Assessing and Treating Pediatric Clients With Mood Disorders

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 client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

· At each decision point stop to complete the following:

· Decision #1

· Which decision did you select? Begin Zoloft 25 mg.

· Why did you select this decision? Support your response with evidence and references to the Learning Resources.

I chose Zoloft because an SSRI is the best option to treat this adolescent who is presenting with depressive symptoms because the line of medication is least likely to produce negative side effects (Moreland & Bonin, 2019.) Starting at half the amount of a standard dose will lower the risk of side effects. Every patient reacts differently to different medications based on their metabolism, therefore, it is safer to start at a lower dose because it can always be increased (Shultz, Malone, & Cleveland Clinic Journal of Medicine, 2015).

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

I was hoping to decrease symptoms by 50% after 4 weeks without any negative side effects associated with taking the new medication. There are 3 phases of treatment when dealing with depressed patients. These include: 1. the acute phase which the goal is to minimize depressive symptoms, 2. the continuation phase which the goal is to prevent the return of symptoms after minimization has been achieved, and 3. the maintenance phase which the goal is to prevent any return of depressive symptoms throughout the lifetime (Clark, 2014). This goal with this decision was the acute phase goal because it was not achieved at the first visit.

· Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

I believed that there would be may have been some decrease in depressive symptoms since the child is young and has never taken any antidepressants before, however, I did not think that the symptoms would be 50% decreased, which was the initial goal for treatment, because 25 mg is a small dose. However, starting at a lower dose is a safer option when starting a new medication. Upon return at 4 weeks, the child did not have any change in his depressive symptoms with the 25 mg of Zoloft.

· Decision #2

· Why did you select this decision? Support your response with evidence and references to the Learning Resources.

I decided to increase the dose to 50 mg orally daily. I chose this because the patient did not have any decreased symptoms with 25 mg, which is not too surprising because it is a small dose, however, I do believe that this drug is the best option for this patient with his reported symptoms because of the fact that it is the least likely to cause side effects and manage his symptoms. Therefore, doubling the dose to 50 mg will allow an opportunity to see if the medication at a higher dose will provide the desired effect to decrease depressive symptoms by 50%.

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

I was hoping to, once again, reduce this patient’s depressive symptoms by 50% without producing any side effects from the medication. This is the acute and initial phase of treatment when dealing with patients who are presenting with depressive symptoms (Clark, 2014). Choosing a medication that will increase serotonin production to improve energy and mood will help reach that goal (Stahl, 2013).

· Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

I was hopeful that the patient would see changes after the dose of the Zoloft was doubled to 50 mg. I believed that he would see changes with the increased dose, however, I was unsure if he would experience any side effects. Anticipating side effects can prepare a psychiatrist for any unwanted symptoms and allow them to be treated accordingly without any surprises (Shultz, Malone, & Cleveland Clinic Journal of Medicine, 2015). The patient returned after 4 weeks with depressive symptoms decreased by 50% and without any negative side effects from the medication.

· Decision #3

· Why did you select this decision? Support your response with evidence and references to the Learning Resources. Maintain current dose.

I chose this because the desired outcome was achieved. The patient reports having 50% of his symptoms being decreased and is tolerating the medication well. The desired effect has been achieved, therefore, there is no point in changing what is working.

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

I was hoping to maintain the results achieved by prescribing the 50mg dose of Zoloft. This is the third and final phase of treatment called the maintenance phase. This is where we as psychiatrists prevent any return of symptoms or new negative symptoms (Clark, 2014). The goal is to maintain what is working.

· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

There was no difference in what I expected to achieve and what the results of the follow up were. At this point, the patient was doing well with the medication and not experiencing any side effects, therefore, I did not expect any changes from this point on. However, months down the road the patient may report a return of depressive symptoms if he for some reason builds a tolerance to the medication. Educating this patient on what to be aware of and when to seek help if symptoms present is important. Also educating the patient on drug interactions such as Tramadol, MAOI’s, or the fact that NSAID’s may impair the effectiveness of SSRI’s is significant information (Stahl, 2013). Informing the patient to not stop taking the medication regardless of how much better they feel is imperative as well. An ethical consideration to keep in mind before deciding on treatment options is whether or not the parent will provide consent for the patient to be on antidepressant medications (Hiriscau, Stingelin-Giles, Wasserman & Reiter-Theil, 2016). The minor may also refuse to take the medication which could be another issue.

References

Clark, D. A. (2014). The mood repair toolkit: proven strategies to prevent the blues from turning into depression. New York: The Guilford Press.

Hiriscau, E. I., Stingelin-Giles, N., Wasserman, D., & Reiter-Theil, S. (2016). Identifying Ethical

Issues in Mental Health Research with Minors Adolescents: Results of a Delphi Study. International journal of environmental research and public health, 13(5), 489. doi:10.3390/ijerph13050489

Moreland, C. & Bonin, L. (2019). Patient education: Depression treatment options for children

and adolescents (Beyond the Basics). Retrieved from https://www.uptodate.com/contents/depression-treatment-options-for-children-and-adolescents-beyond-the-basics

Shultz, E., Malone, D. A., & Cleveland Clinic Journal of Medicine. (2017, September 25). A

practical approach to prescribing antidepressants. Retrieved from https://www.mdedge.com/ccjm/article/95887/drug-therapy/practical-approach-prescribing-antidepressants

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical

applications (4th ed.). New York, NY: Cambridge University Press.