Ghb Research Paper

Ghb Research Paper
SODIUM OXYBATE Sodium oxybate is the sodium alkali of gammahydroxybutyrate (GHB) is an
endogenous metabolite of gamma–aminobutyric acid approved by FDA for sleepiness and cataplexy
is the only medication recommended for all the symptoms of narcolepsy.34,35 Sodium oxybate,
may act as neurotransmitter/neuromodulator which can act through its very own receptors and
through stimulation of GABA – B receptors. GHB was useful to control catalepsy, decrease day
time sleepiness, enhance night sleep in narcolepsy patients.36 The dose alignment from 3 to 9 g
nightly,the dose starting at 4.5g per night divided in to two equal dosesof 2.25g per night two
increased by 1.5g at two weeks interval. Adverse effects were dose related and includes nausea,
vomiting, dizziness, confusion,enuresis, anxiety, depressive symptoms, sleepwalking. Sodium
oxybate is fastly absorbed through oral administration, reaches plasma peak within 25 – 75 min after
ingestion and its half – life is 90 – 120 min. Overdosing of GHB can results CNS sedation,
respiratory depression, bradycardia, and seizures.37 Sodium oxybate should not be recommended
during pregnancy. Sodium oxybate plus venlafaxine (for cataplexy) or sodium oxybate plus
modafinil (for EDS) is given in severe cases(cataplexy or EDS) until the sodium oxybate is effective
and tapering of ... Show more content on Helpwriting.net ...
Declining severity and frequency of cataplexy at doses of 25–75mg and at low dose of 10–20mg
daily are more effective.Adverse effects consist of anticholinergic effects including dry mouth,
sweating, constipation, tachycardia, weight increase, hypotension, diffi culty in urinating, and
impotence.Rebound cataplexy may occur on withdrawal of Tricyclic anti depressants causes
increased in number and severity of cataleptic
... Get more on HelpWriting.net ...

Stop Bang Theory
Patients were recruited from the Late–life Depression Clinic and Memory Disorders Clinic at New
York State Psychiatric Institute (NYSPI)/Columbia University Medical Center. Patients were
eligible for participation in a long–term open antidepressant treatment trial, if they were 55 to 95
years of age with a minimum 8 years of education, who had subjective memory complaints and met
the inclusion criteria: 1), the Diagnostic and Statistical Manual of Mental Disorders, 4th edition
(DSM–IV) criteria by SCID for major depressive disorder or dysthymic disorder for a minimum of
6 months; 2), a baseline 24–item Hamilton Rating Scale for Depression (HRSD)(Hamilton 1960)
score was ≥ 14; 3), the criteria for cognitive impairment, a score ≤ 11 on the Logical ... Show more
content on Helpwriting.net ...
The Stop–Bang has eight yes/no questions with scores ranging from 0 to 8, including four questions
in STOP (loud Snore, Tired, Observed apnea, and high blood Pressure) and four questions in BANG
(BMI, Age, Neck size, and Gender). It has the highest methodological quality and the highest
sensitivity in predicting moderate (AHI≥15) and severe OSA (AHI ≥ 30).(Abrishami, Khajehdehi et
al. 2010) For Stop–Bang 5 or higher, the specificity is 79.7%, and the positive predictive value is
79.4% (PPV %) for OSA.(Chung, Subramanyam et al. 2012) In this study, patients were separated
into two groups based on the Stop–Bang scores. The OSA–group had a high probability of OSA
(Stop–Bang ≥5) and the non–OSA group had a moderate–to–low probability of OSA (stop–Bang s
Disease Assessment Scale–cognitive subscale (ADAS–cog, delayed recall test).(Rosen, Mohs et al.
1984, Raghavan, Samtani et al. 2013) Stroop and SRT results were presented with z–scores, which
represent the number of standard deviations (SD) from the norms (z score=0). Lower z scores
indicate worse cognitive functioning compared to the population. Other measurements were
vascular risk factors (CVRFs), including hypertension, obesity (BMI ≥ 30), diabetes, and
cardiovascular

The Effectiveness Of Cymbalta On Major Depressive Disorder
The effectiveness of Cymbalta on Major Depressive Disorder
Introduction:
Depression has dramatically increased over the years. It is becoming a chronic disease for people.
According to Wimett and Laustsen (2005), "Depression is a psychiatric disorder that affects an
estimated 18 million U.S citizens and is expected to be the second leading cause of death or injury
by 2020". Depression is the change in brain chemistry that comes with a feeling of severe
despondency and dejection. Although there are more than several types, the most familiar type is
called Major Depressive Disorder. In 2003, Kessler, Berglurd, Demler, ... & Wang noted that "Major
Depressive Disorder is a common disorder, widely distributed in the population, and usually
associated with substantial symptom severity and role impairment". There are many types of
treatment for Major Depressive Disorder, which include various types of therapies, electric shock
therapy, and medication. The most common form of treatment is Cymbalta alongside some various
types of therapy. Cymbalta is a medicine prescribed by doctors or therapists to reduce the symptoms
of depression.
Statement of the Problem: This research study need to be conducted because depression is becoming
a serious problem for people. If we do not research this issue more than we could probably see a
potential increase. Which means if we do not find a proper cure than we could have an increase in
people with depression because we cannot proper cure those who

Negative Effects Of Ssris
The SSRIs are advantageous due to their ease of dosing and low toxicity in overdose. They are
preferable over the other classes of antidepressants when treating minors and are also the first–line
medications for late–onset depression. The common adverse effects of SSRIs include sexual
dysfunction, gastrointestinal upset, as well as changes in energy level. The SSRIs are relatively
unproblematic in patients with cardiac disease, as its agents does not affect blood pressure, heart
rate, cardiac conduction, or cardiac rhythm.
The serotonin and norepinephrine reuptake inhibitors, SNRIs include duloxetine (Cymbalta),
desvenlafaxine (Pristiq), levomilnacipran (Fetzima), and venlafaxine (Effexor) are used as first–line
agents and are administered ... Show more content on Helpwriting.net ...
However, St. John's wort induce drug metabolizing enzymes resulting in a number of important
interactions with other drugs.
Of the non–pharmacological interventions of depression, CBT is the most effective as indicated by
research. Enhanced CBT focuses on the processes that maintain the disorder while specific
interventions while psychodynamic psychotherapy looks into the roots of the problematic
manifestations to see how the factors affect current relationships and behavior. CBT is fast evolving
and when integrated with mindfulness and constructivist as well as narrative approaches to therapy,
it produces the effective results. Although different patients respond differently to different models
of treating depression the integrative care model, when combined with other methods, such as
antidepressants seem to alleviate the disorder without further recurrences. The mindfulness–based
therapy combined with yoga, meditation, and other health–improving behaviors in addition to and
drugs have been proven as effective in preventing subsequent relapses.
In some instances, antidepressants have been found to be more effective among depressed patients
with suicidal ideation at baseline. The medication involved a combination of sustained–release
bupropion and escitalopram to reduce the suicidal ideation than sustained–release venlafaxine plus
mirtazapine. In patients with mild to moderate depression, the antidepressant medication had

Narcolepsy: Extreme Sleep Disorder (OSA)
Narcolepsy is a uncommon sleep disorder characterized for excessive daytime sleepiness and
significant daily dysfunction. Daily periods of irresistible need to fall asleep during times when
individual is supposed to be awake, as driving or at work, that may result in an accident. Patients
with narcolepsy must of the times suffer from insomnia caused by sleep fragmentation this is why is
imperative for narcolepsy to be diagnosed and treated.
Target for this disorder are children and adolescents being adults diagnosed with narcolepsy
reporting that onset begun before age 15 years. Alternate names for narcolepsy are: hypocretin
deficiency syndrome, narcolepsy–cataplexy, narcolepsy with cataplexy. Narcolepsy can be also
accompanied by cataplexy, ... Show more content on Helpwriting.net ...
It thought to be caused by a loss of hypocretin producing cells in the lateral hypothalamus.
Narcolepsy Type II without cataplexy where cataplexy is absent. The hypersomnolence and MSLT
findings are insufficient sleep, OSA, delayed sleep phase disorder o medical substances.
Criteria for the diagnosis of narcolepsy has been changing through time being the ICSD –3 who
divided Narcolepsy in 2: Narcolepsy with cataplexy and Narcolepsy without cataplexy.
FDA approved treatments for narcolepsy because paucity in clinical trials. Pharmacologic and
behavioral treatment for symptoms should alleviate daytime sleepiness to optimize patient daily
functioning at work, school and home goals should control nocturnal complains of fragmented
sleep, cataplexy hallucinations and sleep paralysis.
Pharmacologic treatment include modafinil, ritanserin and armodafinil, that are effective for treating
daytime sleepiness due to narcolepsy. Sodium oxybate, trycyclic antidepressants, venlafaxine and
reboxetine to treat cataplexy. Serotonin reuptake inhibitors and venlafaxine for sleep paralysis and
hypnogogic

Thesis Statement For Major Depressive Disorder
Major depressive disorder is a common mental disorder characterized by low mood, decreased
mental and motor activity, pessimistic view of everything around, loss of interest in life. It is one of
the most common types of depression, in contrast with other type depression, major depression
represent complex of symptoms. Major depression is also known as major depressive disorder,
clinical depression or unipolar depression. The word unipolar refers to the presence of one "pole" –
a range of emotions, which is characterized by only one type mood, without manic episode.
According to the WHO about 350 million people is suffered from depression. It damages not only
people with depression, also to the relatives and other. Mullarkey et.al. suggest that due to reduced
ability to work of depressed workers employers annually loss approximately 30 billions $. Thesis
statement_____ Preview_______ ... Show more content on Helpwriting.net ...
These are loss of self–esteem, loss of a spouse or loved one, or purpose in life. Everyday a person is
exposed to various negative effects, although not everybody gets depressed. The explanation for this
could be presence of support. This assumption is supported by Merry (2007) and Patel (2007) that
major depressive disorder is predominantly developed in the absence of support (quoted in Arean
and Ayalon 2010). Another explanation can be presence of other factors affecting on major
depression development: socioeconomic, genetic and biological

Obsessive Compulsive Disorder ( Ocd )
Obsessive compulsive disorder (OCD) was once thought to be extremely rare, but recent
epidemiological studies have shown it to be the fourth most common psychiatric disorder (after
substance abuse, specific phobias, and major depression). OCD is often a chronic disorder that
produces significant morbidity when not properly diagnosed and treated. The mainstay of treatment
includes cognitive behavioral therapy and medication management. The use of clomipramine in the
1960s and then the introduction of serotonin reuptake inhibitors in the 1980s represented important
advances in the pharmacologic treatment of OCD. Despite effective treatment modalities, many
patients demonstrate only a partial response or are resistant to available medications. SRI–resistant
OCD is one of the few diagnoses in modern psychiatry for which invasive neurosurgical procedures
remain part of the established treatment armamentarium. We review current treatment strategies
used in the management of OCD symptoms. Introduction Obsessive compulsive disorder (OCD) is a
debilitating neuropsychiatric disorder with a lifetime prevalence of 2 to 3 percent and is estimated to
be the 10th leading cause of disability in the world. Patients with OCD experience recurrent,
intrusive thoughts (obsessions) and/or repetitive, stereotyped behaviors (compulsions) that last for at
least one hour per day and significantly interfere with the individual 's normal level of functioning.
The intrusive obsessional thoughts

Evidence-Based Treatment of Hot Flashes Related to Cancer...
Hot flashes are one of the many side effects of cancer treatment. A hot flash is defined as "a
subjective sensation of heat that is associated with objective signs of cutaneous vasodilation and a
subsequent drop in core temperature" (Kaplan, Mahon, Cope, Keating, Hill & Jacobson, 2011).
Another description of a hot flash is a "sudden sensation of intense warmth that begins in the chest
region and rises to the neck and face" (Loprinzi, Barton & Rhodes, 2001). Hot flashes are difficult to
measure because they are a subjective experience. Electronic monitoring devices have been used to
assess skin temperature and objectively measure hot flashes (Carpenter, 2005). Hot flashes cause
discomfort and can affect a patient's quality of life, especially when associated with night sweats,
sleep disruption, and mood swings (Loprinzi, Barton & Rhodes, 2001). There are certain types of
cancer treatments that cause hot flashes in patients. Cancer treatments that target estrogen and
testosterone production cause more incidences of hot flashes than other cancer treatments (Kaplan et
al., 2011). The side effects of these types of cancer therapies include hormone–deprivation
symptoms, one of which can be hot flashes (Kaplan et al., 2011). These treatments are used for
breast cancer in women and prostate cancer in men (Kaplan et al., 2011). Premenopausal women
who undergo treatment for cancer may also experience hot flashes. This is because "about 80% of
premenopausal women who receive

Literature Review On Psychotropic Drugs
Psychotropic Drugs: Is Prozac Being Overprescribed? As the world becomes more knowledgeable
about mental health, psychotropic drugs have become popular in the treatment of major depression.
For example, primary care physicians prescribe psychotropic drugs to patients who seek help for
and complain about their mental issues. According to Smith (2012), "Writing a prescription to treat a
mental health disorder is easy, but it may not always be the safest or most effective route for
patients" (p.36). Prozac, a popular psychotropic drug, has been known to cause many uncomfortable
side effects while treating major depression. Psychotropic drugs, while still practical, are not the
only treatment for dealing with major depression, and there will be patients that respond positively
towards the drugs while other patients require treatment such as cognitive behavioral therapy. While
the physicians try to cure their patients of the symptoms of depression with Prozac, major
depression often requires additional therapy alongside the prescribed pills. This literature review
considers whether the increased use of Prozac is appropriate for treating major depression by
responding to the following questions: 1. What are the implications of major depression? 2. Is
Prozac effective at treating major depression? 3. Is Prozac safe? 4. Is Prozac the best solution?
Because written prescriptions have become easily accessible, patients often are not aware of less
risky treatments that could be more

Major Depression Research Paper
Major Depression Definition Major depression is when a person is in a depressed state for most of
the day, especially in the morning, and loses interest in relationships and normal activities. If these
symptoms persist for more than two weeks, major depression may be the cause. Causes The exact
cause of major depression is unknown. Some researchers believe that it may be linked to chemical
changes in the brain or defects in the individuals genes. Risk Factors Loss of job Divorce Social
Isolation Abuse (Physical, sexual, emotional) Death of loved one Signs and Symptoms Behavioral
Irritability Hopelessness Guilt Loss of interest Difficulty concentrating Physical Fatigue Sleep
problems Weight gain/loss Destructive actions Treatment Treatment

A Research Study On Palliative Punctures
Palliative Punctures Who would have thought that having 10 to 20 small stainless steel needles
inserted into your body can actually alleviate pain and improve health? Well for cancer patients this
practice can ease nausea, hot flashes, and yes pain. The practice is acupuncture, a 2,000 year old
component of traditional Chinese medicine involving stimulation of predetermined points on the
body called acupoints. These acupoints have needles inserted for a therapeutic effect. According to
the Chinese history, it is the traditional belief that energy flows through the body through channels
called meridians. Certain organs, tissue, or organ systems can have increased energy flow through
these meridians by stimulating specific acupoints. Thus, in a 30 minute session any person can have
a specialized treatment that targets only the ailments specific to that person. This is a great medical
practice for anyone, with most patients experiencing no pain from needle insertion, and a fewer than
1 in 10,000 adverse event statistic in risk of injury to the patient (Memorial Sloan Kettering Cancer
Center, 2010).
Acupuncture has been shown to assist with numerous health issues, such as osteoarthritis, high
blood pressure, back pain, chronic headaches, and infertility to name a few. So someone came up
with the ingenious idea to apply its abilities to cancer patients. Let's just say that the people afflicted
with breast cancer will forever be grateful for that light bulb.

Effectiveness of Antidepressant Drugs Essay example
Effectiveness of Antidepressant Drugs
In Issue 13 of Taking Sides, the controversial question Have Antidepressant Drugs Proven to be
Effective is analyzed. Psychiatrist Peter D. Kramer argues in this issue that antidepressant drugs
"can transform depressed patients into happy people with almost no side effects" (p.212). On the
contrary, professors of psychology Seymour Fisher and Roger P. Greenburg "claim that the studies
that demonstrate the effectiveness of antidepressants are seriously flawed" (p.212). Kramer's
agreement with the statement above is due mostly to the testing he did with his patient Tess and
antidepressant drugs. However Fisher and Greenberg disagree with the statement mainly because of
the bias drug studies that ... Show more content on Helpwriting.net ...
In Tess taking the drug Kramer found out very quickly what remarkable changes it had on her.
Kramer learned that the drug had a "quickly alteration in ordinary intractable problem of personality
and social functioning" (p.218). Kramer also learned that Prozac enabled a person to understand
what was important to them and who they were and wanted to be. Although Kramer saw the effects
Prozac had on Tess, Tess also taught him to look at the border picture. Tess made Kramer think what
if this "redefinition of self led to a culture in which this biologically driven sort of self understanding
becomes widespread" (p.222). Kramer found it unbelievable what the drug Prozac could do to a
patient, something that psychiatrists have always hoped to accomplish. The main thing though that
Tess taught Kramer and what the drug itself taught him was that the effects of the drug would have
to re examined and our sense of what is constant in the self to be revised. As earlier stated, Fisher
and Greenberg disagree with the effectiveness of antidepressant drugs which is mainly due to the
bias studies. As Fisher and Greenberg state, "no one actually knows how effective antidepressants
are. Confident declarations about their potency go well beyond the existing evidence" (p.223). One
of the main biases on antidepressant drugs is that "patients learn to discriminate between drug and
placebo largely from body sensations and symptoms" (p.225). Another point Fisher and

Mania Antidepressant
According to a new study, mental health illness such as mania and bipolar disorders may be caused
by antidepressant therapy, particularly the use of Venlaxafine and Selective Serotonin Reuptake
Inhibitors (SSRIs).
Past studies have also believed that antidepressant therapy causes acute symptoms of hypomania;
however they were not able to establish a concrete evidence to prove it. These studies also looked at
some other results and not just mainly focused on finding out the rate at which mania or hypomania
happening from specific antidepressants. The current study focuses on this with a "real–world
sample" of men and women aged 16 to 68 that are already diagnosed with depression.
Subjects of the study were all undergoing mental health care from ... Show more content on
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After studying the data, they separated data on previous antidepressant use and successive
diagnoses; prior use was described as any antidepressant taken before a formal diagnosis was done.
The antidepressant under investigation were were monomine–oxidase inhibitors; mirtazapine;
SSRIs; TCAs; trazodone; venlafaxine; duloxetine; agomelatine and reboxetine.
Among the 21,012 records that the researchers reviewed, 994 were diagnosed with mania or bipolar
disorder during a follow–up. The "peak–diagnosis" was with patients aging between 26–35 who
were prescribed with SSRIs, Mirtazapine, Venlafaxine, and Tricyclics. They found greater risk
connected with the use of SSRIs and Venlafaxine.
Previous antidepressant use was linked with an increased risk of an after diagnosis of either mania
or bipolar disorder, a risk that happens every year ranging from 1.3 to 1.9 percent. The researchers
explained that their findings show a significant connection between antidepressant therapy in
patients with unipolar depression and an increased occurrence of mania. They also added that this
link stayed the same even after they adjusted factors such as, age and gender in the

Leg Pain Case Studies
SUBJECTIVE Patient attends with complaints of leg pain for a period of about 1–1/2 weeks. Pain is
so severe that he has to keep active, the more active he is the less the discomfort bothers him. He
finds that sleeping at night really is uncomfortable because of the cramping in his legs, the cramps
start in the base of his feet and run up into the calves, but again, if he gets up and is active it seems
to reduce the discomfort considerably. His joints have not been red, or hot, or swollen. He has not
had his limbs buckle or give way. He has not tried any medications for this. Interesting to note that
he has started jogging some three weeks ago, and the discomfort in his shins is subsequent to that.
He did not temporize that activity. The patient is concerned that he was on methadone and he knows
that this can cause bony structure problems, dental problems. He was on it for about a year and he
has been off of that now for at least two years. He is also concerned about his weight. He states he
used to be 200 pounds he is now down to 160 pounds. Chart review shows that since he has been
incarcerated in Faribault his weight has been pretty stable running between 155–165. I reassured
him that this ... Show more content on Helpwriting.net ...
His current medications include acetaminophen two tabs three times a day p.r.n., ferrous sulfate one
tab daily, gabapentin 800 mg b.i.d., levetiracetam 1000 mg two in the morning and one at bedtime,
loratadine 10 mg daily, omeprazole 20 mg daily, sertraline 100 mg two at bedtime, venlafaxine ER
150 mg once daily and venlafaxine

Behavioral Medicine : Cognitive Behavior And Medication
Cognitive Behavior and Medication
Studies have been done on the cognitive behavior and medication. Some studies looked at the
behavior with bipolar disorder and the medication that they take for the (Micheal Bauer, Tasha
Glenn, Paul Grof, Natalie L Rasgon, Wendy Marsh, Kemal Sagduyu, Martin Alda, Ute Lewitzka,
Rita Schmid, &Perter C Whybrow 2009). Some studies focus on depression treatment and the
serotonin reuptake (Benedetto Vitello 2009), (Sonya S. Descheˆnes Michel J. Dugas 2012) (Bjo¨ rn
Paxling, Jonas Almlo¨ v1, Mats Dahlin, Per Carlbring, Elisabeth Breitholtz, Thomas Eriksson6 and
Gerhard Andersson 2011), and (Alastair J. Flint 2005). Each study is focused on the behavior of
patients with behavioral medicine. Studies also focus on the cognitive behavior. The purpose of this
literature review is to show how research of behavioral medicines can affect the cognitive behavior
of a person with treatment of medication. It also to show how different medication affect the
treatment of patients in the clinical trials.
Literature Review
Sonya S. Descheˆnes Michel J. Dugas (2012) studied the way that the cognitive behavior changed
for patients who received the treatment for general anxiety disorder. The treatment was based on a
14 week treatment with 59 adult patients that had the anxiety disorder. They get weekly
questionnaires and they also get the symptoms of the treatments of the patients. They were supposed
to testing to see if there were sudden gains from the

Nursing Case Study
Polen KN et al.,(47) in an earlier study suggested a relation between prenatal venlafaxine exposure
and congenital anomalies as cardiac anomalies and anencephaly which agreed the findings in the
present work. Moreover, a population–based study of more than 2,000 exposed pregnancies was
parallel with the results in the present work and stated that overall maternal use of SSRIs in early
pregnancy was associated with a 1.7–fold increased risk of congenital cardiac malformations. (48)
Another population–based cohort study by Wogelius P. et al., (49) concluded an increased risk of
congenital malformations after exposure to SSRIs in early pregnancy. There was significant increase
in the number of children with congenital malformations who was ... Show more content on
Helpwriting.net ...
The use of SSRI was assessed. They identified 546 fetuses with congenital heart anomalies (519
livebirths, 12 stillbirths, 2 miscarriages, and 13 termination of pregnancy) and of these were 11
exposed to SSRIs in the first trimester of pregnancy. The risk estimates for the association between
SSRIs and respectively Ebstein's anomaly were statistically significant. They concluded that
maternal use of SSRIs during first trimester increases the risk of congenital heart diseases.
Furthermore, a population based cohort study done by Pedersen et al.,(53) agreed with the findings
of the present work. There was an increased prevalence of septal heart defects among children who
were exposed in ureto to SSRI.
Another population based study by Colvin et al.,(54) included 123,405 pregnancies from 2002 to
2005. The study results showed an increased risk of cardiovascular defects and confirmed that in
utero exposure to SSRI leads to increase in the prevalence of cardiovascular defects.
A previous cohort study by Vasilakis–Scaramozza(55) disagreed with the result of the present work
and suggested that the exposure to tricyclic antidepressants (TCAs) and SSRIs during the first
trimester of pregnancy was not associated with a significant increase of the risk of congenital
anomalies in the offspring of mothers exposed to these drugs. The lack of association between in
utero exposure to SSRI and congenital

Panic Disorders: A Case Study
It is estimated that 1% to 5% of people will experience a Panic Disorder at some point in their life
(Andrisano, Balzarro, Fabbri, Chiesa & Serretti, 2012). A Panic Disorder is a chronic and severe
anxiety disorder that is defined by the presence of frequent panic attacks and persistent worrying
about future panic attacks (Andrisano et al., 2012). Panic disorders have been known to cause
impairment in both qualities of life and functioning (Andrisano et al., 2012). It is important to treat
individuals that have panic disorders because studies have shown that people who suffer from panic
disorders generally get worse over time if proper treatment interventions are not established
(Andrisano et al., 2012). Treatments have been found to be effective ... Show more content on
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It looked at data regarding first–line pharmacotherapy for treatment for patients with panic disorders
(Batelaan, Van Balkom & Stein, 2012). After reviewing evidence–based pharmacotherapy for panic
disorders, they concluded that SSRIs along with SNRIs venlafaxine and Benzodiazepines should be
the primary medications for panic disorders (Batelaan et al., 2012). When analyzing the efficacy of
these drugs, it showed that these medications stayed effective in both short–term and long–term
treatment (Batelaan et al., 2012). The three aspects researchers looked at to determine the
effectiveness of the drugs were side–effects, drop out rates and time of onset (Batelaan et al., 2012).
When looking at the panic disorder clinical trials, drop out rates for SSRIs and Benzodiazepines
were 18% and 15% respectively. TCAs and MAOIs on the other hand showed a 30% dropout rate
among patients with panic disorders (Batelaan et al., 2012). When looking at onset of action,
antidepressants (SSRIs and SNRIs venlafaxine) are relatively slow, however TCAs showed a slower
onset than SSRIs, SNRIs venlafaxine and Benzodiazepines (Batelaan et al., 2012). Researchers
concluded that both SSRIs and SNRIs venlafaxine should be considered as first–line agents for
treatment along with Benzodiazepines. The study did mention however, that there have not been one
to one comparisons between SSRIs and SNRIs

Research Paper On Hoarding
Assessment/Intervention Hoarding patients has a high rate of co–occurrence with the disorder
performing an assessment is highly recommending. Professionals would want to rule out or see if
there are attributable of any other medical conditions such as dementia, traumatic brain injury or
alcoholism. Individuals that are diagnose with hoarding disorder needs therapy to assist with the
disorder. It is important that social worker perform good assessment to provide the appropriate
intervention. Hoarding disorder has many health risk that affect or incapacitate a person life and
impair their functioning. There are many types of treatment for the hoarding disorder. Cognitive
Behavioral Therapy One type of treatment that is proven to work with

Major Depressive Disorder Research Paper
Pre–Discovery Introduction As a disorder that is predicted to affect 9.5% of the US adult population
in any given year, Major Depressive Disorder (MDD) is a mental illness that can last for long
periods of time if left untreated (National Institute of Mental Health, n.d.). The symptoms associated
with MDD vary from person to person, but the most common include a depressed mood, lack of
energy, feelings of hopelessness, pessimism, irritability or guilt, fatigue, lack of interest in hobbies
and activities that used to be pleasurable, weight fluctuations, suicidal thoughts, and having trouble
focusing and making decisions (National Institute of Mental Health). When someone is suffering
from depression, they have an observable chemical imbalance. ... Show more content on
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282). Because MDD is associated with a chemical imbalance, duloxetine interacts with the
imbalanced chemicals, which are the neurotransmitters serotonin and norepinephrine (Knadler,
Lobo, Chappell, Bergstrom, 2012, p. 282). Since a lesser amount of serotonin and norepinephrine
are associated with depression, having a SSRI allows for one to have an increased amount of those
neurotransmitters, which is a mechanism that will help or cure one's depression (Knadler, Lobo,
Chappell, Bergstrom, 2012, p.

St. John's Wort As A Treatment For Depression: Herbal...
St. John's Wort As A Treatment For Depression: Herbal Healer or Ineffective Alternative?
This country has its share of major health issues, and Depression has remained a prominent one.
With a prevalence rate of one in twenty suffering from this psychological disease in the US, (1) it is
no wonder that many varying treatment options now exist for sufferers. The most common approach
to treating Depression is with some form of psychotherapy coupled with prescription drugs.
However, this traditional course of treatment now has the so called 'alternative' approaches to
contend with. One such alternative therapy is Hypericum, an herb that is more commonly known as
St. John's Wort. There is a bubbling debate between believers in the herbal ... Show more content on
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The process can take close to a year. With St. John's Wort, however, the herb is easily obtainable,
does not need a prescription, and is available at a much lower cost than prescription drugs. It also
boasts few side effects and mild ones at that, versus the multiple side effects that go along with such
popular prescription antidepressants such as Prozac. (2)
Now we will turn to the other side of the coin, as it were. The US Food and Drug Administration has
not yet approved St. John's Wort as an effective treatment for depression. This lack of approval is
mostly due to the fact that little research has been conducted on the effects of St. John's Wort. That
is, until recently.
In April 2001 and again this month (April 2002) The Journal of the American Medical Association
(JAMA) published the results of clinical trials conducted to test whether St. John's Wort works to
treat Depression. (3, 4, 5) Both times the results did not favor the use of the herb. The most recent
JAMA report concluded, "...hypericum should not be substituted for standard clinical care of proven
efficacy, including antidepressant medications and specific psychotherapies, for the treatment of
major depression of moderate severity." (3)
When interviewed about the results of the JAMA reports, Psychiatrist Mark

Major Depressive Disorder ( Depression )
Major Depressive Disorder (Depression) is a mood disorder where a person has a constant feeling of
sadness and complete loss of interest in everyday life. It is considered more serious than a case of
the "blues" and might require long–term treatment. During major depressive disorder, the person
thinks and behaves differently and may experience emotional and physical problems.
Causes
The exact cause has yet to be pinpointed. It is believed that specific neurotransmitters in the brain
may stop acting the way they should and therefore affect the state of the individual's mood. The
impact of hormones is also called into question because hormone imbalances, for example
pregnancy and thyroid dysfunction, are believed to cause depression. ... Show more content on
Helpwriting.net ...
Overwhelming feeling of sadness or hopelessness.
Trouble concentrating and making decisions.
Feelings of guilt, worthlessness and shame. Worrying over past indiscretions or failures.
Slower thinking.
Treatment
Many people with depression find that medications along with regular visits to a psychologist or
psychiatrist are a very effective form of treatment.
Cognitive Therapy – this form of cognitive therapy starts out by educating the client on what may
cause the depression and that negative thoughts should be redirected. The therapist teaches the client
how to identify the bad thoughts as they occur throughout the day and the emotions that are
associated with them. It is helpful because once the person can identify the negative thoughts, they
can begin the steps to try to change them.
Family Therapy – this therapy should be considered if the affected individual's depression begins to
affect his/her family. This treatment creates a therapeutic environment for each person to discuss
their feelings openly and encourage open communication between family members.
Hospitalization – in severe cases where a person with depression has expressed suicidal thoughts or
even attempted suicide, an inpatient treatment program with constant monitoring can be very
helpful.
Electroconvulsive Therapy/ Transcranial Magnetic Stimulation – this type of therapy is viewed as a
last resort option. In ECT, a current is passed through the skull into the

Desvenlafaxine Case Study
Answer: Desvenlafaxine is recommended for this patient among SSRI and SNRI. Because
desvenlafaxine is least affected by this patient's CYP2D6 poor metabolizer and CYP2C19 poor
metabolizer status among SSRI and SNRI, has no drug–drug interaction with the current
medications and has better safety profile compared with other SSRI and SNRI. Rationale: Based on
the PharmGKB website and relative articles, the patient has CYP2D6 *4/*4 genotype means she is a
poor metabolizer of the CYP2D6 enzyme, CYP2D6 *4 allele has inactive CYP2D6 enzyme activity,
she has two inactive alleles resulting being a poor metabolizer of CYP2D6. Also, the patient has
CYP3A4 *1/*1 genotype, CYP3A4 * 1 allele has active CYP3A4 activity, however, there is no
uniform phenotype ... Show more content on Helpwriting.net ...
Among SSRIs, paroxetine, fluvoxamine, and fluoxetine are mainly metabolized by CYP2D6.
Sertraline, citalopram, and escitalopram are mainly metabolized by CYP2C19. There are CPIC
guidelines for fluvoxamine and paroxetine regarding CYP2D6, also for citalopram, escitalopram,
sertraline regarding CYP2C19. These guidelines suggest the reduction of the dose or alteration of
medication if the patient has a poor metabolizer phenotype. Since this patient is a poor metabolizer
for both CYP2D6 and CYP2C19, patients may experience side effects from relevant SSRIs due to
higher plasma concentration, we may need to avoid using the above SSRIs. Additionally, she tried
paroxetine, fluoxetine, and sertraline in the past which were all not successful, we would like to
avoid those as well. SNRI that approved to treat depression includes desvenlafaxine, duloxetine, and
venlafaxine. Among these SNRIs, venlafaxine is mainly metabolized by CYP2D6, desvenlafaxine is
mainly metabolized by conjugation and minor metabolized by CYP3A4, it is also an inhibitor of
CYP2D6. Duloxetine is mainly metabolized by CYP1A2 and CYP2D6. Based on the information
above and patient's genotyping result, desvenlafaxine will be the best choice for her. Although it is a
dose–dependent inhibitor of CYP2D6, this patient has no CYP2D6 enzyme activity, desvenlafaxine
won't cause the clinical impact on CYP2D6 in this

Argumentative Essay On Anti Depressants
Depression is a serious mental disorder that may be displayed by major episodes of sadness,
restlessness, and loss of interest. Depression has several symptoms such as excessive sleep,
increased or loss of appetite, aches, cramps, insomnia, and fatigue. It can affect anyone of all ages
and may not be recognizable for those who are experiencing it. A medication called anti–depressants
helps treat depression by altering the serotonin receptors levels. There are several types of anti–
depressant medications such as Abilify, Celexa, Aplenzin, Asendin, and many more. There are
individuals that may argue that anti–depressants are an over–prescribed medications. They believe
that this medication can affect the patient's mental status and inhibit self–control with this addictive
drug. On the other hand, the opposition may argue that anti–depressants are not overly prescribed
and that it should not be problematic because it is an accessible, helpful, and a quicker treatment.
The debate of whether anti–depressants are an over–prescribed medication has been an ongoing
controversial issue as evidenced by statements of supporters and those in opposition.
According to Wehrwein (2011), statistics usage of antidepressants demonstrated that 23% of women
between ages of 40 to 50 take antidepressants as compared to other age groups. Wehrwein
mentioned that 14% of non–Hispanic white people use antidepressants more often compared to 4%
of Hispanics and 3% of Mexican Americans.
There are better

Ptsd Essay
PTSD is a growing issue in New Zealand and our current methods for treating this are in sufficient.
6.1% of people living in New Zealand have some kind of anxiety disorder in the year 2010 and in
2006, 3.5% of the New Zealand population at that time, had been diagnosed with PTSD. The New
Zealand Government should subsidize 70% of surf lesson costs for people with PTSD and build 6
Float Centers in New Zealand's key cities. In conjunction with this, the Ministry of Social
Development should raise awareness of their funding program for people with mental illness. This
report will be focusing on what is PTSD, what is PTSD, what is being done, what could be done and
what should be done. What is PTSD? PTSD means Post–Traumatic Stress ... Show more content on
Helpwriting.net ...
Another sign of PTSD is avoidance. People suffering from PTSD can feel somewhat detached from
society, their friends, family and they can end up stopping activities they had once enjoyed. An
additional indication that someone has PTSD is hyperarousal. Hyperarousal is when a person with
PTSD constantly feel on alert and jumpy. Also disturbed sleep and are more irritable. There are may
risks of PTSD This can lead depression, that can lead to suicidal thoughts and this happened mostly
when it isn't treated. It can lead to panic attacks. This can develop food disorders. Issues with drugs
or alcohol use. People who have experienced depression in their lives are more likely to be affected
by PTSD. PTSD is an individual mental illness but involves depression and anxiety. Meaning that
someone who has PTSD is constantly feeling on edge. In the 2011/2012 New Zealand health survey
it revealed that 14.3% of New Zealand adults (over 500,000 people) had been diagnosed with
depression at some time in their lives, and over 200,000 people (6.1%) had been diagnosed with
anxiety disorder including PTSD. The rates of depression and anxiety in Women is much higher
than the rate of Men with these illnesses. 17.9% of Women in New Zealand had been diagnosed
with depression, and 7.7% with anxiety. Compared to men with depression, 10.4%, and anxiety,
4.4%. These figures include everyone with any kind of depressive illness and any kind of anxiety
disorder which include many other

Summery
Article Summaries Part 2
Carrie Wilson
Client Perceptions of Therapy Component Helpfulness in Group Cognitive–Behavioral Therapy for
Anxiety Disorders.
The objective of this study was to evaluate the helpfulness of group cognitive–behavioral therapy in
patients with anxiety disorders. The treatment required participants to be highly motivated and
willing to endure unpleasant emotional states. The treatment encouraged participants to challenge
long standing maladaptive beliefs. The researchers used archival data of 48 participants who
completed clinical trials at University training clinic. They recruited participants by advertising in
local newspapers and by obtaining referrals from mental health professionals. Participants were ...
Show more content on Helpwriting.net ...
The objective of this study was to compare the effectiveness of virtual reality exposure therapy to
the cognitive–behavioral approach to treating anxiety disorders. PsycINFO, PubMed, ISI Web of
Science and Academic Search Premier were used to gather date. Dependent variables included
primary outcomes, and real–life impact outcomes. They calculated Cohen's d effect size using the
means and SDs that were available. They found out that in the case of anxiety disorders, VRET did
far better than the waitlist control. VRET also had a similar impact as the classical evidence–based
treatment. Reducing anxiety sensitivity with exercise.
This study was conducted to extend the findings in using exercise to reduce anxiety sensitivity as
well as depressed mood in persons with anxiety disorders. The study participants were made up of
psychology students at the Methodist University in Dallas as well as a community sample in Boston.
A 16 item questionnaire was given to participants and questions were scaled on a 5 point Likert type
scale. The Beck Anxiety Inventory was used to measure the severity of anxiety symptoms and the
Beck Depression Inventory was used to measure the symptoms of depression. Exercise was
completed on a treadmill that was programed with a specific training program. They found that 20
min of exercise at 70% of heart rate yielded a large reduction in anxiety sensitivity as well as
depression symptoms.
Serotonin noradrenaline reuptake

Ambien Case
DOI: 11/27/1996. This is a 63–year–old male route salesman who sustained a work–related injury to
his low back when he attempted to dislodge a dolly from groove between his truck and the floor.
Patient has an industrially aggravated periodontal disease, gingival inflammation, and xerostomia
condition.
Per medical report dated 03/17/16, patient's medications are chlordiazepoxide 10 mg, Butrans 10
mcg, Fentanyl 75 mcg, Norco 10 mg/325 mg, venlafaxine ER 75 mg, Ambien CR 12.5 mg,
Cymbalta 60 mg, Capsaicin Hot Patches 0.025% Ext Pads, terazosin, Levothyroid 125 mcg and
Androgel pump 1%.
Based on the medical report dated 04/14/16, the patient presents for medication maintenance. He
reports ongoing pain, withdrawal symptoms such as increased pain, ... Show more content on
Helpwriting.net ...
Diagnoses include failed back surgery, lumbar; degenerative disc disease, lumbar spine; back pain;
lumbar radiculopathy; spondylosis without myelopathy or radiculopathy, lumbar region;
impingement syndrome of bilateral shoulders; myalgia; xerostomia; erectile dysfunction; testicular
hypofunction; chronic anxiety; chronic depression; and chronic insomnia.
With medications, he is able to attend baseball games (grandkids), attend church weekly and walk
the dogs. Without needed medications, he is bed bound and unable to perform functions.
A trial of Butrans was prescribed as this as a viable long acting agent.
He was encouraged a gradual and progressive daily stretching regimen to help minimize chronic
pain.
Patient has been previously certified with 4 Butrans Patches 10 mcg/hr on 04/12/16 ( Review
256727).
Current request is for 4 Patches of Butrans (Buprenorphine) 10 mcg/hr; and 15 Patches of Fentanyl
Patch 75 mcg/hr between 4/15/2016 and 6/14/2016.
This is 1 out of 2

Essay On Polypharmacy
Polypharmacy by definition is the concurrent use of multiple medications. More often than not, it is
supplementary with the prescription and use of too many or unnecessary medicines at dosages or
frequencies higher than therapeutically essential (National Prescribing Service Newsletter, 2000). It
is becoming a prevalent concern in the nation given that there is an increase in the older adults who
are being treated for multiple chronic diseases. Research indicates, "44% of men and 57% of women
older than age 65 take five or more medications per week; about 12% of both men and women take
10 or more medications per week" (Woodruff, 2010, para. 1). In that same research, it pointed out
that most of the commonly used over the counter drugs are ... Show more content on
Helpwriting.net ...
It is therefore crucial for physical therapists to review patients' current medications and medications
taken in the past when conducting an initial evaluation (Lieberman & Vyas, 2012). Though as a
therapist, we do not have the authority to make medication changes, it is still essential to be able to
communicate with the prescribers for patient safety. On the part of the patient, it is imperative that
we continuously educate the patient on the side effects of the medications that they are currently
taking and inform them that it is of great consequence that they provide their primary care
practitioners with an updated list of medications upon office

The Pathophysiology Of Depression And Depression
The pathophysiology of depression is multifaceted and difficult to pinpoint. Depression can arise
from a multitude of precipitating factors, both external and internal to the patient. There are varying
theories about the cause of depression, each of which "are based on studies investigating
psychosocial stress and stress hormones, neurotransmitters such as serotonin, norepinephrine,
dopamine, glutamate and gamma–aminobutyric acid (GABA), neurocircuitry, neurotrophic factors,
and circadian rhythms" (Hasler, 2010). Due to the vast immensity of theories available, Woo, &
Robinson (2016) recommends that treatment for depression should be tailored to each patient and
their disease state individually. In Mary Smith's case her depression appears ... Show more content
on Helpwriting.net ...
Mary is a strong candidate for depression screening and assessment, as well as several diagnostic
tests to assess potential causes of her symptoms. These additional diagnostic tests would include:
CBC, BMP, Vitamin D levels, LFTs, TSH, and T4. To rule out a physiological disease process. In
2016 the US Preventive Services Task Force (USPSTF) recommended that screening be completed
within the general population for depression assessment. While the frequency of the screening was
not specified, it was made clear that screening should be implemented with adequate systems in
place to ensure diagnosis, treatment, and appropriate follow–up (Siu, Bibbins–Domingo, Grossman,
Baumann, Davidson, Ebell & Krist, 2016). Of the available screening tools, the Patient Health
Questionnaire (PHQ 9) is the most frequently used, and somewhat more accurate screening tool than
the other screening tools available. A score greater than 10 would indicate a possible depressive
disorder, in a scale of 0–27. The PHQ–9 includes questions about depressive symptoms impairing
function, which is a key criteria in order to establish a DSM–based diagnosis of depression, and the
PHQ–9 can be used to monitor response to treatment (Manea, Gilbody, & McMillan, 2015). A
shortened version of the PHQ 9 is available and called PHQ2, this abbreviated version is

Pattern And Higher Risk Of Suicide Case Study
pattern and higher risk of suicide attempt.
There are a variety of treatments to treat severe depressive episode such as antidepressant
medications such as Sertaline hydrochloride 100mg daily–PO and Venlafaxine 37.5mg– PO– nocte
showed effect in treating severe depressive episodes by increasing available serotonin leading to
improved or elevated low depressed mood. Mrs. Brown's mood slightly improved after taking
medications as per charted (O'Brain, 2013). Antipsychotic drugs such as Quetiapine 12.5– PO–
mane/nocte showed effect in treating severe depression by reducing the intensity of negative
perceptions as they work on the dopamine receptors found in the brain (O'Brain, 2013). Mrs. Brown
was going to have ECT treatment ... Show more content on Helpwriting.net ...
She was back to the ward and was continually monitored for side effects such as headache, muscle
pain, HR, BP, RR and short memory lost. By administering Paracetamol 1g–PO–QID as prescribed I
promoted pain free environment and quality of life. It was her ECT treatment number 6. She was
removed from the Mental Health Act and as an informal patient wanted 3 further ECT treatments.
Her mood had improved slightly.
Nursing Diagnosis Goals
1. Self–neglect related to lack of motivation due to depressed mood. Patient will be able to perform
self–care activities independently within 2 weeks and with assistance every day.
Patient is able to eat and drink independently within 2 weeks
2. Disturbance in sleeping pattern related to hypersomnia evidence by stating being over tired, low
mood, want to stay in bed. Patient's sleeping pattern will improve within 1 week
3. Risk for loneliness related to social withdrawal evidence by lack of interest in interacting with
others or pleasure. Patient will participate in the group activities with co–patients within 2 weeks
time
Intervention Rationale
1.
Ensure to set up bathing area– e.g. shower chair
Ensure to assist when patient cannot function

Ensure to encourage patient's independence by keeping aids within easy reach
Consult occupational therapist about appropriate aids
Ensure to maintain nutritional By preventing fatigue and frustration /to allow the patient

Understanding And Changing Behavior And Thinking Patterns
understanding and changing behaviour and thinking patterns. This involves education, relaxation
and controlled exposure to anxiety provoking stimuli. It is used for GAD, social anxiety disorders
with OCD requiring more focused CBT techniques that focus on exposure and response prevention
(ERP). PTSD requires Trauma focused psychological treatments including CBT, ERP and eye
movement desensitization and reprocessing (EMDR) (Sharpiro & Maxfield, 2002). Alternative
treatments may also present in the future with a randomised blind study in Prehospital Transport
Settings showing that ambulance patients who receive auricular acupressure from trained
paramedics "at relaxation points are less anxious, anticipate less pain, and more optimistic about the
outcome of their illness" (Kober et al., 2003).
When looking at drug therapies for the treatment of anxiety in Australia we are confronted with an
overwhelming number of drug treatments ranging from benzodiazepines e.g. midazelam,
temazepam and diazepam for short term management of anxiety disorders, β– adrenoceptor
antagonists (beta blokers), anti convulsants (Lyrica: pregabalin), azapirones (5–HT1A receptor
agonists: buspirone) and long term drug treatment regimes with antidepressants – Selective
Serotonin Reuptake Inhibitors (SSRI's) which act by blocking the reabsorption and reuptake of
serotonin by nerve cells in the brain, leaving more serotonin available improving mood. Serotonin &
norepinephrine reuptake inhibitors (SNRI's)

Analysis Of The Narrator Of Zoloft Announces
"You know when you feel the weight of sadness." The narrator of Zoloft announces. "[Depression] a
serious medical condition that affects over twenty million Americans. While the cause is unknown,
depression may be related to a chemical imbalance between nerve cells and the brain." Each
sentence in this one minute episode is used in a careful way to suck the audience in to buy their
depression saving drug. Zoloft, a company that is advertising the sale of their pill that claims to help
the population feel happier and cope with their depression. It starts off with a simple sketch of a
circle or a ball that appears to be sad and is under a constant storm. It does not seem to be going
away regardless of the fact that the circle sluggishly ... Show more content on Helpwriting.net ...
For example, the announcer says, "You know when you feel the weight of sadness." He does not
specifically say how long and how many times it occurs. The broadness leaves it up in the air for
interpretation; therefore, a person who has experienced sadness for three seconds yesterday could
self–diagnose themselves with depression. Since everyone has experienced sadness before, it
immediately relates to everyone watching while making it personal to them at the same time
because he uses the word "you" ten times in the span of a minute. It makes a large effort to relate to
the largest amount of people possible the commercial can attract a larger amount of potential buyers
and convince doctors. The advertisement even goes as far as to make the main character a
featureless ball. Everything seems extremely bland from the creation of the circle and a single blade
of grass, which makes it open to interpretation as well. The main character is a generic circle that is
mostly associated with a human head. It is raceless, genderless, and ageless; therefore, a person can
look at the ball and compare it to themselves because it is a bland as a stick figure majority have
drawn in the first grade. The audience has the ability to evaluate it any way they wish to make it
more relatable to their specific situation. The more a person feels a connection with something, the
more likely he or she would

Symptoms Chemical Imbalance Of Serotonin And...
17.5 million Americans are diagnosed with clinical depression every year. It 's not "just the blues" or
some "made–up disease" that many people can just get rid of. It affects your moods, thoughts, body,
and behavior. Researchers believe depression is caused by the two naturally occurring chemical
imbalance of serotonin and norepinephrine. These chemicals are located in the brain and body.
Serotonin and norepinephrine are thought to be associated with mood. There are four types of
depression. Those are mild depression, major depression, situational depression, and seasonal
affective depression also known as the "winter blues." It is thought that by the year 2020 depression
will be the second largest killer after heart disease, and studies show that it is a contributing factor to
coronary disease. People who have depression experience some of these signs: sadness all day and
feeling that way every day; Loss of interests or enjoyment in your favorite activities; Feeling
emptiness or hopelessness; Fatigue; Sleeping to much; Change in appetite. Many doctors today are
prescribing thousands of prescriptions in the battle to fight depression. I believe they need to look at
other alternatives to fighting depression first before they so easily reach for that pen and prescription
pad. Some of the drugs used to treat depression are Prozac, Paxil, Zoloft, and Cymbalta. Many of
these drugs have serious side effects and have been linked to suicide, violence, psychosis, abnormal

Estrogen Deprivation Therapy: A Case Study
Management of Side Effects of the androgen deprivation therapy The side–effects of the ADT are
well–known in various studies. As a clinician, it is important to have knowledge regarding the
effective treatment options to treat, prevent, or manage the side effects associated with the ADT.
There are various studies that have identified evidence–based pharmacological and non–
pharmacological interventions used to alleviate the side effects of the ADT (Hutton et al.; 2015;
Kaplan et al., 2011; Ahmadi & Daneshmand, 2013; Rhee et al., 2015; Dueregger et al., 2014;
Grossmann & Zajac, 2011; Millar & Davison, 2012) . The management of side effects due to the
ADT for men with the prostate cancer is discussed below: Hot Flashes The management of hot ...
Currently, the medical castration used as the ADT is one of the treatment option for an advanced and
metastatic prostate cancer. This treatment option has shown to improve the overall rate of survival
among men with prostate cancer, however there are various potential side effects associated with the
ADT. It is important to discuss these potential side effects with the patient prior to initiating the
treatment. There are various studies that have confirmed the use of both pharmacological and
nonpharmacological interventions to mitigate the side effects of the ADT. Therefore, as a provider
the patient who are seeking treatment for the prostate cancer should be fully informed about the side
effects of the ADT, and educate them on the prevention and management of these potential side
effects by implementing up–to–date evidence–based pharmacological and non–pharmacological

Diagnosis : Major Depressive Disorder
This is a 47–year–old male with a 12/15/2005 date of injury. A specific mechanism of injury has not
been described.
DIAGNOSIS: Major depressive disorder, recurrent.
01/11/16 Progress report by the requesting provider documented that the patient was unable to come
to the appointment due to his physical condition and distance. Phone conversation with the patient
was noted. He described his depression s mild. His sleep has been decreased. He uses CPAP
machine. He enjoys being outside. He has occasional feelings of hopelessness. His energy and
concentration have been fair. His appetite has decreased ad he has lost weight. He now weights 207
pounds. He denies any suicidal or homicidal ideation. Plan was to continue Pristiq 100 mg daily for
depression. He also gets Temazepam, methocarbamol muscle relaxants, and Buspar. Patient
education was discussed in detail about medication risks and benefits, adverse effects, side effects
and therapeutic effects.
12/03/15 UDT Report showed that the patient is consistent with the opioids.
10/29/15 Psychological QME indicated that the patient had an injury in December 2005. He noticed
an immediate onset of soreness in the right elbow. He was diagnose dwith right epicondylitis.
According to 10/29/13 report the patient was stable on his current pain medication regimen. He was
having a lot of trouble sleeping. He brought his old sleep medications, including Benzodiazepines,
Trazodone, and Ambien. He had been taking Relpax intermittently for

Depression Treatments: The Use Of Antidepressant Medication
In general, depression can be effectively treated, even in some of the most severe cases. However,
the earlier depression treatments begin, the more effective they are.
The most common depression treatments are medication and psychotherapy. Medications most often
begin with antidepressant medication. Antidepressants primarily work on brain chemicals called
neurotransmitters, especially serotonin and norepinephrine, although there are some antidepressants
that work on the neurotransmitter dopamine. Some of the newest and most popular antidepressants
are called selective serotonin reuptake inhibitors (SSRIs). Fluoxetine (Prozac), sertraline (Zoloft),
escitalopram (Lexapro), paroxetine (Paxil) and citalopram (Celexa) are some of the most common

Cacstromethorphan Case Studies
1.Dextromethorphan is believed to have rapid acting antidepressant properties at high dosage
because it's similar to glutamate NMDA receptor antagonist ketamine, which has shown rapid
(within hours after administration) antidepressant effects. However, ketamine has adverse effects
and a high potential to be abused [16].
2.C. Previous Studies and case reports of with Dextromethorphan/Rationale of Study
Currently, numerous studies are examining the use of Dextromethorphan in the treatment of
neurological and psychiatric disorders because of its' profile and diverse pharmacokinetic and
pharmacologic actions in the central nervous system. Several preclinical, open–label and blinded
clinical trials have shown the clinical and beneficial ... Show more content on Helpwriting.net ...
[18]
A case report showed Dextromethorphan was effective in a middle–aged man with Major
Depressive Disorder. A 51–year–old Caucasian male with DSM–V Major Depressive Disorder,
recurrent, severe, non–psychotic and Generalized Anxiety Disorder was treated with 600 mg/day of
CYP2D6 inhibitor bupropion XL (a common antidepressant drug) and a 60 mg BID oral dose of
Dextromethorphan. The patient showed improvement in major depressive disorder without side
effects. This case study was the first to show the fast acting effect of Dextromethorphan in major
depressive disorder in humans. This adds to the building literature on the antidepressant effects
observed in Dextromethorphan. The report suggested the administration of other common
antidepressants with Dextromethorphan, such as lithium might prolong the duration of the rapid–
antidepressant effect [19].
Although this case report illustrates that Dextromethorphan has rapid antidepressant effects in
humans, there are very few clinical trial on the effect of Dextromethorphan on major depressive
disorder. This clinical trial will be one of very few controlled evaluating the safety and efficacy of
Dextromethorphan in patients with major depressive disorder. Therefore, various assumptions will
be required to estimate sample size. This trial will focus on patient who have

Post-Traumatic Stress Disorder: A Case Study
The claimant testified he has Post–Traumatic Stress Disorder, which cause him to have running
thoughts, lake of sleep, and paranoia. Crowds, smells, loud noises, or perception of things triggers
him. He stated he is hyper–vigilant and watches everything. He also has panic attacks and starts
breathing heavy, sweating, and has a tight feeling in his chest. He has problems sleeping which
interferes with his concentration. In a typical day, he goes up, goes to group counseling, reads, takes
a short walk, and mainly stays to himself. The only household chores he does is clean his room. He
further testified, he has been sober since 2012 but has relapsed three time. However, he went into
treatment the same week he relapsed. The last time

Antidepressants
Biological Treatments for Depression
Antidepressants are a type of medication that is used to treat people with the symptoms of
depression. There are 30 different types of antidepressants available to give patients depending on
their severity of depression.
The aim of antidepressants is to increase the levels of the neurotransmitter which are chemicals, they
are produced in the brain. The antidepressants targets and increases the levels of three types of
neurotransmitters; (A neurotransmitter is a chemical which is released in the brain which allows the
messages to travel.) serotonin (this neurotransmitter regulates the other neurotransmitter) and
noradrenaline (noradrenaline is compulsory for energy, anxiety, alertness and attention to life) and
dopamine (this ... Show more content on Helpwriting.net ...
The neurons communicate by sending electrical impulses called the 'nerve impulse' through the
axon. The pre–synaptic neuron is activated therefore the neurotransmitters at end of the pre–synaptic
neuron release the message into the synapse which activates the receptors on the post–synaptic
neuron.
As mentioned above there are 30 different types of antidepressants below are the most common
types of antidepressants;
Selective serotonin reuptake inhibitors (SSRI) – There are many types of SSRI antidepressants an
example of a SSRI antidepressant is Fluoxetine is the well–known SSRI, this antidepressant is sold
under the brand named Prozac.
Serotonin–noradrenaline reuptake inhibitors (SNRI) – Duloxetine, this medication is sold under the
brand named Cymbalta also Venlafaxine is sold under the brand named Efexor
Noradrenaline and specific serotonergic antidepressants (NASSA) – the main type of this
antidepressant that is given in UK is mirtazapine, this medication is sold under the brand named

Citalopram Case Study
Question: What are the possible complications for an adult AAM who has been diagnosed with
depression and is also taking Citalopram and Trazadone every night?
Background: WJ is an African American male with depression, and chronic pain. Due to a tragic car
accident, he is now permanently in a wheelchair. The patient has been taking 20 mg of citalopram
and 50 mg of trazodone every night and has heard about possible complications from taking these
medications together. The patient wants to know if there is any truth to this and what potential issues
can arise. Information: Depression is much more than a momentary case of the blues. It is an
ongoing problem that can considerably impair a person's conduct, judgments, daily activities, ...
Citalopram, which was one of the first selective serotonin reuptake inhibitors approved by the Food
and Drug Administration, is one of the antidepressant drugs that clinicians prescribe for routine
generalized depression.3 "Thirty–seven trials compared citalopram with other antidepressants (such
as tricyclics, heterocyclics, SSRIs and other antidepressants, either conventional ones, such as
mirtazapine, venlafaxine and reboxetine, or non–conventional, like hypericum). Citalopram was
shown to be significantly less effective than escitalopram in achieving acute response (odds ratio
(OR) 1.47, 95% confidence interval (CI) 1.08 to 2.02), but more effective than paroxetine (OR 0.65,
95% CI 0.44 to 0.96) and reboxetine (OR 0.63, 95% CI 0.43 to 0.91). Significantly fewer patients
allocated to citalopram withdrew from trials due to adverse events compared with patients allocated
to tricyclics (OR 0.54, 95% CI 0.38 to 0.78) and fewer patients allocated to citalopram reported at
least one side effect than reboxetine or venlafaxine (OR 0.64, 95% CI 0.42 to 0.97 and OR 0.46,
95% CI 0.24 to 0.88, respectively)."4 Citalopram is a great drug choice for depression due to its low
cost, good efficacy, and reduction of the amount of side effects. 4, 8 Trazodone effects are does
dependent, depending upon what it is going to be used for.

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