This assignment focuses on the treatment offered to an African American child presenting mood swings and suffering from depression. Such will be achieved through the selection of the correct therapy for pediatric patients who suffer from depression. Background information about the patient will be vital in guiding the selection criteria of the treatment. According to the information provided, the patient does not suffer from other health conditions, and thus there will be no extra complications to the pharmacokinetics that will be administered. Therefore, there is no need to conduct a CYP 450 enzyme genetic testing unless otherwise needed later. It is vital to know pharmacodynamics to select the patient's appropriate drug regimen. Pharmacodynamics studies the interaction between drugs and the body and its effect on the healing process. Hence with this as the foundation, only medication that improves the patient's depression will be selected, focusing on three alternative drugs, the reason for their selection, and the ensuing outcomes.
Decision #1
Sertraline (trade name Zoloft) will be prescribed in a daily dosage of 25 mg. Stahl (2014) notes the drug to have antidepressants functionality but poses it to be more than an antidepressant and optimal for patients with OCD. This drug has not been approved for depression treatment by the Food and Drug Administration (FDA) and is categorized as 'off- label' ; however, it has been shown to improve depression symptoms among pediatrics (Magellan Health Inc., 2013). Its viability has been tested and proved via various randomized and controlled studies on pediatrics. The patient and his mother were first informed of this off-label categorization, action mode, and various studies' outcomes. Magellan health (2013) also provides that the parents allow selective serotonin reuptake inhibitor (SSRI). Southammakosane & Schmitz (2015) also conclude that this drug's efficacy in treating depression among pediatrics has been established by evidence from the Allied Professions and International Association for Child and Adolescent Psychiatry.
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It is expected that within four weeks, the use of this drug should have positive outcomes that point to depression remission (Stahl, 2014). The drug is expected to have changed, such as reducing irritating moods, increased interactions at school and other social places, and improved appetite. However, the results were not as optimistic, and the patient still displayed symptoms of depression. If the medication is not working within 6-8 weeks, a dosage increase may be needed (Stahl, 2014). The dosage amount may, therefore, be the reason for this observation.
Decision #2
A follow up was conducted to investigate the reason the first dosage was not working. The patient was questioned on whether he had received any possible drug side effects or intolerance indicators. The patient answered in the negative and was put on a few days monitoring period during weeks 5. The conclusions from this thorough assessment showed that there were no intolerance indicators, and still, the depression symptoms continued unabated. Such formed the basis for increasing the dosage from 25mg administered in the previous decision to 50mg. This decision was arrived at from the previous period's results and discussions with the patient and his mother. The risks associated with the decision were well discussed among all parties.
Stahl (2014) stated that an increment of the dosage after no effects in the first four weeks might improve the patient's symptoms. In this case, it was useful since the patient had not displayed intolerance or adverse side effects. The new dosage was administrated for weeks 6-8. Afterward, the patient's condition was assessed, and the results matched the expectations; the patient’s symptoms improved. The patient also showed no signs of adverse side effects.
Decision #3
The drug Zoloft will continue to be administered to the patient for four more weeks. The patient's progress will be monitored, and the results recorded. Such is in line with Magellan Health Inc. (2013), who proposes that improvement of symptoms should be the determinants of the care plan to be used, and as such, the improvements should encourage the continued use of 50 mg of Zoloft. This period is called the continuation phase; the care should move to the maintenance phase as provided by (Lorberg et al., 2019). After the four weeks, the maintenance phase should be undertaken at the express agreement of the parent. This period aims to continue treating the patient; he should be closely monitored monthly.
These initial 12 weeks provide a short-term treatment plan, and therefore the data collected during this period should be analyzed to come up with a long-term treatment plan. The parental follow-up and the monthly appointments should make it easy to implement this long-term care plan. The results will be the continued improvement of the patient. Such is because sticking with the same regimen was found by the American Academy of Child and Adolescent Psychiatry to have better outcomes for pediatrics suffering from major depressive disorders.
Ethical Considerations
Some ethical considerations guide the above decisions. The first is using an ‘off-label’ Selective Serotonin Inhibitor, which should not be taken lightly. This is because SSRIs in treating major depressive disorders and their impacts on patients are scarcely researched and not well known or explored (Southammakosane & Schmitz, 2015). Therefore, the patient has to be closely monitored to ensure no unknown adverse side effects manifest themselves.
Secondly, the side effects of antidepressants, which include the risk of suicide, should be considered. Gordon and Melvin (2014) state that the FDA requires that antidepressants administered to children less than 18 years should have a suicide risk label. Therefore, this concern was discussed thoroughly with the child's parents, and a commitment from them to monitor the side effects and behaviors of the child was first sought before treatment commenced. The parent also promised to involve the teachers so that the child could be observed while at school. This is especially important for the first week as the patient responds to the drugs. The parent also had to allow long-term treatment to continue to secure full recovery.
Summary
This assignment has gone through the process of treating a child suffering from depression. The decision to use Zoloft was informed by its success in randomized and controlled studies among children. The treatment plan was maintained even after unimpressive initial results because studies have shown that one single treatment agent produces better outcomes when correctly chosen and thoroughly followed. It also saved time and avoided the complications that come with interactions of different drugs in a patient’s body. The drug was also used after special care was taken to ensure that the patient did not suffer from side effects. Due diligence and clinical accuracy are therefore needed for successful treatment. Such has also exposed me to the ethical and legal concerns associated with the treatment of pediatrics. The child patient has no right to consent, and therefore a mental and psychiatric nurse has to advocate the care plan to the patient's family.
References
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Paediatrics and Child Health , 50 (11), 847-854. https://doi.org/10.1111/jpc.12655
Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents . https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf
Magellan Health Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. https://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Southammakosane, C., & Schmitz, K. (2015). Pediatric psychopharmacology for treatment of ADHD, depression, and anxiety. PEDIATRICS , 136 (2), 351-359. https://doi.org/10.1542/peds.2014-1581
Stahl, S. M. (2014). Prescriber's guide: Stahl's essential psychopharmacology. Cambridge University Press. https://psycnet.apa.org/record/2014-19018-000
