Therapy for Patients With Major Depressive Disorder Essay Assignment

, ,

Therapy for Patients With Major Depressive Disorder Essay Assignment

Introduction to the case

This case study involves an 8-year-old African American child suffering from depression. He reported to E.R. with his mother while exhibiting signs of depression. He appeared sad. The mother said that her son is withdrawn from peers in class, has decreased appetite, and has occasional episodes of feeling irritated. Upon assessment of data and physical examination, the child had normal developmental milestones, a remarkable physical exam, and lab results were WNL. The child was seen by a psychiatric nurse and referred for physiatry evaluation. Therapy for Patients With Major Depressive Disorder Essay Assignment

ORDER HERE A PLAGIARISM-FREE PAPER

This paper explores the assessment and management of a child with depression. Three decisions regarding the medication to factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes shall be discussed. A child exposed to recent undesirable life events should be assessed for symptoms and risk factors for depression. The assessment should consider the potential child maltreatment, self-harm, and history of alcohol and drug (Lawton & Moghraby, 2016). Depressive disorders are frequent, chronic and recurrent, and chronic and need management. Depression in children contributes to other problems such as personal distress, reduced friends and sources of support, emerging somatic symptoms such as stomachaches and headaches, dwindling educational and job opportunities, an elevated five-fold risk of suicide attempts, reduced social functioning, declining school performance (Dawson,2018)Therapy for Patients With Major Depressive Disorder Essay Assignment. Symptomatic review and current drug targets depression severity, such as suicidal tendencies (Kupfer,2022). The focus of treatment is the rapid resolution of depression during an acute phase, followed by continuation. Maintenance therapy is needed when the exposure to recurrence is high (Kupfer,2022). Depression medications are used based on the benefit/risk ratio. Depression affects all ages, but contestation exists in the context of the children population. Interpersonal therapy works to resolve interpersonal problems may cause.

Decision 1: prescribe Sertraline

Sertraline (Zoloft) can be started at 25 mg daily and increased to 37.5 mg., then 50mg as a maintenance dose. Its age-related aspect is that 25–200 mg daily of Sertraline is recommended for children and adolescents (Tini et al.,2022)Therapy for Patients With Major Depressive Disorder Essay Assignment. Depressive symptoms will reduce by 50%, and the client will tolerate them well. With the achievement of a 50 % symptomatic reduction in depression, Sertraline (Zoloft) 50 maintenance dose would consider the best option but can be altered if no changes after four weeks or if the client reports the need for a different drug, such as Prozac.

Paxil 10 mg orally daily is not recommended based on its pronounced side effects such as nausea, vomiting, and diarrhea. Equally, Wellbutrin 75 mg orally BID has not been considered the best decision due to the influence of Wellbutrin on sleep patterns. It is expected that Zoloft will slightly enhance mood, have no adverse events reported, and the client will return to the clinic after four weeks. The ethical consideration involves seeking consent from the client and ensuring engaging communication between the client, provider, and caregiver. Studies show that Sertraline is an effective antidepressant among children. Sertraline can be combined with non-pharmacological interventions such as counseling and cognitive behavioral therapy to optimize outcomes.

According to Melton et al. (2016), Sertraline substantially enhances depressive symptoms compared with placebo. Sertraline is an antidepressant. It acts by primarily inhibiting presynaptic serotonin reuptake, thus, leading to increased accumulation of serotonin. Serotonin regulates mood, personality, and wakefulness; thus, it can help in reducing symptoms of depression. Therapy for Patients With Major Depressive Disorder Essay Assignment

Sertraline is SSRI. However, despite its prevalent use and clinical benefits, the pharmacokinetics, efficacy, pharmacodynamics, and tolerability of Sertraline in children are not fully understood. It is a well-tolerated short-term treatment for children with depression and mood-related disorders. However, it should be monitored for adverse effects. Sertraline-induced adverse outcomes include Stevens-Johnson Syndrome and reversible hepatic injury, and toxic epidermal necrolysis (Huddart et al.,2020). Other adverse outcomes that should be monitored include syncope, lightheadedness, diarrhea, sweating, nausea, dizziness, xerostomia, hallucinations, confusion tremor, somnolence, fatigue, and rhinitis .When compared to other medications such as Venlafaxine and paroxetine that increase the risk of suicidal behavior/ideation, Sertraline could reduce such risks (Boaden et al.,2020). Sertraline is linked to first-pass metabolism. Sertraline is better tolerated than monoamine oxidase inhibitors or tricyclic antidepressants. It is metabolized to N-desmethyl sertraline, where multiple cytochrome P450 (CYP) mediates its biotransformation. Sertraline is gradually absorbed, with peak concentrations happening between 4–10 hours, and taking Sertraline with food may raise the peak concentration (Huddart et al.,2020)Therapy for Patients With Major Depressive Disorder Essay Assignment.

Decision 2: prescribe Fluoxetine

If there the eight-year-old American boy returns to the clinic in four weeks with no change at all in symptoms, the medication can be changed to Prozac (fluoxetine)10mg orally. 10 mg of fluoxetine a day in the morning can be started and adjusted to 20 mg daily. 20 mg P.O. daily of fluoxetine dose as a maintenance dose can delay the time of relapse of depressive symptoms. The client is now on a sub-therapeutic dose of Prozac- a low regimen suitable up the first week of therapy to minimize side effects. This dosage will be changed to 20 mg orally so that a therapeutic dose is achieved. Therefore, increasing to 20 mg orally daily is appropriate. At this stage, there is no indication to change to another SSRI or SNRI. This reason results from the fact that the client has had no adequate trial of this medication at a therapeutic dose. Thus, the client in this case study should stick with one antidepressant for adequate therapy at optimized dosing Therapy for Patients With Major Depressive Disorder Essay Assignment.

However, if a satisfactory response has not been achieved or maintained, the dosing regimen can be reviewed. The decision, in this case, involves client’s return to the clinic in four weeks, feeling a little bit better and depressive symptoms declining by 20%. One of the most frequent treatments that are used to manage depression in children and adults is fluoxetine. Fluoxetine belongs to the selective serotonin reuptake inhibitors (SSRIs) class. The use of antidepressants in children and adolescents has raised uncertainties about the safety and efficacy of these antidepressant medications. Fluoxetine and escitalopram are the primary antidepressants that are approved by the U.S. FDA for treating depression in children and adolescents.

Fluoxetine can be used by children above eight years, such as the one in this case. SSRIs such as Fluoxetine may improve response and functional status. However, SSRIs are linked to a higher risk of serious adverse events and an increased risk of withdrawal. FDA has cautioned against the potential risk of arrhythmias, such as Q.T. interval prolongation and ventricular arrhythmia associated with the use of fluoxetine. Patients with existing cardiovascular conditions hypomagnesemia, hypokalemia, or who show an increased risk of prolonged Q.T. interval should be discouraged from using fluoxetine. Any medication that prolongs Q.T. interval will negate the potential use of fluoxetine. Furthermore, fluoxetine should be applied with caution in children/patients with recent myocardial infarctions/ congenital long Q.T. syndrome /uncompensated heart failure, hypokalemia, bradycardia, or hypomagnesemia. Therapy for Patients With Major Depressive Disorder Essay Assignment

Decision 3: No change of medication

Since sufficient symptom reduction has been achieved as a “response” to therapy, the client will continue with the current therapy. Discussing the benefits and risks of increasing drug doses will be important. Thus, there is a need to empower the client to be part of the decision. Changing therapy to SNRI is unwarranted. The client in this case study should stick with one antidepressant for adequate therapy at optimized dosing, which is either a 20mg maintenance dose of Prozac or Zoloft 50mg daily. The evidenced-based practice supports interventions that combine cognitive-behavioral therapy (CBT), counseling, and pharmacotherapy, such as maintenance therapy of Prozac as a multifaceted approach to holistic management of depression not only in adults but also in children (Rao, 2013).

ORDER HERE

It is essential to assess each medication and balance the pros and cons while examining its safety and efficacy standards. In the increasingly growing evidence-based practice, health practitioners must carefully assess the risk and benefits of using psychological and pharmacological therapies in children while resolving grave concerns of overdiagnosis and overtreatment (Magellan Health,2013)Therapy for Patients With Major Depressive Disorder Essay Assignment. The ethical consideration involves seeking consent from the client and ensuring engaging communication between the client, provider, and caregiver.

Conclusion

Management of depression across all age groups requires a multifaceted approach. Both non-pharmacological and pharmacological psychotherapy is needed to manage depression. However, in the case of children, caution must be held to reduce the risk of adverse effects and to improve outcomes through adopting interventional options that have optimal efficacy and safety.

Treatment is designed to resolve a patient’s interpersonal problems to enhance interpersonal functioning and mood by allowing Patients to identify interpersonal problem areas and modifying communication patterns. Regular telephone calls, supportive problem-based counseling visits, and face-to-face visits are some of the non-pharmacological approaches to managing depression amongst children and adults. When psychotic symptoms or suicidal intent is present, fluoxetine remains the single best intervention, with fluoxetine plus CBT as an optimal approach. Psychotherapy may not be adequate to mitigate the emotional difficulties that some patients face, which necessitates psychopharmacologic intervention. Thus, more often, a multifaced approach is required to manage depression. Healthcare practitioners are expected to adopt various principles to ensure the effective use of pharmacotherapies. Before starting pharmacotherapy, a psychiatric evaluation is completed, a medical history is obtained, medical evaluation is considered when appropriate, plus effective communication with other professionals. It also involves developing a psychosocial and Psychopharmacological treatment plan based on EBP, proper monitoring plan, documentation, and follow-ups Therapy for Patients With Major Depressive Disorder Essay Assignment.

References

Boaden, K., Tomlinson, A., Cortese, S., & Cipriani, A. (2020). Antidepressants in children and adolescents: meta-review of efficacy, tolerability and suicidality in acute treatment. Frontiers in psychiatry, 717.

Dawson, R. S. (2018). Depression in children and adolescents: the pediatrician at the front lines. Pediatric annals, 47(7), e261-e265.

Huddart, R., Hicks, J. K., Ramsey, L. B., Strawn, J. R., Smith, D. M., Bobonis Babilonia, M., Altman, R. B., & Klein, T. E. (2020). PharmGKB summary: sertraline pathway, pharmacokinetics. Pharmacogenetics and genomics, 30(2), 26–33. https://doi.org/10.1097/FPC.0000000000000392 Therapy for Patients With Major Depressive Disorder Essay Assignment

Lawton, A., & Moghraby, O. S. (2016). Depression in children and young people: identification and management in primary, community and secondary care (NICE guideline CG28). Archives of Disease in Childhood-Education and Practice, 101(4), 206-209.

Kupfer, D. J. (2022). The pharmacological management of depression. Dialogues in clinical neuroscience.

Melton, T. H., Croarkin, P. E., Strawn, J. R., & Mcclintock, S. M. (2016). Comorbid anxiety and depressive symptoms in children and adolescents: a systematic review and analysis. Journal of psychiatric practice, 22(2), 84.

Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. https://doi.org/10.1002/da.22171

Tini, E., Smigielski, L., Romanos, M., Wewetzer, C., Karwautz, A., Reitzle, K., … & Walitza, S. (2022). Therapeutic drug monitoring of sertraline in children and adolescents: A naturalistic study with insights into the clinical response and treatment of obsessive-compulsive disorder. Comprehensive psychiatry, 115, 152301.

Sukhatme, V. P., Reiersen, A. M., Vayttaden, S. J., & Sukhatme, V. V. (2021). Fluvoxamine: a review of its mechanism of action and its role in COVID-19. Frontiers in Pharmacology, 763. Therapy for Patients With Major Depressive Disorder Essay Assignment

Assignment: Assessing and Treating Pediatric Patients With Mood Disorders
When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this weekâ€™s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.

To prepare for this Assignment: Therapy for Patients With Major Depressive Disorder Essay Assignment
Review this weekâ€™s Learning Resources, including the Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.
The Assignment: 5 pages
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 patientâ€™s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.

Introduction to the case (1 page)

Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Therapy for Patients With Major Depressive Disorder Essay Assignment

Decision #1

Which decision did you select?

Why did you select this decision? Support your response with strong scientific evidence and references. Why did you NOT select the other treatment options available? Again, provide STRONG scientific evidence. Clinical studies or treatment guidelines are a good place to start!

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

What ethical considerations impacted your treatment plan and communication

plan with the patient?

Decision #2

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

What ethical considerations impacted your treatment plan and communication plan with the patient?

Decision #3

What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

What ethical considerations impacted your treatment plan and communication plan with the patient? Therapy for Patients With Major Depressive Disorder Essay Assignment

Conclusion (1 page)

Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.

CASE STUDY; https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_02/index.html THIS THE LINK TO THE DECISION TREE. Decision option should be first to start zoloft 25 mg daily, then increase to 50 mg daily and then maintain dose.

Resources
Required Readings (click to expand/reduce)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21â€“24. https://doi.org/10.3928/02793695-20080901-06

Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21â€“24. https://doi.org/10.3928/02793695-20081001-05 Therapy for Patients With Major Depressive Disorder Essay Assignment

Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-textbook of child and adolescent mental health. https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf

Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

ORDER NOW

Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scaleâ€”Revised. Western Psychological Services.

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787â€“791. https://doi.org/10.1002/da.22171

Yasuda, S. U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417â€“423. https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/â€¦/UCM085502.pdf

use the resources as well as scholarly journals. at least 5 references. paper must include a reference page Therapy for Patients With Major Depressive Disorder Essay Assignment