Comment about Generalized anxiety disorder and major depressive disorder
neurobiology and rationale, to support your diagnoses, medications, and overall plan.
should be a minimum of 200 words, scholarly written, APA formatted, and referenced. Refer to the APA Publication Manual 7th ed. A minimum of 2 references are required.
*(This was the medication and plan, for a patient with a diagnosis of Generalized anxiety disorder and major depressive disorder).
- Patient will continue Wellbutrin XL 300mg 1 tablet PO daily. Wellbutrin (bupropion) is an norepinephrine and dopamine reuptake inhibitor (NDRI) antidepressant used in the treatment of depression (Fava et al., 2005). Bupropion works by inhibiting the reuptake of both dopamine and norepinephrine (Nam et al., 2017). It is the only antidepressant available with a dual effect on norepinephrine (NE) and dopamine (DA) neuro-transmitter systems (Fava et al., 2005). The therapeutic effect of bupropion is due to the antidepressant activity of three metabolites: hydroxybupropion, threohydrobupropion, and erythrohydrobupropion (Fava et al., 2005). The most common side effects of bupropion include headache, dry mouth, nausea, insomnia, constipation, and dizziness (Fava et al., 2005). Bupropion XL is a once a day formulation with the goal to further improve tolerability and compliance (Fava et al., 2005).
- Will add Lexapro 5mg 1 tablet PO daily as adjunctive therapy. Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) that works to inhibit serotonin transporters from reuptaking serotonin which results in an increase in serotonin levels at synapses (Nam et al., 2017). This enhances the activity of serotonin in the central nervous system (Nam et al., 2017). The most common side effects of Escitalopram include insomnia, nausea, excessive sweating, fatigue/somnolence, and decreased libido (Kirino, 2012). Combining Bupropion with Lexapro is an augmentation strategy that is used to target an efficient therapeutic effect with minimal SSRI induced side effects such as weight gain, sexual disfunction, and emotional detachment (Nam et al., 2017).
- The patient will continue to attend cognitive behavioral therapy (CBT) with her therapist. The goal of using CBT in conjunction with medication management is to bring about beneficial change in the patient’s mood and way of living her life (Hofmann et al., 2012. The approach of CBT is to work collaboratively with the patient to modify patterns of thinking and behavior (Hofmann et al., 2012).
An appointment was made for four weeks for follow-up evaluation. M.M. verbalizes understanding of plan of care and agreeable to plan. Patient advised she may contact the office with questions and concerns as needed prior to appointment.
Fava, M., Rush, A., Thase, M. E., Clayton, A., Stahl, S. M., Pradko, J. F., & Johnston, J. (2005). 15 years of clinical experience with bupropion hcl. The Primary Care Companion to The Journal of Clinical Psychiatry, 07(03), 106–113. Retrieved January 21, 2022, from https://doi.org/10.4088/pcc.v07n0305
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. Retrieved January 21, 2022, from https://doi.org/10.1007/s10608-012-9476-1
Kirino, E. (2012). Escitalopram for the management of major depressive disorder: A review of its efficacy, safety, and patient acceptability. Patient Preference and Adherence, 853. Retrieved January 21, 2022, from https://doi.org/10.2147/ppa.s22495