Decision Steps based on Patient Factors
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The patient was initially begun on 50 mg of Zoloft orally. Zoloft, a Selective Serotonin Reuptake Inhibitor (SSRI), is among the first lines for treating GAD alongside SNRIs, benzodiazepines, α2δ ligands, and buspirone. SSRIs have shown better and faster responses than serotonin-norepinephrine reuptake inhibitors (SNRIs). While imipramine, a tricyclic antidepressant, is also effective as an anxiolytic, it has adverse effects like cardiac arrhythmias, extrapyramidal symptoms, and so forth (Newman et al., 2017). It is also a sedative; hence may worsen sedative effects in someone taking alcohol and even promote suicidal ideation. Buspirone has no immediate anxiolytic effects as it takes 2 to 4 weeks for the onset of action and is typically administered to augment the actions of SSRIs and SNRIs. The client returns to the clinic in four weeks with reduced symptoms and a HAM-A of 18, down from 26. Also, there are no reported side effects.
For the second decision point, I decided to up the dosage of Zoloft to 75 mg since the patient experienced no side effects from the medication. The choice was to increase to 75 and not 100 to monitor response and avoid side effects. The goal was to lower the HAM-A score by lowering his anxiety levels even more. Four weeks later, the client presented a further reduction in anxiety levels with a HAM-A of 10. His symptoms had reduced by 61%. This indicated good response and tolerance to the medication at the prescribed dose.
The client was showing good tolerance and response at 75mg of Zoloft. The decision at this point was to maintain the treatment at the same dose rather than increase and risk causing side effects that might impact adherence. Buspirone would have been added as an augmentation had the patient failed to respond to treatment. The expectation is that in 12 weeks, we would expect further improvement.
Pharmacotherapeutics
Sertraline is an SSRI which means that it blocks the uptake of serotonin at the neuron junction. The neurotransmitter accumulates, facilitating transmission that ensures appropriate emotions and helps reduce anxiety levels. The medication is well tolerated and appropriate, particularly for this individual, given his history of alcohol abuse, as it has no sedative effects.