Decision #1
Begin with Zoloft 25mg orally daily. I made this decision because Sertraline is a viable prescription option when it comes to treating major depressive disorders. The drug is an antidepressant that belongs to a group of drugs called selective serotine uptake inhibitors (SSRIs) ( Stahl, 2013 ). It works by affecting positive changes in the chemicals which may be unbalanced in the brain for people with depressive disorders, in this case, the African American child. His withdrawal symptoms and feelings of sadness coupled with frequent irritation and loss of appetite all point to the fact that he is suffering from depression. One interesting symptom that he exhibits is the fact that even though he does not have suicidal thoughts, he often has thoughts of what it would feel like to be dead. The diagnosis is enough to deduce that he is suffering from a depressive disorder and if it continues, the condition may be very serious. In most cases, the drug is normally administered as a combination of another therapy but in this case, since the patient is a child, we will administer the 25mg dose first and wait for results.
With this dosage, I was hoping that the drug would reduce the depression symptoms exhibited by the child. As Vitiello (2012) notes, Sertraline works by increasing the amount of serotine in the brain, thus improving the symptoms of depression and maintaining a state of mental health balance. After three weeks, I observed that there was no change as I anticipated meaning that a change in the dosage was required. The results were different because the dosage was administered was not effective for the child.
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Decision #2
After the administration of the first medication and observation for four weeks, the child comes back and there is still no change and as such, a different approach has to be used. The second decision would, therefore, prompt me to increase the dose of sertraline to 50mg orally daily. According to Rao (2013 , it usually takes between four to six weeks for the medication to work. In this case, since there has been no observed improvement in the depressive symptoms of the child and no side effects experienced, then an increase of the dose regimen is essential at this point. He further notes that this dose is effective as a therapeutic treatment method and it will be administered as a single dose at any time of the day.
By making this decision, I was hoping to reduce the depressive symptoms that were exhibited by the child by altering serotine in the brain. Increasing the dosage to 50mg will probably increase the likelihood of treating the child. The dose was administered for a duration of four weeks after which the child reported back to the clinic for observation. It was established that the depressive symptoms had decreased by 50% and the child seemed to be doing well with the current prescription. It is imperative to note that the increment did not have significant side effects t the child because the dose regimen is administered orally as a syrup ( El Marroun et al., 2014 ).
Decision #3
The third decision would be to increase the dose regimen to 75mg orally daily. One can easily note that the symptoms of depression have been reduced by a significant margin. The child’s response to this therapy has proved to be positive and he seems to be doing well. The main course of action at this point would be to let the child continue with the dose for four more weeks so as to establish if there are any further reductions in the symptoms. Magellan Health Inc. (2013) note that if there are no notable side effects at this stage, the drug therapy should not be changed. After the duration, the depressive symptoms exhibited by the child had reduced by 75%, showing that the treatment was working. For all the decisions that I had made, I had to keep close communication with the parents so that I could advise them of the possible treatment options and the impacts they would have had on their child. It was only after they agreed to the therapy that I administered the change in dosage and ultimately achieved positive results with the patient.
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. DOI:10.1002/da.22171
Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.
El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. DOI:10.1007/s00787-014-0558-3
