Explain the appropriate drug therapy for a patient who presents with MDD and a history of alcohol abuse. Which drugs are contraindicated, if any, and why?

Major Depressive Disorder (MDD) is a psychological disorder that affects an individual’s mood and emotional state. It is usually characterized by feelings of sadness, emptiness, worthlessness and hopelessness that become persistent over time. For a patient who presents with MDD and a history of alcohol abuse, the appropriate drug therapy is determined by the degree of severity of the symptoms, any co-occurring mental health or medical conditions, as well as any potential for substance abuse or addiction (Mental Health America). The most widely used class of drugs to treat MDD include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants (TCAs).

Selective serotonin reuptake inhibitors are generally recommended as first line treatment for patients with moderate to severe MDD. These drugs work by increasing levels of serotonin in the brain which can help relieve symptoms such as lack of energy and concentration difficulties. Common SSRIs prescribed to treat depression include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft)