Therapy for Patients with Anxiety Disorders

Introduction

From the onset, it would be prudent to note that most people at some point in their lives experience anxiety. However, anxiety could be deemed abnormal or unusual when it is not only frequent, but also rather excessive or intense. Client X (a hypothetical name), a 46-year-old white male, presents with symptoms consistent with generalized anxiety disorder (GAD). It is important to note that he has been referred by his PCP following an ER visit where he complained of breath shortness, chest tightness, and an impending doom feeling. At present, Client X indicates that he still experiences shortness of breath and chest tightness. He further indicates that he experiences the impending doom feeling on an intermittent basis. He reports frequent alcohol use to help him cope with the aforementioned symptoms. The results of a Hamilton Anxiety Scale (HAM-A) return a score of 26. In essence, this could be interpreted as moderate to severe anxiety. There are a number of patient factors that I would be taking into consideration in the making a decision about which pharmacological intervention would be most appropriate on this front. The said factors are inclusive of; patients age, occupation, and socioeconomic status. I would also be seeking to establish whether the patient is on any other medication and whether he has in the past been diagnosed with any psychiatric disorder or chronic illness. There may also be need to establish whether at this point in time, Client X has any other comorbid psychiatric disorder. The relevance of the factors highlighted above cannot be overstated when it comes to the need to minimize the probability of side effects, and further enhancement of patient convenience. In as far as the latter objective is concerned, i.e. patient convenience, it should be noted that past studies have established that this happens to be a crucial consideration in efforts to promote adherence to the treatment regimen.

Decision #1: begin Paxil 10 mg po daily

From the onset, it would be prudent to note that I opted to commence the treatment journey with Paxil 10 mg po daily prescription. I selected this particular decision owing to the fact that Paxil happens to be a selective serotonin reuptake inhibitor (SSRI). Strawn, Geracioti, Rajdev, Clemenza, and Levine (2018) point out that SSRIs happen to be an ideal first-line treatment for GAD. In the words the authors, SSRIs inhibit the reabsorption of serotonin by neurons, so increasing the availability of serotonin as a neurotransmitter (1059). They also have less side effects which is ideal in this case given Client Xs occupation.

I selected the SSRI indicated, as opposed to the two other options, because as Strawn, Geracioti, Rajdev, Clemenza, and Levine (2018) observe, SSRIs happen to be rather safe and are known to have fewer side effects. This is in comparison to anxiolytics (i.e. buspirone) and tricyclic antidepressants (i.e. Imipramine). Paxil 10 mg was also selected with Client Xs hypertension in mind. Unlike the SNRIs and tricyclic antidepressants such as Imipramine, Paxil 10 mg is less likely to have an adverse impact on the clients blood pressure. More specifically, as Calvi et al. (2021) indicate, tricyclic antidepressants have been associated with increases in blood pressure, as well as orthostatic hypotension, particularly imipramine (113).

I expect Client X to experience relieved symptoms 2-6 weeks after commencement of treatment. He will be...

…of the need to ensure that the side effects of the SSRI were minimized. Available evidence indicates that SSRIs are rather safe and are known to have fewer side effects (Strawn, Geracioti, Rajdev, Clemenza, and Levine, 2018). The need to blunt the said side effects cannot be overstated owing to the fat that the client works in a sector that requires maximum concentration and focus. Some of the common SSRI side effects are inclusive of, but they are not limited to; blurred vision, dizziness, feeling agitated, etc. These side effects could be amplified at higher doses.

Going forward, there will be need to ensure that the client is well-informed about how to maximize the benefits of any of the proposed intervention. This is more so the case with regard to what to avoid whilst taking the medications as well as when to take the medications (i.e. before or after meals). Client X will also be advised that it could take a few weeks for him to experience noticeable changes in as far as alleviation of symptoms is concerned even after revision of dosage. He will also be advised to report any serious adverse effects.

In the final analysis, it would be prudent to note that to enhance the effectiveness of the interventions proposed above, there may be need to also incorporate cognitive behavioral therapy (CBT). There are studies indicating that combining CBT with the various pharmacological interventions results in better treatment outcomes. For instance, as Strawn, Geracioti, Rajdev, Clemenza, and Levine (2018) indicate that there is evidence indicating that the effects of SSRIs could be amplified by CBT.

References

Calvi, A., Fischetti, I., Verzicco, I., Murri, M.B., Zanetidou, S., Volpi, R., Cought, P., Tadeschi, S.,…