Angela presented with insomnia, depression, and feelings of a senseless life. The psychiatrist prescribed sertraline (Zoloft) and ramelteon (Rozerem) to treat her insomnia and depression. After 2 weeks, Angela reported no improvement in her mood. The psychiatrist advised her to continue treatment as it can take 2-4 weeks for effects. Side effects of the medications were also discussed, as was continuing treatment for 4-6 weeks with clinical monitoring.

1. [From 10$/Pg] Attitudes Towards Internet Interventions
[From 10$/Pg] Attitudes Towards Internet InterventionsReply 1 What medication would
you first prescribe to this patient?Angela has presented key medical concerns with the main
issue being ranging insomnia depression of unknown cause to emotional dysregulation
disorder having a feeling of senseless life. The patient will need mood fixation medication.
The best medication to prescribe for Angela is coupling an antidepressant medicinal drug
with psychotherapy (counseling and talk therapy). The antidepressant of choice is selective
serotonin reuptake inhibitors more specifically sertraline (Zoloft) When this is combined
with ramelteon (Rozerem); a drug that mimics the action of melatonin, treatment of
insomnia would be achieved (Chew et al., 2016). However, before deciding to use the
combination of the drugs, effective drug interaction should be observed. Two drugs can be
used for the treatment of different symptoms in a patient, but the two drugs may combine
to produce unusual side effects, therefore, worsening the health condition of the
patient.Selective serotonin reuptake inhibitors such as fluvoxamine should not be taken
together with ramelteon to manage depression symptoms (Levin, 2019). The medication
sertraline will be taken as 25 mg PO qDay for social anxiety disorder. Alongside the
medication, psychotherapy which is a talk therapy that targets clinical depression will be
used to help her restore the mental issue from the social and medical problems cutting
across cognitive therapy, behavioral therapy, and cognitive behavioral therapy and helping
in the primary focus of the patient. a combination of the therapy and medication should
help her gain her emotional balance including engaging in physical exercise.She comes back
in 2 weeks and states she has not noticed a change in her mood since starting on the
medication. What would be your response?The drug selective serotonin reuptake inhibitors
are effective after a dosage duration of between 2 to 4 weeks (Hieronymus et al., 2016) The
duration of drug efficacy is fluid, it varies depending on natural physiological
responsiveness to a drug that is specific to a given individual. Some people will take a
shorter duration to start noticing health beneficial changes attributed to the drug use while
others will take a longer period. Sertraline is contraindicated in patients with documented
hypersensitivity to the drug or its components (Rauch et al., 2019). The coadministration of
sertraline with thioridazine, pimozide, or monoamine oxidase inhibitors, including linezolid
or methylene blue, is also contraindicated. Patients who are taking other serotonergic
medications should receive education regarding the risks of coadministration with

2. sertraline. The advice is to encourage Angela to be strict with her medication as the
medication combination takes time to restore normality and ease the major symptoms.
Angela should not rule out the drug effectiveness since she is within the standard range for
the drug efficacy duration. She needs to have the drugs alongside taking her therapy
sessions seriously and getting socially engaged including being physically active to help her
restore her mental health.What are the possible problem with the medication you
prescribed?A drug is a foreign substance to the body; the body will perceive it and generate
the counter antibody to its effect. When the body counteracts the effect of the drug in the
system, the effect of this counteraction is manifested in terms of signs and symptoms and is
described as the possible side effects. Again, individuals have specific genetic makeup, and
their physiology is different. This fact will explain why it is not universal for a side of a drug
to be attributed to a specific sign and symptom. In other word perception of a drug in the
body differ from one person to another.However, in medical professionalism, it is required
to list to a patient some of the possible abnormalities that she/he might feel during the use
of a given drug. The case Angela: an adult, sertraline (Zoloft) usage might result in the side
effects such as nausea, loss of appetite, diarrhea, increased sweating, decreased sex drive,
shaking, agitation, tiredness, and fatigue (Poweleit et al., 2019). Another medication that
has been used in the treatment ramelteon (Rozerem) to facilitate sleeping might result in
side effects such as severe allergic reaction; difficulty in breathing; nausea and vomiting;
swelling of face, lips, tongue, or (Asnis et al., 2016).How long should you continue the
treatment regimen?Treatment is best achieved by a combination of effective drug use and
clinical monitoring. The health caregiver will proceed with the selected treatment regimen
as long the side effects of the drug are outweighed by the clinical manifestation of the
patient, when the sides are not life-threatening, and when the set dosage duration has not
been reached. In the case of Angela, the treatment is expected to continue for up to 4 to 6
weeks with thorough and close clinical monitoring. The estimated dose efficacy duration for
sertraline is between 2 to 4 weeks but an allowance of another two more weeks will help to
eliminate the possibility of slow response to the drug as may be indicated by some
individuals. The patient will also need to have a lifetime of exercise therapy to help her
control the depression disorder.ReferencesAsnis, G. M., Thomas, M., & Henderson, M. A.
(2016). Pharmacotherapy treatment options for insomnia: a primer for clinicians.
International journal of molecular sciences, 17(1), 50.Chew, R. H., Hales, R. E., & Yudofsky, S.
C. (2016). What your patients need to know about psychiatric medications. American
Psychiatric Pub.Hieronymus, F., Nilsson, S., & Eriksson, E. (2016). A mega-analysis of fixed-
dose trials reveals dose-dependency and a rapid onset of action for the antidepressant
effect of three selective serotonin reuptake inhibitors. Translational psychiatry, 6(6), e834-
e834.Levin, J. (2019). Mental health care for survivors and healthcare workers in the
aftermath of an outbreak. In Psychiatry of pandemics (pp. 127-141). Springer,
Cham.Poweleit, E. A., Aldrich, S. L., Martin, L. J., Hahn, D., Strawn, J. R., & Ramsey, L. B.
(2019). Pharmacogenetics of sertraline tolerability and response in pediatric anxiety and
depressive disorders. Journal of child and adolescent psychopharmacology, 29(5), 348-
361.Rauch, S. A., Kim, H. M., Powell, C., Tuerk, P. W., Simon, N. M., Acierno, R., … & Hoge, C. W.
(2019). Efficacy of prolonged exposure therapy, sertraline hydrochloride, and their

3. combination among combat veterans with posttraumatic stress disorder: a randomized
clinical trial. JAMA psychiatry, 76(2), 117-126.Reply 2 The medication that should be
offered to the patent who is having mental issues having no signs of having a life and may
significantly develop suicidal throughs of which she denies that she might have. The patient
is having mild depression that has caused her to have a negative attitude towards life
stating that the family members can easily do without her if she would not be there. Mild
depression is a mental illness that is associated with sadness feeling having loss of interest
and causing a range of behavioral changes and physical symptoms including sleep
alteration, appetite alteration, and energy levels (Schröder et al., 2017). The medication for
such an illness will include having a counseling session to help her restore her mental
strength and identify the possible environmental or social source of her stress before
developing an effective counseling session making her understand that the life challenges
exist and can be overcome through various solutions. The recommended medication for the
patient would be Selective serotonin reuptake inhibitors (SSRIs) which are having few side
effects when use and are effective in restoring the brain coordination responsible for the
depression illness (Otto-Meyer et al., 2020) The dose would include taking a dose
paroxetine 20 mg PO qDay before graduating to the increased content by 10 mg/day but
should not be more than 50 mg qDay. The medication will be taken alongside the occasional
therapy counseling the patient about the affected interests, work-related and the family that
are the possible causes of the patient’s stress. The family should also be involved in the
session to help her recover from the social problem and degenerate the social support.She
Comes Back in 2 Weeks and States She Has Not Noticed and Change in Her Mood Since
Starting on The Medication. What Would Be Your Response?Angela has not been able to see
any remarkable change after taking the paroxetine as a Selective serotonin reuptake
inhibitor for relieving the depression illness. The Selective serotonin reuptake inhibitors
that have been applied in the patient work by having alterations to the normal functioning
of the body organs with the expected side effects of paroxetine including having nausea,
difficulty in falling asleep at night causing Insomnia, lack of energy, and may extend to dry
mouth and dizziness (Hieronymus et al., 2018). The patient within the two weeks may
therefore still feel the lack of energy that was a major symptom with insomnia cases and the
future not noticing any major changes after using the medication for two weeks.The
information that I will give the patient is to continues with the doses that were previously
prescribed with an additional 50 mg qDay of the Selective serotonin reuptake inhibitors
paroxetine to help her get better. The other information that I would inquire about is to let
her record the side effects noted to compare with the noted side effects to make the
necessary adjustment that might include the change of the medication or using the
medication alongside the other over-the-counter medications. The response will also
include taking the therapy session alongside the medication for comprehensive
treatment.What Are the Possible Problems with The Medication You Prescribed?The
medications that are used to cure depression and mood disorders work differently with the
common variable being to correct the hormonal balance in the brain responsible for the
mood alteration (Sun et al., 2017) it is the balance that the antidepressant medication solves
the mood of the patient, however, the medication that has been used in Angel’s case is

4. specifically paroxetine with various side effects to the patient that are like the depression
symptoms. The noted problem with the use of paroxetine as prescribed to Angela is that
they are not able to restore the normality and controlling the symptoms within the shortest
time as expected by the patient. the possible problem of using paroxetine is showing side
effects including weakness, nausea, dry mouth, insomnia, headache, anxiety, and
nervousness (Khushboo, & Sharma, 2017). The problem with the side effects will be
experienced during the initial’s first two weeks as the body will be reacting to the
medications. the continuous use of the medication however should at long last improve the
mood of the patient and restore normality with great energy and proper sleeping pattern.
The patient should be made aware of the expectations.How Long Should You Continue the
Treatment Regimen?The treatment schedule for Angela will focus on controlling the major
manifestations including insomnia, boredom, loss of interest, and getting tired most of the
time. The use of the selective serotonin reuptake inhibitors paroxetine will be expected to
be effective in controlling most of the symptoms within a month (Kantor et al., 2017). The
therapy however should be done even after the symptoms have been controlled. The
therapy session will include weeks of engaging the patient on the various possible lifestyle
and social stressors and eliminating them or control them to get better. The patient will
additionally need seasonal therapy sessions that might be done for a year to make the
patient emotionally stable and have regular clinical checkups
afterward.ReferencesHieronymus, F., Lisinski, A., Nilsson, S., & Eriksson, E. (2018). Efficacy
of selective serotonin reuptake inhibitors in the absence of side effects: a mega-analysis of
citalopram and paroxetine in adult depression. Molecular Psychiatry, 23(8), 1731-
1736.Kantor, S., Varga, J., Kulkarni, S., & Morton, A. J. (2017). Chronic Paroxetine treatment
prevents the emergence of abnormal electroencephalogram oscillations in Huntington’s
disease mice. Neurotherapeutics, 14(4), 1120-1133.Khushboo, S. B., & Sharma, B. (2017).
Antidepressants: mechanism of action, toxicity and possible amelioration. J. Appl.
Biotechnol. Bioeng, 3, 1-13.Otto-Meyer, S., DeFaccio, R., Dussold, C., Ladomersky, E., Zhai, L.,
Lauing, K. L., … & Wainwright, D. A. (2020). A retrospective survival analysis of Glioblastoma
patients treated with selective serotonin reuptake inhibitors. Brain, Behavior, & Immunity-
Health, 2, 100025.Schröder, J., Berger, T., Meyer, B., Lutz, W., Hautzinger, M., Späth, C., … &
Moritz, S. (2017). Attitudes towards internet interventions among psychotherapists and
individuals with mild to moderate depression symptoms. Cognitive therapy and research,
41(5), 745-756.Sun, L., Sun, Q., & Qi, J. (2017). Adult hippocampal neurogenesis: an
important target associated with antidepressant effects of exercise. Reviews in the
Neurosciences, 28(7), 693-70