The prevalence of depression among children has become a matter of concern in the scientific field over the years. Conditions such as Major Depressive Disorder (MDD) affect about 2.8% of children before puberty, and the rate doubles during adolescent years, affecting more girls than boys (Seedat, 2014). The need for the treatment of the mental issues that children exhibit has resulted in the use of medication such as antidepressants and stimulants in adolescent and child psychiatry (Vitiello, 2012). The treatment guidelines governing the use of antidepressants when offering care services for a range of mental illnesses among adolescents and children vary depending on the hierarchy of treatment. It is agreed upon that the medications mentioned above are crucial to the healing process (Gordon & Melvin, 2014) . Thus, despite their possible adverse consequences, they must be used to counter depression symptoms in children.
Research on pediatric depression indicates that most of the biomarkers that are expressed in adult depression can also be observed in children or adolescents as characterized by the observable traits of REM density and latency (Rao, 2013). Hence, the role that antidepressant prescriptions may play in facilitating depression in children among the offspring of the affected mothers comes into question. The prescribed drugs can go through the placenta and affect both fetal and brain development, resulting in long-term consequences on the brain development capacity of the offspring (El Marroun et al., 2014). Thus, the treatment of depression in children requires careful consideration of the pharmacodynamics and pharmacokinetic processes involved .
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Case Background
The case focuses on an 8-year-old African American boy that was checked into the hospital exhibiting signs of depression. The patient stated that he felt “ sad, ” and the mother said that his teacher had observed that the boy had been withdrawn from his peers in the class. Additionally, the mother reported that she had seen that the patient ’ s appetite had decreased and he occasionally became irritable. It was established that the client reached all landmarks of development during the expected periods, and the physical exam conducted on him showed no remarkable results to affirm that he was depressed. Similarly, the laboratory results were regular.
Consequently, the patient was advised to get a psychiatric evaluation from the Psychiatric Nurse Practitioner. The results of the Mental Status Exam showed that he was alert and oriented X3. His speech was clear, spontaneous, coherent, and goal-directed. However, his affects were reported to be dull, but he smiled suitably severally during the interview session. Furthermore, the client indicated that he was not experiencing visual or auditory hallucinations, and the practitioner observed no paranoia or delusions during the interview session. The patient’s judgment and insight seemed appropriate for his age. Despite not being suicidal, he reported that he thought of himself as being dead most of the time and wondered how the state of death would feel . Upon the examination of the boy’s condition using the Children's Depression Rating Scale, a score of 30 was obtained (Poznanski & Mokros, 1996). The patient exhibited significant depression signs .
Decision 1
Among the options presented, the best treatment for the client would be the oral administration of 25 milligrams of Sertraline daily. The decision stated above was made based on the provisions of the research published by Magellan Health (2013) highlighting the suitability of Sertraline in the treatment of children suffering from stress. Moreover, the study indicates that the administration of Paxil and Wellbutrin, the other treatment options presented, is restricted to individuals that are above the age of 18, considering the associated risks of seizures and anorexia (Magellan Health, 2013). Therefore, the decision to use Sertraline to treat the patient ’ s depression was made with the hope of eliciting a high response rate to the treatment process since Magellan Health (2013) indicate its high possibility of obtaining results ranging between 40%-70%. Additionally, the Sertraline treatment would allow the facilitation of therapy without increasing the depressive symptoms that the patient was exhibiting at the time. The results of the treatment did not match the expectations because upon returning to the hospital in four weeks, there were no changes in the depression signs that the patient exhibited previously. It was expected that he would at least show minimal response to the treatment. The difference noted may be attributed to the fact that the nature of depression varies in different individuals, and a procedure that is effective for one person may not elicit similar results in another .
Decision 2
The selected decision was to increase the amount of Sertraline administered by 25 milligrams to raise the daily dosage to 50 milligrams. The resolution above offered the best treatment option because of Sertraline ’ s appropriateness in treating depression among children and its allowance of titration of up to 200 milligrams (Magellan Health, 2013). Also, Sertraline is useful in treating significant depression symptoms exhibited by children that are above the age of six (Vitiello, 2012). The other treatment options that were presented were unsuitable because the administration of 37.5 milligrams of Sertraline daily would be below the suggested therapeutic dosage of 50mg (Vitiello, 2012). Similarly, the Prozac option presented was not viable because the goal of the treatment process was to reduce the depression symptoms that the patient exhibited using the same treatment therapy. The purpose of the treatment process was to reduce the signs of depression without further escalating the symptoms that the patient was already exhibiting. The result of the treatment was the decrease in the client ’ s depression symptoms by 50%. The practitioner did not expect such a large margin of results. The difference exhibited shows that the response rate to depression treatment among children may vary as expressed by Magellan Health (2013). Thus, the patient responded better to the treatment than expected.
Decision 3
The choice made was to maintain the current dosage, the oral administration of 50 milligrams of Sertraline daily. The decision was based on Stahl ’ s (2013) assertion declaring that a 50% symptom reduction rate following antidepressant treatment is a viable response. Therefore, maintaining the same dosage was meant to establish whether it was possible to reduce the signs of depression further and possibly eliminate them with continued treatment. Resultantly, the decision aimed at achieving similar progressive results, considering the client ’ s previous positive response to the form of therapy. Thus, continuing the treatment in its current dosage sought to reduce the symptoms of depression further or eliminate them (Stahl, 2013). In this case, the results of the treatment matched the expectations because the signs of distress exhibited by the patient were eliminated.
Ethical Considerations Impacting Treatment Plan and Communication with Client
The ethical considerations that practitioners must account for when treating children differ with those that are made when treating adults. Vitiello (2012) explains that child patients below the age of 14 are incapable of understanding their treatment. Therefore, the treatment plan for the patient ’ s case presented above would have to revolve around informing the patient’s mother about the benefits and risks of the treatment that he was undergoing. Additionally, the physician would require to address any concerns about adhering to treatment and the responses, thereof, by collaborating with the patient ’ s parent. In cases that involve pediatric patients, parents play a supervisory role, which allows them to inform the practitioner about the perceived effectiveness of the treatment on their children ( Vitiello, 2012).
References
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
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of paediatrics and child health , 50 (11), 847-854. doi:10.1111/jpc.12655
Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale--Revised. Los Angeles, CA: Western Psychological Services.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. doi:10.1002/da.22171
Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2), iii–v. doi:10.2989/17280583.2014.938497
Vitiello, B. (2012). Principles in using psychotropic medication in children and adolescents. IACAPAP e-textbook of child and adolescent mental health. Geneva, Switzerland: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
