 415–431. https://doi.org/10.1016/j.pop.2012.03.010

What Is Depression? (2017). Retrieved from http://www.webmd.com/depression/guide/what-is depression#1