Assessing and Treating Pediatric Patients With Mood Disorders Assignment

Assessing and Treating Pediatric Patients With Mood Disorders Assignment

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

Assessing and Treating Pediatric Patients with Mood Disorders

Depression is a major psychiatric disorder affecting a significant number of children and adolescents in the United States. The major depressive disorder was found to affect about 5% and 17% of children and adolescents in 2016 (Selph & McDonagh, 2019) Assessing and Treating Pediatric Patients With Mood Disorders Assignment . The process of assessing, diagnosing, and treating children with mood disorders is quite complex compared to adults. This is because the signs and symptoms of mood disorders differ in children compared to adults. The process of drug metabolism is significantly different. However, the same pharmacological interventions for mood disorders may be used for children and adults. Therefore, nurse practitioners must be cautious when prescribing psychotropic medications to these patients. The aim of this essay is to examine a case study of a child with a depressive disorder and how to consider three choices for treating the patient.

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Background Information of the Case

The client in this scenario is an African American male child aged eight years and arrives at the emergency room accompanied by his mother. The patient exhibits signs of depression. He complains of feelings of sadness, and the mother reports that the teacher said the child is withdrawn from peers in class. The mother notes reduced appetite and occasional periods of irritability in the patient. The patient has reached all the developmental landmarks at the appropriate ages. However, the physical examination is remarkable. Upon investigation, the laboratory studies are within the normal ranges. The child is referred for psychiatric evaluation and is seen by a Psychiatric Nurse Practitioner.

Mental status examination shows that the patient is alert and oriented X3. He has a clear and coherent speech; he is goal-oriented and spontaneous. The self-reported mood is sad, and the effect is somehow blunted. He smiles appropriately at various points of the clinical interview. However, the patient denies any visual or auditory hallucinations. No delusional or paranoid thoughts were noted. His judgment and insight are appropriate for his age. Although he has active suicidal ideation, he admits that he often thinks of himself being dead and how it would look. After the administration of the Children’s Depression Rating Scale, the child scores 30, which is indicative of significant depression Assessing and Treating Pediatric Patients With Mood Disorders Assignment .

Decision #1; Start with Zoloft 25 mg orally daily

The first choice of treatment for the patient, in this case, is Zoloft 25 mg. Zoloft (Sertraline) is a serotonin reuptake inhibitor which had demonstrated effectiveness, safety, and tolerability in the treatment of adults with major depressive disorder. Although few studies have been carried out to evaluate the effects of SSRIs in children and adolescents, a significant number of research demonstrate improved symptoms of children with the major depressive disorder when compared to placebo (Sharmi 2018). Sertraline improved the symptoms of children with depression compared to placebo over a period of ten weeks (Liu et al., 2021). Despite the adverse side effects that occurred after sertraline use, Sertraline is recommended for short-term treatment of depression in depressed children and adolescents (Sharmi 2018). In this case, after treating the patient with Zoloft 25 mg OD, the patient returned to the clinic after four weeks with a slight increase in mood, no HAM-D results, and no reported adverse events. Thus, it is ethically acceptable to continue with Zoloft since there are slight improvements and no adverse reactions are reported.

Moreover, since FDA- evaluations on the safety of Paxil are not yet completed, FDA recommends that Paxil should not be used in the treatment of children and adolescents with major depressive disorder. Further, although Wellbutrin may be effective in the treatment of MDD and ADD, it has not been shown to be effective in the treatment of patients under the age of eighteen years old. Besides, there is no approved dosage of Wellbutrin for children by the FDA Assessing and Treating Pediatric Patients With Mood Disorders Assignment . While making the treatment decisions, the main focus is on the effectiveness and safety of the patient. Patient safety is a key issue of concern in healthcare settings. Ensuring patient safety helps in the prevention and minimization of injuries and adverse reactions which may risk the health of the patient or even cause death. Effective communication with the patient is crucial to establish rapport with the patient and explain the benefits and risks of the treatment. It helps in medication adherence, thus, improving the outcomes of the treatment.

Decision #2; Increase Zoloft dose to 50 mg orally daily

The reason for choosing this decision is that, after the patient returns to the clinic after four weeks, the depressive symptoms have significantly improved by 50%, and the client is tolerating the medication well. 50 mg per day Sertraline was found to be an effective and tolerable therapeutic dose for treating individuals with depressive symptoms. The second choice of medication depends on the effectiveness of the drug in improving depressive symptoms. I did not choose to increase the dose to 37.5 mg orally daily because only a small change in symptoms (20%) was noted. At this point, sufficient symptom reduction was not achieved. The choice is either to increase the Zoloft dose or consider another SSRI. Evidence suggests that by eight weeks post-initiation of therapy, the symptoms of the disease should significantly decrease by 50% for the antidepressant to be considered appropriate and effective (Zhou et al., 2020). Besides, changing Zoloft to Prozac 10 mg orally daily would not be effective for the patient since after the client returns after four weeks, there are no changes in symptoms at all. Therefore, the best option would be to increase the Zoloft dose to 50 mg orally daily due to symptoms improvement by 50% and without any adverse reactions reported. The main consideration while making the decision is the degree of symptom improvement and side effects. Although no adverse events are reported, Zoloft 50 mg orally daily works the most effective for the patient. The ethical decision aims at improving the patients’ quality of life and ensuring the effectiveness and safety of the medication.

Assessing and Treating Pediatric Patients With Mood Disorders Assignment  Decision #3; Increase Zoloft Dose to 75 mg Orally Daily

The main reason for choosing this decision is because sufficient symptom is achieved, is considered a response therapy. Therapy effectiveness and safety are the main focus when treating individuals with psychiatric disorders. The main goal of the treatment is to alleviate the symptoms of the conditions while ensuring the safety of the patient and achieving desirable therapy outcomes (Anvari et al., 2020). Although maintaining the current dose of Zoloft leads to sufficient symptom reduction, this would not be considered a full response therapy when the symptoms are reduced by 50% or more on the HAM-D. Therefore, this should not be confused with full symptom resolution, which should be achieved by 100% symptom reduction as measured on the HAM-D. Thus, continuing with the current dose would reset the full assessment of therapy efficacy. Besides, there is no indication that the patient should change from SSRI to SNRI at this point since the patient is clearly responding to the Zoloft therapy. At this point, the decision is guided by full resolution of the depressive symptoms and if there is an indication for changing therapy to SNRI. The patient should continue with Zoloft 75 mg orally daily and be reassessed after four weeks to monitor any further reduction of symptoms. An increase of the dose of warranted since the patient has not reached full remission. However, effective communication between the psychiatrist and the patient is key at this point. It would be ethical to explain to the patient the pros and cons of increasing the Zoloft dose at this time. This empowers the patient to be part of the decision-making concerning his health. However, since the patient is a child, informed consent should be sought from the mother.

Conclusion

The case involves a child aged eight years who presents to the emergency department with depressive symptoms. The choices for treating the patient depend on the effectiveness, safety, and tolerability of the therapy. Zoloft is the first choice for treating the patient since it has been approved by the FDA for the treatment of mood disorders in the pediatric population due to its effectiveness and safety. However, the start dose should be low to avoid any adverse events of the medication. After giving Zoloft 25 mg orally daily, there is a significant improvement of depressive symptoms, and no adverse reactions are reported. Thus, the next option is to step up the Zoloft dose to 50 mg. At this point, the patient is tolerating the dose, and the symptoms improve by 50%. This indicates that the patient is responding to the therapy effectively without any side effects. However, further dose increment may be warranted to achieve full remission of symptoms Assessing and Treating Pediatric Patients With Mood Disorders Assignment . Thus, the third decision would be to increase the Zoloft dose from 50 mg orally daily to 75 mg orally daily and monitor the patient for full remission of the depressive symptoms.

References

Anvari, A. A., Carroll, M. P., & Klein, D. A. (2020). Primary Care Clinicians Can Effectively Treat Depression in Children and Adolescents. American Family Physician, 102(4), 198-199.

Liu, W., Li, G., Wang, C., Wang, X., & Yang, L. (2021). Efficacy of Sertraline Combined with Cognitive Behavioral Therapy for Adolescent Depression: A Systematic Review and Meta-Analysis. Computational and Mathematical Methods in Medicine, 2021.

Selph, S., & McDonagh, M. S. (2019). Depression in children and adolescents: Evaluation and treatment. American family physician, 100(10), 609-617.

Sharmi, V. J. (2018). A prospective randomised open-label comparative study of efficacy and safety of escitalopram versus Sertraline in major depressive disorder in a tertiary care hospital (Doctoral dissertation, Chengalpattu Medical College, Chengalpattu).

Zhou, X., Teng, T., Zhang, Y., Del Giovane, C., Furukawa, T. A., Weisz, J. R., … & Xie, P. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis. The Lancet Psychiatry, 7(7), 581-601  Assessing and Treating Pediatric Patients With Mood Disorders Assignment .