A 45-year-old Caucasian man presents to your clinic with complaints of anxiety, which he describes as “constant worry and nervousness.” He reports that his symptoms have been present for several months and are impacting his ability to work and enjoy his hobbies. He has no history of drug abuse or serious medical issues.
You diagnose your patient as having generalized anxiety disorder.
Decision 1: What class of medication should be prescribed for this patient’s anxiety?
Selective serotonin reuptake inhibitors (SSRIs) are a class of medications that is often prescribed to treat anxiety. The lower abuse and dependence potential of these medications makes them a better choice than benzodiazepines. SSRIs can also be used to treat the symptoms associated with GAD.
What specific SSRI would you prescribe for this patient?
The choice of SSRI depends on several factors, including the patient’s medical history, potential drug interactions, and individual response to medication. As the patient has denied any medical issues or medications currently being taken, no specific SSRI is contraindicated in this situation.
However, it is important to consider the patient’s pharmacokinetic and pharmacodynamic processes. There are no notable differences in pharmacokinetic or pharmacodynamic process between the middle-aged Caucasian patient and the general population. Individual variations are possible and must be considered. SSRIs generally are tolerated well, although some patients experience nausea, vomiting and sexual dysfunction. Therefore, the choice of medication should take into consideration the potential for side effects and the patient’s preferences.
Decide 3: What should be the starting dosage for your chosen medication?
The appropriate starting dose for the chosen medication depends on several factors, including the patient’s age, weight, medical history, and potential drug interactions. SSRIs are generally low-risk medications, so a standard dose is recommended for the majority of patients.
This patient would benefit from a daily starting dose between 10-20 mg of sertraline or escitalopram. As needed, these doses can gradually be increased in order to obtain the desired result. However, they should not exceed every 1-2 week. Close monitoring of the patient’s response and any potential side effects should be done during dose titration.
In conclusion, the choice of medication for the treatment of anxiety should take into account the patient’s medical history, potential drug interactions, and individual response to medication. A selective serotonin reuptake inhibitor is the preferred class of medication for anxiety, and the choice of medication within this class should be made based on the patient’s individual needs and preferences. The appropriate starting dose should be determined based on the patient’s individual characteristics and close monitoring should be done during dose titration.