Your client is Allen, a 27 year-old investment advisor with a large insurance firm. Allen has been diagnosed four months ago with major depression and anxiety disorder NOS. He also has essential hypertension that he controls through exercise, diet and a low dose of a beta-blocker. Neither the hypertension or beta-blocker is believed to contribute to his anxiety or depression. His anxiety is correlated with obsessions about his job. His work is stressful, as it is commission only. The commissions can be substantial when he is successful but there are no guarantees. Colloquially he manifests mixed anxiety and depression. He was started on paroxetine 20 mg. once a day. After 2 months he was experiencing relief from his symptoms but is becoming quite bothered and embarrassed by impotence and delayed ejaculation. He wonders if he should consult again with the psychiatrist and if there is anything that can be done for this. He hesitates to go back to the psychiatrist because of the co-pay and he is not sure if his problem can be solved.
What would you tell Allen about his current problem?
Describe at least two medication strategies a psychiatrist may try with Allen to correct the problem.
In addressing this problem with Allen, what medications may require at least temporary monitoring of his blood pressure?
Of the options listed in #2, pick one and note what you would tell Allen about the side effects likely in that option.
