Therapy for Pediatric Clients with Mood Disorders
Depression is a common mental disorder with severe symptoms, especially in pediatric patients. The condition causes substantial impairment among the pediatric population in several aspects of life such as interpersonal interactions, family engagement, suicidal thoughts, interpersonal communication, and academics. There are however numerous challenges when it comes to diagnosing mood disorders such as depression, especially among pediatric patients due to developmental variations and overlap and presentation of appropriate symptoms. Accurate diagnosis of depression among pediatric patients can be achieved by using fundamental screening questions to evaluate the psychiatric characteristic of the patient through interview methodology (Gupta, Gersing, Erkanli, & Burt, 2016). It is only through accurately diagnosing this mental disorder that a Psychiatric-mental health nurse practitioner (PMHNP) can formulate a relevant therapeutic care plan for the patient comprising of both pharmacological and behavioral interventions. The choice of the most appropriate treatment regimen is based on drug efficacy and potency. In the case of d
rug combination therapy, the nurse must make sure that the interaction between the two drugs is synergistic (Stahl, 2013). However, in case the care plan is not effective within the predetermined duration of time, the PMHNP will have to review the treatment regimen, and enhance interpersonal psychotherapy with the patient. This paper examines a case of an African American male, aged 8-year old, who was diagnosed with depression and the treatment options that were recommended by the PMHNP (Weersing et al., 2017). The care plan outcome including the effectiveness of the choice of treatment will also be discussed for a comprehensive understanding of the management of depression among the pediatric population.
Decision Point One
Selected Decision. Begin Zoloft 25 mg OD
Reason for selection. Zoloft (sertraline) belongs to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), which are very effective in managing depression. Several studies have approved the safety and effectiveness of this drug among the pediatric population. Considering the above case scenario, the 8-year-old patient scored a 30, according to the PMHNP report, on the Children’s Depression Rating Scale. The patient’s score suggests a significant depression that needs immediate medical intervention. From the antidepressant list provided for this case study, Zoloft is the best choice of drug, in this case, given that it is the most effective and better tolerated by pediatric patients in managing depression (Dobson & Strawn, 2016). Inasmuch as Paxil 10mg could also be administered, it would not be useful given the patient’s age, and the side effects associated with the drug in managing the symptoms of depression, especially heightened suicidal thoughts.
Consequently, Wellbutrin can only be used as a second-choice drug in case of failure of the SSRI to elicit the desired
treatment outcome, or when the level of depression is not pronounced. Combination of Zoloft and Paxil is also discouraged given that both two drugs belong to the same class, SSRI, hence having the same mechanism of action (Stahl, 2014), which can lead to toxic doses causing serotonin syndrome. Consequently, this leaves us with Zoloft 25mg as the best choice of drug for this case scenario.
Expected Results. Given than SSRIs are used for long term depression therapy, Zoloft’s therapeutic effects are expected within about six weeks from the initial dose. However, several studies have revealed that Zoloft is expected to mitigate the symptoms of depression within four weeks. When properly administered, Zoloft should be able to reduce the patient’s symptoms close to normal, in terms of the level of concentration within two weeks (Varigonda et al., 2015). Within three weeks, the patient should be able to have an improved appetite with no irritations. Hence, four weeks of Zoloft use should enable the patient to relate well to his peers. The withdrawal and isolation symptoms should have seized by this time.
Difference between Expected Results and Actual Results. After four weeks, the patient reported back to the hospital with unresolved symptoms. This was not entirely expected according to the prescribed care plan and the expected therapeutic outcome as outlined by the PMHNP. The patient depression state was expected to improve after four weeks of medical therapy. In as much as the drug might exhibit some side effects, failing to work was entirely out of the picture. The only explanation for this incident might be a failure to adhere strictly to the dosage regimen. The patient might have been taking an underdose. Generally, the treatment outcome was quite the opposite of the expected care plan results.
Decision Point Two
Selected Decision. Increase dose to 50 mg orally daily.
Reason for Selection. Antidepressants work by taking away or reducing the symptoms of depression. When the patient’s depression state did not resolve or become better within four weeks of medication therapy, the only two assumptions that can be drawn are that either the drug was not working, or the dose of the drug administered was below the therapeutic index. Since Zoloft was not responsive in this case, the PMHNP can either increase the dose of the drug to maximum, but within pediatric therapeutic limits or use another antidepressant (Stahl, 2013). However, the main reason behind the drug not working is not known, and thus increasing the dose seems to be the best intervention. Most studies recommend a dose of 50mg rather than 25mg for the desired effects to be felt. The main reason behind this is that a higher dose will trigger the release of serotonin to desired levels to reduce the symptoms caused by depression.
Expected Results. An increased dose from 25mg to 50mg should be able to elicit the desired effects and reduce the symptoms of depression. Initially, the patient was given 25 mg Zoloft, which is the starting or minimum dose for pediatric patients. 50 mg is still within the therapeutic range for this age group. Given that this is the maximum dose for pediatrics, the desired effects and reduced symptoms are expected within the shortest time possible (Zehgeer et al., 2018). The patient is expected to exhibit improved appetite, reduced irritations and improved social interactions with his peers.
Differences between Expected Results and Actual Results. The patient came back to the hospital after four weeks from the day that the Zoloft dose was increased from 25mg to 50mg. The expected outcome was that the patient would have reduced symptoms and in a better mental state. Remarkably, the patient registered a 20% decrease in depression symptoms, just as anticipated. The patient claimed he felt better than before. It was also astonishing that even after increasing the dose, the patient did not report any side effects of the drug, given that most studies have related Zoloft to several side effects. Generally, the treatment outcome of the patient was positive in as much as it was to a lower extent.
Decision Point Three
Change to a different SSRI
Reason for Selection. The eight-week therapeutic management of depression by Zoloft called for the need for an intervention. The drug was only able to reduce 20% of the patient’s symptoms. Previous studies have recommended a change in drug regimen in case of failure of a given antidepressant drug to elicit the desired outcome. Studies have also claimed that there is a likelihood of improved outcome when the fairly active drug is combined with another therapeutic agent to boost its effect (Riddle, 2019). Considering the two options, changing the drug regimen from Zoloft to another antidepressant agent is the most favorable solution.
Expected Results. Administering a different antidepressant agent, other than Zoloft, is expected to produce the desired outcome and reduce the depression symptoms. The patient is expected to show more than 30% reduced symptoms within four weeks of taking the new medication. The responsiveness of the new antidepressant agent in terms of reduced symptoms will improve the patient’s attitude towards adhering to the new treatment regimen and maintain the dosage to attain complete recovery (Southammakosane & Schmitz, 2015).
Differences between Expected Results and Actual Results. The therapeutic intervention of changing the antidepressant agent seems to be the standard way of handling such a situation. After increasing the dose of the initial drug to maximum, the only way that the patient’s condition could improve was by changing from the initial drug to a different antidepressant agent (Association for Youth, Children and Natural Psychology, 2012). According to several studies, different people respond differently to various antidepressant agents and hence, administration of the best choice of drug will undoubtedly elicit the desired treatment outcome.
Impact of Ethical Considerations on Treatment Plan
The use of antidepressant agents in pediatric patients has posed several challenges as a result of therapeutic complications. According to the FDA, most antidepressant agents heighten the suicidal tendencies among teenagers, and thus only a few should be used when necessary (Riddle, 2019). Nonetheless, even the recommended few exhibit undesired effects which undermine the health of the minors. As a result, patient evaluation by nurses reveals that majority of antidepressant agents should not be used in cases of depression among the pediatric population. For instance, when a patient presents with symptoms such as being isolated or withdrawn from classmates, such a patient’s treatment plan should not include antidepressants that are prone to inducing suicidal thoughts.
Conclusion
Pediatric depression is a severe mental condition that should be addressed by psychopharmacological intervention with immediate effect. Depressed children tend to exhibit symptoms such as poor social interaction skills, low self-esteem and suicidal thoughts which affects both their academics and family. Hence, upon conducting an accurate diagnosis of the mental condition, an appropriate care plan should be formulated with the most suitable medication. However, since the bests drug regimen for the mental condition is not definite, the clinicians need to observe the patient’s response make the necessary interventions. Lastly, the clinician must also consider other interventions such as psychoeducation apart from pharmacotherapy.
References
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