Question

Kyne lost his job of 25 years after the company he was working for fell into bankruptcy. He started stressing about how he would take care of his 11-year old daughter considering his wife had passed on 3 years prior. Consequently, he became severely depressed and spent most of his days lying in bed, which resulted in back pain.

a. Suggest an appropriate antidepressant drug class, and an example thereof, to prescribe to Kyne. Justify your rationale.

b. Kyne is not a heavy drinker, but often drinks a beer or two in a week. His doctor is working with an international clinical trial organisation that seeks to recruit patients to test the effects of an antidepressant that primarily inhibits dopamine reuptake. The doctor has considered recruiting Kyne for the trial. Would this be a wise consideration? Justify your rationale.

To help him deal with depression, Kyne started a local support group and he met one of his old high school mates. When they were conversing, they started discussing their antidepressant therapy. Kyne’s friend mentions that after not responding well to other antidepressants, he was moved to a monoamine oxidase inhibitor (MAOI). He didn’t have much luck with the MAOI and his doctor decided to put him back on one of the earlier drug classes at it proved to have better effects.

c. Explain the procedure to be followed when switching Kyne’s friend from the MAOI to one of the earlier options.

d. Why was the MAOI not given as first-line treatment to Kyne’s friend?

Prior to Kyne receiving psychotherapy and pharmacotherapy, he became suicidal and on one occasion his daughter caught him trying to overdose on his late wife’s medication. This left her shaken and each time she sees him taking medication she becomes very scared and watches him to see if he is taking the right dose. She was diagnosed with chronic anxiety and was prescribed fluoxetine. When the doctor noticed worsening of her anxiety in the early stages, he decided to switch her to a benzodiazepine for that initial period and revert to fluoxetine.

e. What kind of anxiety disorder could Kyne’s daughter be suffering from?

f. Explain how a benzodiazepine would produce an anxiolytic effect.

g. If Kyne’s daughter was suffering from haemophilia, explain why fluoxetine would have been contraindicated.

Answer 1

a, SSRI these drugs are safe for him this include Citalopram,Escitalopram,Fluxetine,Paroxetine, Sertraline and vilazodone.

b, monoamine oxidase isn involved in removing the neurotransmitter norepinephrin serotonin and dopamine from the brain MAOI prevent this from happening which makes more of this brain chemicals avilable to effect changes in both cells and circuit. these include selegiline,isocaboxazid,phenelzine.

c, Stop take MAOI start SSRI in next day

tapper and switch the current medication

Taper , washout and switch

Cross taper