Major Depressive Disorder In Children And Adolescents Research Paper

Major Depressive Disorder In Children And Adolescents Research Paper

An African American Child Suffering from Depression

Depression is a severe mental condition that can have catastrophic consequences for children and teenagers. Depression is one of the most frequent mental diseases in the United States, affecting an estimated 2.8 million children and adolescents, according to Scott et al. (2019). While depression can strike at any age, it is most common in children and adolescents during their formative stages, when their brains are quickly growing and developing. This sickness has a tremendous influence on the physical and emotional health of a child. Depression, for example, raises the risk of drug addiction, eating disorders, and suicidal thoughts or behavior. In fact, depression is responsible for roughly one-third of all youth and teen suicides (Alqueza et al.,2021) Major Depressive Disorder In Children And Adolescents Research Paper.

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There are various possible causes of childhood depression. These can include biological factors such as inheritance or chemical imbalances in the brain, psychological factors such as low self-esteem or negative thinking patterns, and environmental factors such as bullying or a major life upheaval (Schroder et al.,2020). Some children may be predisposed to depression owing to a combination of these factors. Depression therapy varies depending on the cause, but it commonly includes counseling and medication. This article is based on a case study of an African American adolescent who was diagnosed with depression. It gives three therapy options depending on the patient’s pharmacokinetic and pharmacodynamic processes Major Depressive Disorder In Children And Adolescents Research Paper.

Case scenario

The case study involved an eight-year-old African-American male patient who presented with a chief complaint feeling sad, socially withdrawn, having no appetite and occasional irritation. On examination, he was found alert, and oriented x3. The patient denies visual and auditory hallucination. But admit thinking about himself as dead. He scores 30 on CDRS suggestive of significant depression.

Decision 1#

In this decision point, PMHNP has an option to start the patient on sertraline 25mg PO, Paxil 10mg PO to be taken once daily and Wellbutrin 75mg PO to be taken twice daily. I chose to start the client on Sertraline 25mg orally OD. This decision was made because sertraline has been shown in many studies to be effective treatment for depression in children (Brown et al.,2022). It is typically considered first-line due to its efficacy and safety profile. Besides, Sertraline is well-tolerated with few side effects. While it cannot be effective in managing depression in all children, it has been proven to be highly efficacious in management of depression in children with mild to severe depression (Anvari et al.,2020). This SSRIS works by increasing the level of serotonin in brain which is often deficient in people with depression.

Paxil 10mg is a fantastic choice for the client, but I prefer not to take it at this time owing to the potential of serious side effects in youngsters, such as suicidal thoughts and behavior. Furthermore, the medication takes weeks to months to take effect, making it an unsuitable alternative for the client (Hengartner, 2020). Wellbutrin, on the other hand, was not chosen at this time since its efficacy in treating pediatric depression has yet to be proven (Dwyer et al.,2020). It may also induce anorexia and convulsions in children.

By selecting sertraline in this choice point, I am expecting that the patient would report a major improvement in his symptoms as well as a significant fall in his depression rating score. After 28 days of therapy, the patient reported no improvement in his symptoms Major Depressive Disorder In Children And Adolescents Research Paper.

Decision #2

In this decision point, PMHNP can either put the patient on Prozac 10mg po, sertraline 37.5mg PO daily, and sertraline 50mg PO. I elected to raise sertraline doses from 25 to 50mg while retaining the route and frequency of administration. This choice was made based on the known variability in sertraline reactions. Sertraline’s impact might take up to 8 weeks to be felt, according to research (Hengartner,2020). Furthermore, its effectiveness has been demonstrated to increase with increasing doses Major Depressive Disorder In Children And Adolescents Research Paper.

I did not select Prozac 10mg at this decision point since it is not FDA approved for treating depression in children and its long-term effect has not been demonstrated (Mullen et al.,2018). It also has the potential to cause suicidal thoughts, anxiety, and agitation in youngsters, making it dangerous for the client. Increasing the dose of sertraline from 25 to 37.5 was not an option since it did not fall within the permitted dosage ranges of 25, 50, and 200.

It is anticipated that by making this decision, the client would report an improvement in his mood, self-esteem, and a major decrease in dismal thoughts about death. After four weeks of treatment, the patient reported a 50% reduction in symptoms.

 

Decision #3

At this point, the PMHNP has the choice of keeping the patient on the present dose, switching to SNRIS, or increasing the sertraline dosage to 75mg po. I opted to keep the client on his current dose based on the client’s report of a 50% favorable reaction, and it is expected that continuing the prescription will improve the response. Furthermore, quitting sertraline may result in a recurrence (Horowitz et al.,2022).

I did not examine other choices, such as increasing the sertraline dosage to 75 mg, due to the client’s positive response to medication. Additionally, higher sertraline doses may be hazardous to the client. However, switching to SNRI is not required at this time because of its snris potential to increasing the risk of suicidality and relapse. I am hoping that by making this decision, the client’s problems will improve.

Ethical consideration

Children are a vulnerable group, and when it comes to depression, they may be even more vulnerable. This is due to a variety of causes, including the fact that children are still developing emotionally and cognitively and may lack the coping strategies needed to deal with depression. Furthermore, children may be more inclined to internalize their emotions, making the illness even more difficult to cure.

Given these considerations, it is critical that any therapy for depression in children be ethical. This implies that the intervention selected must be both successful and safe, while also respecting the child’s autonomy and rights. It is also critical to evaluate the child’s culture and religion, since these variables may influence how they perceive and deal with depression. When treating depression in children, there are a few ethical factors to keep in mind. Before initiating any therapy, it is vital to obtain informed consent from the child’s parents or guardians, and the child’s best interests must always be addressed (Nollett et al.,2019). Instead of just treating the depression, treatment should aim to reduce the child’s symptoms and enhance their quality of life. Furthermore, the patient and his mother or caregiver must be informed about the basics of the disease and why they must adhere to medical treatment. The selected language must be simple and easy to grasp Major Depressive Disorder In Children And Adolescents Research Paper.

Conclusion

Depression is a mental condition that can have a long-term influence on a person’s life. It is distinguished by a poor mood, a sense of sadness, anger, and suicide thinking. This condition has an impact on both the physical and emotional health of the individual. Psychotherapy and medication are both used in treatment. Drugs like as sertraline are important in treating the illness, but the dosage must be titrated to meet the needs of each individual. Furthermore, before delivering any specific medicine, nursing ethics must be considered. The autonomy of the patient must be respected, the therapy must be safe, and clinicians must obtain agreement from the patient’s parents or caretakers Major Depressive Disorder In Children And Adolescents Research Paper.

This is your first interactive case study with a decision tree! In this case study, you will have 3 different decision points to address. The decisions you make will determine the next step scenario and eventually the outcome. At each scenario/decision point, you will need to decide how to proceed, provide your answer, and support your answer with evidence including your rationale for your decision. For each decision, you will explain your decision and explain why you chose that decision-why it is the best for this patient. You will explain why you did not choose the other options and why they are not the best for this patient. Substantiate your rationale using at least 5 academic resources. Be sure to properly cite and reference each of the sources. This will be submitted to SafeAssign, which I will review in great detail.

 

While reading the case study, evaluate and research each option. Then select the option you choose (click on it) and continue forward through the 3 decision points. Do not start over or go back and repeat. Select your option and continue forward to the next screen which will reveal the outcome prior to giving you the next decision point. Not following instructions may result in a 0 or decreased grade.
You must choose an option at each step by clicking your choice. Then you will see the outcome and will be given the next decision. Choose your option for the next step by clicking your choice and you will be given the outcome followed by the last decision. Select your answer and you will be given the outcome. Do not start over or go back.
Follow the assignment instructions for each of the 5 pages, not including the title page or reference page, for this assignment. Do not exceed the page limits for any of the 5 parts. Therefore, you will only have a title page + 5 pages of text + a reference page for 7 pages total. You need to be concise and only include the required information. Exceeding the page limits for each part and/or providing excessive unnecessary information will only count against you in grading.
The decisions you make will determine the outcome.
Know there could be multiple viable options, so as long as you appropriately substantiate it (i.e. with POEM -Patient Oriented Evidence Medicine- guidelines, medication mechanism of action, side effects, time of onset, credible resources, etc.), you could still receive credit if it is an appropriate treatment for this patient specifically.

INTRODUCTION to Case- 1 PAGE IN LENGTH:

Give a concise summary of the assignment purpose and the key aspects of the case study disease state including important information that affects your decision in selecting this patient’s medication you will prescribe. Remember this is a pharmacology and therapeutics course, so medications and treatment plans are the focus here. Therefore, do not write a page on diagnosis. Provide important case information and focus on the information in the case that helps you decide your treatment plan Major Depressive Disorder In Children And Adolescents Research Paper.

DECISION #1- 1 PAGE IN LENGTH, DECISION #2- 1 PAGE IN LENGTH, DECISION #3- 1 PAGE IN LENGTH:

See the assignment instructions which include the questions and information to be covered for each decision page. Each decision will be 1 page of your paper.
Include each option given, explain your option/decision, explain your rationale for your chosen option specifically, and substantiate your decision with evidence such as guidelines, drug studies, and resources.
Do not state you chose this medication because it is an SSRI. Instead be extremely specific and support your choice with information from credible, current sources which may include medication specific factors such as contraindications, warnings, adverse drug reactions, safety profile, drug-drug interactions, dosing, etc.; patient specific factors such as age, allergies, comorbidities because we do not want to exacerbate patient’s other medical conditions if we can avoid it; comparative drug studies; therapeutic guidelines, etc. I have posted some APA guidelines in Doc Sharing as a few of the guidelines you can use.

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State specifically why you did not choose each of the other 2 options and substantiate this with sources. Be extremely specific for each.
Include specific treatment goals for your chosen medication and substantiate these with resources. Be extremely specific.
Include/explain your response to the provided decision outcome for your decision. Did you expect this to be the outcome or not? Why or why not? Be extremely specific.
REPEAT EACH OF THE ABOVE BULLETS FOR EACH DECISION. For example, you will include and explain each of the above bullets for decision 1 on 1 page. Then, you will proceed to include and explain each of the above bullets for decision 2 on 1 page and again for decision 3 on 1 page.
This should all be quality- quality work with quality resources- without exceeding quantity.

Conclusion- 1 page

Explain and provide examples of ethical considerations which may affect your treatment plan and communication with the patient.
Summarize your treatment plan for your selected treatment options for this patient.
Substantiate/ support your recommendations and responses with credible, clinically relevant, patient specific sources.

Examples of Don’ts

Bupropion (Wellbutrin) was chosen because it treats depression.
I chose sertraline (Zoloft) because it’s a SSRI.
Data supports using paroxetine (Paxil) for …

Examples of Do’s

Review the guidelines and recommend a first line medication if appropriate for this patient specifically. See why the guidelines recommend or don’t recommend certain medications. Include these in your decision making and your rationale.
Tailor this to this specific patient. Consider all patient specific factors and medication specific factors as stated above. Be sure this is an appropriate medication for this patient. Include applicable adverse drug reactions/side effects. Do not include side effects which do not apply to this particular patient.
Is there evidence to support a particular medication is more efficacy than another medication in comparative drug trials? Include this in your rationale for your decision if applicable.
Consider special populations such as pediatrics, elderly, pregnancy when selecting and not selecting medications. Include this in your rationale for your decision.

Plagiarism/Cheating

Read my Important Instructions announcement from yesterday and follow it.
All work must be your own work in your own words with proper citations. Use proper paraphrasing.
Do not view or use other students work as this is cheating and will be treated as such.
In-text citations are required for every assignment. Whenever you use a source, you must cite it to give credit to the author. Cite more often than not. Avoid improper or partial citations.
Do not upload your completed work online or to assistive sites as this will be investigated by WU as well.

 References

Scott, K., Lewis, C. C., & Marti, C. N. (2019). Trajectories of symptom change in the treatment for adolescents with depression study. Journal of the American Academy of Child & Adolescent Psychiatry, 58(3), 319-328.

Brown, J. T., Gregornik, D. B., Jorgenson, A., Watson, D., Roiko, S. A., & Bishop, J. R. (2022). Sertraline dosing trends in children and adolescents stratified by CYP2C19 genotype. Pharmacogenomics, 23(4), 247-253.

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.

Hengartner, M. P. (2020). Antidepressant Prescriptions in Children and Adolescents. Frontiers in Psychiatry, 11, 600283.

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275-283.

Horowitz, M. A., & Taylor, D. (2022). Distinguishing relapse from antidepressant withdrawal: clinical practice and antidepressant discontinuation studies. Bjpsych Advances, 1-15.

Nollett, C., Bartlett, R., Man, R., Pickles, T., Ryan, B., & Acton, J. H. (2019). How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study. BMC psychiatry, 19(1), 1-16.

Dwyer, J. B., Stringaris, A., Brent, D. A., & Bloch, M. H. (2020). Annual Research Review: Defining and treating pediatric treatment‐resistant depression. Journal of Child Psychology and Psychiatry, 61(3), 312-332.

Alqueza, K. L., Pagliaccio, D., Durham, K., Srinivasan, A., Stewart, J. G., & Auerbach, R. P. (2021). Suicidal thoughts and behaviors among adolescent psychiatric inpatients. Archives of suicide research, 1-14.

Schroder, H. S., Duda, J. M., Christensen, K., Beard, C., & Björgvinsson, T. (2020). Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample. Journal of Affective Disorders, 276, 537-545 Major Depressive Disorder In Children And Adolescents Research Paper.