A middle-aged white male complains of chest tightness,

 A middle-aged white male complains of chest tightness, shortness of breath, and feelings of impending doom. After an electrocardiogram (EKG) rules out myocardial infarction, the patient is diagnosed with anxiety. This patient has stressors that are contributing to his anxiety: he fears for his job due to a harsh management team, and he’s currently caring for his aging parents. The patient also admits to daily alcohol drinking. According to Watkins, (2019) anxiety and alcohol use are commonly connected due to the fact that people enjoy drinking alcohol, and think of it as a way to relax; however, alcohol abuse can also cause anxiety. Despite the sedative effect of alcohol, using alcohol as a cure for anxiety can have the opposite effect and worsen the symptoms of the person’s anxiety.

            For the interactive media decision tree, I first decided to begin this patient’s treatment with Zoloft 50mg orally daily. Allgulander et al. (2015) conducted a study that examined the efficacy of Zoloft in patients with a Hamilton Anxiety Rating Scale of 18 or higher. After four weeks, it was evident that patients that received Zoloft had greater improvement than those who received the placebo. The patient in the interactive media was no different, as the four week check-up revealed no chest tightness or shortness of breath, a decrease in the amount of worrying about work for several days, and a Hamilton Anxiety Rating Scale score of 18, down from the original score of 26. At the second decision tree point, I decided to increase the patient’s dose of Zoloft to 75mg orally daily because although his symptoms are improving, they are not yet optimal.

After four weeks at 75mg, the patient returns with a further reduction in symptoms, and a Hamilton Anxiety Scale score of 10. Because of the 61% reduction in symptoms, I believe it’s best to maintain the current dose. Allgulander et al. (2015) states that the full efficacy of Zoloft can be assessed after 12 weeks. If at that point this patient’s symptoms have worsened, the dose may be increased.

A necessary point of patient education for this patient would be to stop drinking alcohol. Herxheimer and Menkes (2011) discuss the pathological intoxication that occurs when alcohol and selective serotonin reuptake inhibitors (SSRIs) are mixed. A possible explanation for this pathological intoxication could be attributed to a change in alcohol tolerance when on this medication. The consequences of drinking while taking an SSRI such as Zoloft could include an increase in violent or sexual behavior, and commonly without memories of the incident. It would be imperative to discuss this topic with the patient to prevent any harm.

References

Allgulander, C., Dahl, A., Austin, C., Morris, P., Sogaard, J., Fayyad, R., Kutcher, S., & Clay, C. (2015). Efficacy of Sertraline in a 12-week trial for generalized anxiety disorder. The American Journal of Psychiatry, 161(9). https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.161.9.1642

Herxheimer, A., & Menkes, D. B. (2011). Drinking alcohol during antidepressant treatment – a cause for concern? The Pharmaceutical Journal. https://www.pharmaceutical-journal.com/news-and-analysis/drinking-alcohol-during-antidepressant-treatment-a-cause-for-concern/11091677.article

Watkins, M. (2019). The connection between anxiety and alcohol. Retrieved from https://americanaddictioncenters.org/alcoholism-treatment/anxiety