The paper focuses on children suffering from depression. According to Stahl (2011), depression is one of the mood disorders that affect children in nearly all aspects of their life, a factor that makes executing even the most basic activities challenging for both the children and their families. Specifically, depression refers to a mood disorder that is characterized by feelings of sadness, persistent low mood, and loss of interest in activities or things that one used to love. Depression is not just a temporary condition but a persistent problem that can last for an average of 6 to 8 months ( Stahl, 2011) . Mood disorders are also defined as affective disorders, and they comprise of the bipolar disorder and all the different types of depression. There are several factors associated with causing mood disorders, including such environmental factors as exposure to feelings of grief or sadness as a result of stressful life events, and genetic factors, where children whose parents suffer from mood disorders are at a higher risk of developing a mood disorder ( Stahl, 2011) . In this decision tree, the client is suffering from depression.
My Client
My client is an 8-year-old African American who presents at the ER showing signs of depression ( Laureate Education, 2016) . The client complained of sadness, while the mother reported that his teacher had indicated that the child is withdrawn from his peers in the class. The mother also noted that the so had occasional periods of irritation and decreased appetite. During the mental status exam, the client reported that he is sad but denied auditory or visual hallucinations. The client did not endorse active suicidal ideation, but admits that he frequently thinks of being dead and how being dead would be like ( Laureate Education, 2016) . The exam also revealed that the child's effect is somewhat blunted although the child smiled severally throughout the interview. The child did not demonstrate paranoid or delusional thought processes. The Children’s Depression Rating Scale indicated significant depression as the child’s score was 30 ( Poznanski & Mokros, 1996) .
Delegate your assignment to our experts and they will do the rest.
Medication Decision
The decision tree comprises three medications that are offered;
Zoloft 25 mg daily
Paxil 10mg daily
Wellbutrin 75mg bid
Zoloft
Zoloft or sertraline refers to an antidepressant that belongs to a category of drugs known as selective serotonin reuptake inhibitors (SSRIs). The drug affects the brain chemicals that may be unbalanced for people with panic anxiety, depression, or obsessive-compulsive disorders (Jerrell, Tripathi & McIntyre, 2011). It is not recommended for individuals taking pimozide or those under treatment with the methylene blue injection. Individuals who have also taken an MAO inhibitor, such as phenelzine, linezolid and tranylcypromine among others within 14 days should also not take Zoloft. The recommended start dosage for children aged between 6 and 12 years is 12.5 to 25mg per day and a maximum dosage of 200mg per day.
Paxil
Paxil is also an SSRI, and it is utilized in the treatment of panic attacks, depression, anxiety disorders, the obsessive-compulsive disorder, and post-traumatic stress disorder. The drug works by facilitating the restoration of the balance of serotonin in the brain (Jerrell, Tripathi & McIntyre, 2011) . Some of the key benefits associated with the drug include decreasing unwanted thoughts, anxiety, the number of panic attacks, and fear as well as improving one’s appetite, sleep, mood, and energy levels. Paxil is recommended for individuals above the age of 18 years. For individuals suffering from depression, the recommended dose is 25mg per day, which may increase by 12.5mg per day, but the dosage should not exceed 62.5m ( Jerrell, Tripathi & McIntyre, 2011) . In children, the ideal dosage is yet to be determined since the safety and efficacy of Paxil in pediatrics is not yet established. However, for children aged between 7 and 17 years, a dose of 10 to 60mg per day is commonly applied.
Wellbutrin
Wellbutrin or bupropion refers to an antidepressant that is utilized in the treatment of the seasonal affective disorder as well as the major depressive disorder. The drug belongs to the class of antidepressants known as the aminoketone, which are unrelated to the SSRIs. Doctors recommend that an MAO should not be used within 14 days before or after the intake of Wellbutrin due to the risk of dangerous drug reactions occurring (Jerrell, Tripathi & McIntyre, 2011) . The ideal dosage for the drug has not been established in children below the age of 18 years since the effectiveness and safety of the drug among the children is yet to be determined. However, the suggested dosage for children is between 1.4 to 6mg per day.
Decision Point One
Although the three medications are utilized in the treatment of depression in children, I chose Zoloft because its effectiveness and safety have been established in children and an ideal dosage provided. The other treatment options, Paxil and Wellbutrin, are associated with increased suicidal ideation in children and adolescents, therefore posing a higher risk of children committing suicide or performing suicidal acts. By selecting the decision, which comprised of administering 25mg orally on a daily basis, I hoped to decrease the child’s depressive symptoms within the first month. However, contrary to my expectations, the client returned to the clinic with no change in depressive symptoms at all after four weeks. The difference between the actual results and my expectation emanates from the low dosage administration yet the client’s case is severe (Magellan Health, Inc., 2013).
Decision Point Two
The possible decisions after the initial client's return to the hospital include continuing with the same drug at the same dosage for another one month, changing the drug, or increasing the dosage of Zoloft to 50mg daily. I chose to increase the drug dosage to 50mg since maintaining the same level of dosage was ineffective in meeting my objectives (Vitiello, 2012). Moreover, Zoloft has demonstrated a high-efficiency level in the treatment of depression in children; hence, I considered not changing the drug to the available alternatives. By taking this decision, I expected to the client to demonstrate a significant decline in depressive symptoms within four weeks, of not less than 25% decline in the symptoms. The actual results after the four weeks comprised of a 50% decrease in the client’s depressive symptoms. The results that I acquired after the set period were impressive since they surpassed my target results of 25% decrease in symptoms.
Decision Three
After the implementation of the decision two, the client demonstrated signs of tolerating well with the drug. The available options for decision three include maintaining the current or increasing the dosage. However, I chose to maintain the dose since the client was responding well to the treatment as evidenced by the fact that his symptoms had declined by 50% within the past four weeks. Moreover, referring the client to a behavioral therapist or psychologist will play a crucial role in addressing the issues of depression, sadness, and mood changes (Rao, 2013). Further, the fact that the client is responding well to treatment makes it unnecessary to change the drug therapy o an SNRI. I chose this decision because I wanted to establish whether the client would show a further decline in depressive symptoms in the next four weeks to allow for further appropriate action.
Impact of Ethical Considerations on the Treatment Plan
The client is a minor and therefore has a limited understanding of his illness as well as the relevance of necessary treatment procedures. Hence, involving the client and his parents as well as educating them about the illness is crucial in ensuring better outcomes, since such involvement would minimize resistance to treatment from the child. Moreover, better results will be achieved from the fact that the child will be encouraged to express his feelings better, including feelings of sadness and loneliness, which is crucial in devising, implementing, and improving the treatment plan for better outcomes.
References
Jerrell, J. M., Tripathi, A., & McIntyre, R. S. (2011). Prevalence and treatment of depression in children and adolescents with sickle cell disease: a retrospective cohort study. The primary care companion to CNS disorders , 13 (2).
Laureate Education (2016e). Case study: An African American child suffering from depression [Interactive media file]. Baltimore, MD: Author.
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-psychotropic drugs-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
Stahl, S. (2011). Stahl's essential psychopharmacology: the prescriber's guide . Cambridge New York: Cambridge University Press.
Vitiello, B. (2012). Principles for using the 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. Retrieved from http://iacapap.org/wp-content/uploads/A.7-PSYCHOPHARMACOLOGY-072012.pdf
