Anxiety is natural and to be expected, especially in difficult circumstances in life. However, chronic stress and anxiety may harm one’s health and predispose victims to other psychological problems. Those suffering from generalized anxiety disorder (GAD) frequently experience excessive distress over situations that, on the surface, do not warrant much concern. An excessive preoccupation with potential danger is a common symptom of GAD. People cannot sleep for long if they are concerned about their family, friends, health, employment, schools, or any other important areas of their lives. GAD has mental and physical consequences, and both need attention through therapy or medication. Anxiety symptoms include difficulty sleeping, concentrating, excessive worry, and negative self-judgment. Distractions, restlessness, hesitation, and anxiety about making mistakes may be present in the patient.
Background of the Case
In this week’s assigned reading, the case study titled ‘A Middle-aged Caucasian Man with Anxiety’ about a white man, age 46, who went to the clinic was read. His doctor advised him to go to the emergency room, which he did. He went there complaining of chest pain, shortness of breath, and hopelessness about his future, all of which pointed to a heart attack. The patient admitted to drinking occasionally, being concerned about his job security, and caring for his aging parents at home. Additionally, he claims to drink three to four bottles of beer per night and is unhappy with how the company is run. The HAM-A (Hamilton Anxiety Rating Scale) can help determine the severity of anxiety (Hamilton, 1959). The patient’s Hamilton Anxiety Scale score of 26 indicates severe anxiety. These findings indicate that the patient has a generalized anxiety disorder. Treatment options for this patient would need consideration of factors such as other health issues associated with the patient and allergies to specific medications.
Treatment Decision One
I have determined that the patient should begin daily dosing with 50 mg of Zoloft. The efficacy of Zoloft in treating generalized anxiety disorder piqued my interest. An SSRI such as Zoloft is a common first-line treatment for GAD. The medication raises serotonin levels by inhibiting presynaptic serotonin reuptake (Davidson, 2016). Zoloft was my first choice because it is effective and has few negative side effects.
Why not other Options
Imipramine was ruled out due to the high risk of death if taken in excess. It should only be used to treat GAD if all other medications have failed (Davidson, 2016). Because of its sedative, anticholinergic, and sedative properties, imipramine reduces adherence to treatment regimens. Possible side effects are constipation, dry mouth, and drowsiness. Buspirone was excluded from the list because it has yet to be validated as a treatment for panic attacks. The medication would not have helped because of the patient’s extreme anxiety. Due to the time it takes for Buspirone to begin working, the patient requires a combination of Buspirone and another medication to treat panic attacks and other severe anxiety episodes.
Expected Results and Ethics
I expected the patient’s anxiety symptoms to improve significantly after four weeks on Zoloft. According to Ballinger (2022), Zoloft is among the most promising medications in treating anxiety, with a high probability of success. As this was my original goal, the patient’s HAM-A score should have decreased to at least 14 by the end of the four-week therapy period. In this case, the ethical principles of nonmaleficence and beneficence can help guide patient care decisions. For example, I should ensure that the patient receives the most benefit from the drug while avoiding any negative side effects. The principles guided my choice of medicine with a track record of success and few side effects.
Treatment decision Two
The second decision is to use 75 mg of Zoloft daily if the first intervention fails. Because the patient’s anxiety symptoms persisted after taking Zoloft, I decided to increase the dosage. The HAM-A score of the patient dropped from 26 to 18. The physician can better monitor for adverse reactions when the dose gradually increases. To keep a closer eye on any side effects that might make it difficult for the patient to continue therapy as prescribed, I decided to reduce his dose to 75mg. The goal is further to reduce the patient’s anxiety and HAM-A scores. The patient’s symptoms have improved due to increased adherence to their current treatment plan.
Why not Other Options
I chose a 75 mg once-daily oral dose because monitoring the drug’s effects at higher doses would be too difficult. Because some patients have difficulty tolerating antidepressants, it is critical to precisely dose them when treating GAD (DeMartini et al., 2019). I chose not to increase the dose because the patient only took the recommended starting dose. Increasing the medication dosage may not help alleviate anxiety further if it causes unwanted side effects.
Expected Results and Ethics
I hoped to reduce the HAM-A score to eight or lower in four weeks, so I increased the Zoloft dosage taken by the patient. A nonmaleficence attitude can significantly alter the course of care. A physician’s reaction to adverse drug reactions is critical in determining how to proceed with treatment. During treatment, for instance, I must monitor the patient’s progress and adjust the course of action as necessary (APA, 2010). I decided to increase the patient’s Zoloft dosage because the initial dose had only a mild effect.
Treatment Decision Three
The third treatment option was to maintain the use of Zoloft by the patient. My decision to let the patient continue taking 75 mg of Zoloft daily was based on the drug’s efficacy. Anxiety symptoms were reduced by more than 60% when this dose was administered, lending credence to this theory. I decided to maintain the dosage because there were no negative reactions to the 75 mg increase. There is no need to increase to 100 mg because the patient’s pain has decreased by 61% at the current dose of 50 mg. Doing so may cause unfavorable side effects, preventing the patient from adhering to the recommended treatment plan.
Why not Other Options
I decided not to increase the patient’s daily dosage to 100 milligrams because they seemed to be doing well at the current level. Increases in the current Zoloft dose can help alleviate anxiety symptoms and increase the risk of side effects, which may discourage people from continuing to use the drug (Davidson, 2016). Because the patient responded well to a single dose of Zoloft, I decided against including an augmentation medication in the treatment plan. I did not want to recommend several medications simultaneously because I only needed one to solve the patient’s problems.
Expected Results and Ethics
I reasoned that taking 75 milligrams of Zoloft daily would eventually eliminate the patient’s anxiety. When I started treatment, I expected the HAM- After four weeks, the score would fall below 5, based on findings by Ballinger (2022). Although ethical considerations may influence the direction of therapy, the therapist must always prioritize the patient’s needs. To ensure the best possible outcomes with no unnecessary harm, decisions for a patient’s treatment should be guided by the principles of beneficence and nonmaleficence (Haddad & Geiger, 2019). For instance, I decided not to increase my dosage because taking that much Zoloft can be harmful.
Summary and Conclusions
The patient, in this case study, displayed symptoms of GAD, such as excessive job-related stress, anxiety, chest pain, difficulty breathing, and persistent fear that something terrible would happen. A score of 26 on the HAM-A indicates acute anxiety, which is what he initially felt. The starting dose of Zoloft could have been 50 milligrams once daily. Zoloft was chosen for its anxiolytic effects because it has been shown to help people suffering from anxiety disorders. After taking the medication, the patient reported feeling significantly less anxious, breathless, and chest tightness. Furthermore, it contributed to a decrease in the HAM-A score from 24 to 18. At the second fork in the road, I decided to up my Zoloft dosage to 75 mg to remove the anxiety permanently. The HAM-A score dropped by 10 points, and the intensity of anxiety symptoms decreased by 61% when the dosage was increased. Because the patient responded favorably to 75 mg of Zoloft daily, I chose to keep that dose. Increasing the dosage would have put the patient at greater risk of negative consequences, so it was not recommended. Polypharmacy is another issue that would have arisen from the use of an increased medicine.
Three ethical concepts influencing therapeutic practice are self-determination, beneficence, and nonmaleficence. With these principles in mind, doctors should openly discuss potential treatments with their patients and settle on a strategy that will produce the best results with the fewest side effects. The three principles encourage mercy and kindness to patients, focusing on ensuring patients are exposed to the least possible risks during treatment. I applied the three principles in making the three decisions while I analyzed the case study. The three recommendations outlined can ensure quick recovery of the patient and alleviate the associated symptoms.
American Psychiatric Association (APA) (2010). Practice guidelines for the treatment of patients with acute stress disorder and post-traumatic stress disorder. Web.
Ballinger, J. (2022). Zoloft review. Web.
Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16–e18.
DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized anxiety disorder. Annals of internal medicine, 170(7), ITC49-ITC64.
Hamilton, M. (1959). Hamilton anxiety rating scale (HAM-A). American Psychological Association PsycTESTS.