What approach can be taken to improve symptoms of anxiety and depression in a 28-year-old male patient with a history of prediabetes, overweight, and current medications including metformin (Metformin) 500mg twice a day, Phentermine HCl (Phentermine) 37.5mg daily, tadalafil (Tadalafil) for erectile dysfunction (ED), and fluoxetine (Fluoxetine), who also uses nicotine daily through vaping?

From the Research

To improve this patient's symptoms of anxiety and depression, I recommend a comprehensive approach addressing both pharmacological and lifestyle factors, prioritizing the most recent and highest quality evidence from the 2023 study 1 and 2024 review 2. First, the patient should be evaluated by a psychiatrist for proper diagnosis and treatment of his anxiety and depression, potentially with an SSRI like sertraline 50mg daily, which can be titrated as needed, as suggested by the 2024 review 2. Phentermine should be discontinued as it can worsen anxiety symptoms and has cardiovascular risks. The patient should also discontinue fluoxetine used for sexual stamina, as off-label use can contribute to his psychiatric symptoms. Nicotine cessation is strongly recommended, as vaping can exacerbate anxiety; nicotine replacement therapy or medications like bupropion could assist with quitting. Regular exercise (30 minutes of moderate activity 5 days weekly) would benefit both his mental health and prediabetes, as exercise is known to have a positive impact on mental health and metabolic conditions. Sleep hygiene practices should be implemented, including consistent sleep-wake times and avoiding screens before bed. Given the noninferiority of mindfulness-based stress reduction (MBSR) to escitalopram found in the 2023 study 1, MBSR or cognitive behavioral therapy could provide coping strategies for anxiety and depression, offering a valuable adjunct or alternative to pharmacotherapy. These interventions address the underlying causes of his symptoms while managing his existing health conditions and reducing potentially harmful substance use, aligning with the principles outlined in the 2021 Lancet article on anxiety disorders 3.

Some key points to consider:

• The patient's current medications and lifestyle factors may be exacerbating his anxiety and depression.
• A comprehensive approach including pharmacological, psychological, and lifestyle interventions is likely to be most effective.
• Regular follow-up and monitoring of symptoms and treatment response are crucial for adjusting the treatment plan as needed.
• The patient's prediabetes and overweight status should be managed concurrently, as these conditions can impact mental health and vice versa.
• The most recent and highest quality evidence supports the use of SSRIs, cognitive behavioral therapy, and MBSR as effective treatments for anxiety and depression, as discussed in the 2023 study 1 and 2024 review 2.