Ima Jitters is a high functioning, 24-year-old female graduate education student, with complaints of sweating, heart racing, stuttering, and a sensation of throat-tightening only when she presents to her peers at school once every month. She calmly expresses concerns over taking any medication that might make her gain weight and has previously taken Paxil and Zoloft, which she stopped due to feeling “very manic” on the medications. Her vitals are stable, but she has a history of bradycardia with an in-office heart rate of 54. She has a penicillin allergy and is up to date on vaccinations. Family history includes a mother with depression and GERD and a father with hypertension. Ima Jitters is alert and oriented to person, place and time and …show more content…
Symptoms of anxiety such as stuttering, sweating, palpitations, and dry throat occurs due to exposure to these types of social situations that one fears. Considered the first line drug, SSRIs can greatly benefit patients who have fears for multiple situations and face those situations on a regular base (). But, Ima reports only having symptoms once every month at her presentation. She does not want to take any medication that might make her gain weight and has previously tried Paxil and Zoloft and experienced unwanted symptoms of feeling “very manic.” SSRIs take weeks to take effect and treatment last at least a year until the initiation of gradual withdrawal can start, but relapse is common with the withdrawal of SSRIs (). When taken one to two hours before the scheduled performance to help patients with performance anxiety, propranolol and other beta blockers can reduce autonomic hyperactivity symptoms such as palpitations, tachycardia, tremors, and sweating (). Since Ima has a history of bradycardia and current heart rate of 54, she is not a candidate for beta blocker treatment. Due to these reasons, a SSRI or a beta blocker is not the best treatment option for