Case Study
Case presentation
A 38-year-old male patient presented with symptoms of anxiety and comorbid depression.
The patient had a 5-month history of anxiety and depressive symptoms.
Medical history
- Persistent feelings of restlessness, irritability, difficulty concentrating, agitation, sleep disturbance.
- Depressed following his divorce 6 months ago.
- No history of either substance use or alcohol intake.
Family psychiatric history:
He had a familial background of anxiety issues, with his mother been diagnosed with obsessive-compulsive disorder.
Physical examination
Vital parameters :
| Body mass index | 25.5 kg/m2 |
| Blood pressure | 118/78 Hg |
| Oxygen saturation | 99% |
| Pulse rate | 98 beats/minute |
Investigations
Blood work-up
| Complete blood count | All components in normal range |
| Random glucose level | 140 mg/dL |
| Arterial blood gas analysis | All components in normal range |
| Thyroid function tests | All components in normal range |
| Renal function test | All components in normal range |
Imaging analysis
| Electrocardiogram | Normal |
| Peak flowmetry | 500 L/min |
Mental Assessment
Questionnaire Score:
Hamilton Anxiety Rating Scale (HAM-A) is 31
Hamilton Depression Rating Scale (HAM-D) is 25
Confirmed diagnosis: Anxiety disorder with comorbid depression.
Treatment: SSRIs and BZD for 8 weeks
Follow-up after 8 weeks: Symptoms resolved almost completely after 8 weeks.
Combining a BZD with an SSRI can offer faster relief from anxiety symptoms, mitigate SSRI-induced anxiety, and enhance patient adherence to antidepressant therapy, thereby, making it a valuable option for individuals with comorbid anxiety and depression.
References:
- Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017;19(2):93-107.
- Dunlop BW, Davis PG. Combination treatment with benzodiazepines and SSRIs for comorbid anxiety and depression: a review. Prim Care Companion J Clin Psychiatry. 2008;10(3):222-8.
- Espiridion ED, Fuchs A, Oladunjoye AO. Illness anxiety disorder: A case report and brief review of the literature. Cureus. 2021;13(1).
- Raju NN, Kumar KS, Nihal G. Clinical Practice Guidelines for Assessment and Management of Anxiety and Panic Disorders in Emergency Setting. Indian Journal of Psychiatry. 2023;65(2):181.
- Chojnacki C, Popławski T, Konrad P, et al. Antimicrobial treatment improves tryptophan metabolism and mood of patients with small intestinal bacterial overgrowth. Nutrition & Metabolism. 2022;19(1):66.
- Bushnell GA, Rynn MA, Crystal S, et al. Simultaneous benzodiazepine and SSRI initiation in young people with anxiety disorders. The Journal of Clinical Psychiatry. 2021;82(6):37519.
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