Rheumatoid arthritis is an auto-immune illness that affects the immune system of the infected, thus leading the body’s defense system to attack the patient’s joints accidentally. A 54-year old patient suffering from Rheumatoid arthritis is likely to suffer from both physical and psychological disorder caused by RA. Patients diagnosed with Rheumatoid arthritis, are likely to experience pains in the joints and further suffer from anxiety, depression, and mood changes. Chronic pains caused by RA mental disorders, hence causing the patient to suffer from stress. As a result, stress leads to the release of chemicals that cause changes in a patient’s mood making it hard to sleep. Subsequently, lack of enough sleep leads to fatigue, which explains why Angela always feels fatigued. In addition to that, this intensifies the pain, making it hard to manage the pain.
Medication prescription
Therefore, it is important to address mental health conditions for people suffering from RA. Hence, I would prescribe four types antidepressants for Angela. These drugs help in regulating and blocking brain chemicals that are released by stress. These antidepressants include of SSRIs, that is, selective serotonin reuptake inhibitors. The drugs under SSRIS comprise of sertraline, fluoxetine, escitalopram, and paroxetine. The other type of depressants, which I would recommend for use are SNRIs. They are also called the serotonin-norepinephrine reuptake inhibitors. The drugs under this type of antidepressant include milnacipran, duloxetine, desvenlafaxine, and venlafaxine. The third type of depressants comprise of Tricylic antidepressants, which comprise of Amitriptyline (Andersen, 2013). The final prescription would comprise of norepinephrine-dopamine reuptake inhibitors. These four types of depressants not only apply in the treatment of depression, but also in the relief of chronic pain and help in promoting sleep (Andersen, 2013).
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Response and problems associated to treatment
Nevertheless, the antidepressants prescribed above tend to have varying side effects, which range from fatigue, nauseous, dizziness, constipation, dry mouth, sexual dysfunction, and headaches (Santiago & Geenen, 2015). Hence, Angela may fail to recognize any changes in her mood. In addition, the antidepressants may not turn out to be effective in reducing depression and anxiety. Further, they are likely to lead to weight gain, and increasing the level of serotonin. This causes an imbalance in brain serotonin, hence, interfering with the body functionality. However, the antidepressants may not take effect immediately. Therefore, it is advisable that Angela accompanies the use of the antidepressants with drugs such as opioids, which assist in relieving pain and stiffness. As a result, this will help in improving the patient’s strength and ability to move. In addition, I would recommend that Angela accompany the use of antidepressants with muscle relaxants. These are also aimed at improving pain and thereafter lead to mood improvement.
Period for treatment regimen
Hence, in order for the antidepressants to take effect, it is advisable that Angela takes the prescription on a daily basis. The objective for taking the antidepressant for the first few weeks is to help in relieving symptoms for RA and improve on depression, anxiety, and mood changes. Once this has been achieved, the patient should continue with the therapy for not less than four to nine months, in order to prevent the symptoms from recurring (Singh, Saag, Bridges& Akl, 2015). Moreover, the medication could be taken for a longer period in order to reduce the risk of relapse. Further, during the treatment period, there should be regular appointments with the doctor in order to make a follow up on the improvement of symptoms. Further, in case of adverse side effects, the dosage should be adjusted accordingly. The patient should neither increase nor reduce the dose on her own. Towards the final weeks of treatment, the dosage should reduce gradually. During this period, the patient is likely to suffer from restlessness, nausea, and temporary sleep issues.
References
Andersen, L. (2013). Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain . Pittsburgh: Two North Books.
Santiago, T. & Geenen, R. (2015). Psychological Factors Associated with Response to Treatment in Rheumatoid Arthritis. Current Pharmaceutical Design , 21, 257-269.
Singh, J. A., Saag, K. G., Bridges, S. L. & Akl, E. A. (2015). 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Journal of The American College of Rheumatology , 68, 1-26.
