Ivy, age 23, is a white woman who graduated from college last year. She began working as an accountant one month after graduating. Approximately two months ago, she moved into a two-bedroom apartment with another woman who works at the same accounting firm. She states that her roommate recommended that she sees a doctor to find out if she has anemia or “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past nine months. She becomes easily fatigued and irritable and has difficulty concentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent. 

She reports that all her life she had good grades in school and was very successful in everything she attempted. Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” Ivy reports that she has a good relationship with her boyfriend, but they do not get to see each other very often because he is attending graduate school 100 miles away. She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance. She reports that she has always been healthy and has taken good care of herself. The only medication she takes is birth control pills, which she has taken for the past four years without any adverse effects.

Diagnosis: Generalized Anxiety Disorder

1. List specific treatment goals for Ivy.

2. What drug therapy would you prescribe? Why?

3. What are the parameters for monitoring the success of the therapy?

4. Describe specific patient monitoring based on the prescribed therapy.

5. List one or two adverse reactions for the selected agent that would cause you to change therapy.

6. What would be the choice for second-line therapy?

7. What dietary and lifestyle changes should be recommended for this patient?

8. Describe one or two drug–drug or drug–food interactions for the selected agent.