Anxiolytic Therapy for a 46-Year-Old Caucasian Male with GAD

Anxiolytic Therapy for a 46-Year-Old Caucasian Male with GAD Introduction Anxiety is a common psychiatric disorder that has features of excessive fear and behavioral disturbances. In particular, anxiety disorders are related to somatic signs. Their emotional distress is accompanied by dizziness, shortness of breath, sweating, muscle aches, insomnia, and restlessness. An excessive, uncontrollable, and unmanageable anxiety in everyday life can cause generalized anxiety disorder (GAD). Based on the Diagnostic and Statistical Manual V (DSM-V), persistent worry is the primary cause of GAD (Garakani et al., 2020, pg. 2). Some of the things that make people have anxiety are thoughts about fitness, job safety, performance at work, the health of their parents or offspring, and assets. In the scenario at hand, a 46-year-old Caucasian man showed up in the emergency room (ER) after his primary care provider (PCP) referred him for presenting symptoms of a heart attack. The individual said that he experienced shortness of breath, the feeling of impending doom, and chest tightness. In addition, he has mild hypertension that he treats with a diet of low sodium and is approximately 15 lbs. overweight. His medical history has been unremarkable after his tonsils were removed when he was eight years old. The person’s electrocardiogram (EKG) was normal and his remaining physical examination was within normal limits (WNL). The patient confesses that he uses ethyl alcohol (ETOH) occasionally, about 3-4 beers per night. Despite the man being single, he takes care of his aging parents. His greatest worry is about job security since he cites that the management is harsh. Additionally, the client appears alert and oriented to the event, time, person, and place. He dresses well, and his speech is coherent, goal-directed, and clear. In some instances, he feels nervous but denies overt delusional or auditory or visual hallucinations. He has no suicidal thoughts, and the Hamilton Anxiety Rating Scale (HAM-A) gives a score of 26. As such, the client is diagnosed with generalized anxiety disorder. Decision #1 My first decision is to prescribe the client Paxil 10mg by mouth every daily, 10mg of Buspirone by mouth twice a day, and 25mg of Imipramine orally twice a day. Paxil is effective in treating GAD and it belongs to a class of antidepressants called Selective Serotonin Reuptake Inhibitor (SSRI) (Pollack et al., 2001, pg. 351). Some drugs that can be considered as the first option when treating GAD include SSRIs, Buspirone, Imipramine, Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), and benzodiazepines. However, among these medications mentioned above, the most effective is Paxil. Imipramine refers to a tricyclic antidepressant, which is effective, but not when compared to SSRIs. As a result, the reason for selective Paxil is because it is the most effective antidepressant. Although the other two options, namely Imipramine and Buspirone, can be used, their effectiveness is lower than that of Paxil. As such, one had to put them aside and start with the option that would help the client. Moreover, if Imipramine and Buspirone are used and the patient uses ETOH, since he admitted to drinking 3-4 beers per night, they might cause adverse consequences. My hope when making this decision is to help the 46-year-old Caucasian man to resume his normal life as soon as possible so that he can continue working and supporting his aging parents without being interrupted by GAD symptoms. Paxil being the most effective antidepressant for treating GAD will help the client to improve his physical and mental well-being within a short period (Pollack et al., 2001, pg. 351). Besides, the reason for not using Buspirone is that it might lead to numerous side effects, including vomiting, drowsiness, uneasiness, headache, and faintness. After four weeks, the client returns to the clinic and has no shortness of breath or chest tightness. Over the past four or five days, he says that his worries about work have decreased and his HAM-A has reduced to 18. Overall, ethical considerations might impact the treatment plan, particularly if the client does not take the medications as prescribed. Decision #2 My next decision is to increase the dose of Paxil to 20mg taken orally daily, 40mg of Imipramine by mouth daily, and retain the current dose of 10mg of Buspirone by mouth per day. So far, the client has shown significant mental and physical health improvement without presenting any side effects. The reason that an individual has increased the dosage of Paxil and Imipramine was to further help the client eliminate all symptoms. Nevertheless, it was a slight increase in the dosages to evaluate if they will lead to any side effects on the patient (Bui et al., 2016, pg. 62). Specifically, the emphasis is on Paxil since the other two options are less effective when compared to this SSRI. The most significant thing is that the combination of these three drugs is working well on the client, particularly since the physician started with a low dosage to evaluate if they have any adverse consequences. At this juncture, when making this decision my hope w...