Psychopharmacology for Depressive Disorder and Alcoholism

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Psychopharmacology for Depressive Disorder and Alcoholism Clinicians apply combination therapy to treat major depressive disorders MDD) and alcohol dependence disorders (ADD). Some of the medications included in therapy comprise naltrexone and sertraline. These drugs are safer and well tolerated by the target patient populations. Naltrexone is an opiate antagonist commonly used for opioid use disorder. This medication is also used in persons presenting with alcohol use disorder. Sertraline, a selective serotonin reuptake inhibitor, works by restricting the reuptake of neurotransmitters in the brain.

The medication helps restore the balance of the neurotransmitters, thus alleviating depressive symptoms.

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Naltrexone is started within three days of abstinence to avert the risk of withdrawal symptoms. This medication starts working after an hour of injection or ingestion. Sertraline is started immediately for depressive patients (Winslow, Onysko & Hebert, 2016). This medication takes approximately 4-6 weeks to work and is taken for six more months after the depressive symptoms are cleared.

A depressive alcoholic should not be given Tricyclic antidepressants. These medications are not well tolerated in this patient population (Winslow, Onysko & Hebert, 2016). They can also cause side effects such as increased suicidal thoughts, drowsiness, decreased blood pressure, and urine retention.

Predictors of late-onset generalized anxiety disorder The main predictors of an age-related anxiety disorder include traumatic and stressful life events, inhibited temperament during childhood, physical health problems such as hypothyroidism, and a family history of psychological health issues (Hinrichsen, 2020). Other factors that increase anxiety in older persons are chronic pain, financial problems, abuse, and limited functioning.

The neurobiology causes of psychotic major depression The monoamine-deficiency theory, as highlighted by Patriquin and Mathew (2017), states that the depletion of neurotransmitters dopamine and serotonin in the nervous system is the main underlying pathophysiological basis of major depressive disorders. Studies show that low serotonin levels in the brain result in depressive symptoms, including altered reward-related behaviors and inappropriate mood. Abnormalities in serotonin and dopamine receptors also contribute to an increased risk of depression (Patriquin & Mathew, 2017). Another possible cause of this disorder is the increased availability of monoamine oxidase in the central nervous

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system. These enzymes metabolize neurotransmitters causing serotonin and dopamine deficiency. Central noradrenergic system dysfunction is also associated with major depression (Patriquin & Mathew, 2017). These dysfunctions include decreased dopamine metabolism, decreased density of dopamine transporters and heightened tyrosine hydroxylase activity.

DSM-5 criteria for depressive disorder Major depressive disorder is confirmed in people presenting with five or more symptoms that last for two weeks. One of the presenting symptoms should be decreased interest in social activities of depressed mood. The other symptoms required for a diagnosis of this condition, as noted by Kennedy (2015), are a depressed mood persisting for most of the day every day, decreased interest to participate in previously interesting activities, decreased physical movement, extreme fatigue, and feelings of guilt and worthlessness (Kennedy, 2015). Other important symptoms associated with MDD are decreased concentration and suicidal thoughts.

Classes of drugs that precipitate insomnia Some pharmacological agents used in treating psychiatric conditions can trigger insomnia and other unwanted effects. Below are three classes of medications that precipitate insomnia. 

Selective serotonin reuptake inhibitors – sertraline and Fluoxetine

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Beta-blockers – propranolol

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Psychostimulants- Adderall (Tsai, S., (March 01, 2017).

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References Hinrichsen, G. A. (2020). Assessment and treatment of older adults: A guide for mental health professionals. American Psychological Association.

Kennedy, G. J. (2015). Geriatric depression: A clinical guide. Guilford Publications.

Pary, R., Patel, M., & Lippmann, S. (2017). Depression and Bipolar Disorders in Patients With Alcohol Use Disorders. Federal practitioner: for the health care professionals of the VA, DoD, and PHS, 34(Suppl 2), 37S–41S. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375498/ Patriquin, M. A., & Mathew, S. J. (2017). The neurobiological mechanisms of generalized anxiety disorder and chronic stress. Chronic Stress, 1, 1-9 https://doi.org/10.1177%2F2470547017703993 Tsai, S., (March 01, 2017). Medicines That Can Cause Insomnia. https://www.nationaljewish.org/conditions/insomnia/causes/medicines-that-can-causeinsomnia Winslow, B. T., Onysko, M., & Hebert, M. (2016). Medications for alcohol use disorder.

American family physician, 93(6), 457-465. https://www.aafp.org/afp/2016/0315/p457.html