Treating Pediatric Patients with Mood Disorder
This paper focuses on an 8-year-old African American child and his mother’s visit to the ER. There are indications that he suffers from depression, which he defines as “sad.” According to one of his teachers, he appears to be withdrawing from the rest of the class. Irritability and decreased appetite are two of his symptoms. He has fulfilled all developmental phases at the appropriate times. Following a physical examination and the ordering of laboratory testing, the clinician concludes that there is little cause for alarm. It is determined by the healthcare provider that the child requires a referral to a psychiatrist for further examination Treating Pediatric Patients with Mood Disorder.
ORDER YOUR PAPER HERE
As the healthcare professional observes, the boy seems to be alert and well-oriented (x3), and his speech appears to be coherent and clear. During the examination of his psychological state, he also seemed to be goal-oriented and impetuous. Despite keeping his demeanor reserved, he may be seen grinning and nodding when the situation calls for it. However, the child admits to thinking about death and what it could appear as, but denies having any verbal or auditory hallucinations or suicidality. It was determined that he was suffering from major depressive disorder, as indicated by a score of 30 on the rating scale.
Decision #1: Begin Zoloft 25mg Orally Daily
Zoloft was chosen because it is a selective serotonin reuptake inhibitor (SSRI), which has proved to be particularly successful in treating mood disorders (Stern et al., 2016). To begin zoloft treatment, youngsters should be given dosages ranging from 25 to 50 milligrams daily, with a typical upper limit of 100 to 200 milligrams per day (Stern et al., 2016). Studies demonstrate that the antidepressant SSRIs are particularly effective, with around 80% of youngsters showing some signs of improvement after less than a year of treatment. The client should take SSRIs for at least four to six weeks before deciding that they are ineffective, then wait for a minimum of 8 weeks to see whether their benefits outweigh the risks (Stern et al., 2016)Treating Pediatric Patients with Mood Disorder .
It was not prudent for me to select Wellbutrin because it has been linked to an increased risk of suicidal ideation in children under the age of 13. Negative effects, including restlessness, dizziness, nausea, and vomiting, have also been seen. Other digestive issues have also been linked to it. I also did not choose Paxil because there is presently no proof that it is useful in treating MDD in children, and the medication is not definitively approved to be used in this population. This is because it is associated with suicidality and aggression (Nevels et al., 2016).
I was hoping to lower the client’s current depression score of 30 by at least 50% by administering Zoloft (Stern et al., 2016).
In regards to ethical considerations, practitioners should examine whether or not they aim to stigmatize their patients for the long term while administering medication to children. This means that the child should rely on drugs and medical specialists instead of their own abilities to deal with their problems. Moreover, the stigma attached to using psychotropic medicines may have an influence on a child’s future opportunities.
Decision #2: Increase the Dose of Zoloft to 50mg Orally Daily
Because it is expected that depression symptoms would not get better, this decision was taken. (Stern et al., 2016). As previously said, it takes four to six weeks for Zoloft to have its full effect. In this case, the practitioner may increase the dose since there was no change at the 25mg dose and check back in 4 weeks to examine if the manifestations have eased.
Rather than 37.5 mg, I went up to 50 mg, considering Zoloft’s starting doses are typically 25mg or 50 mg per day (Stern et al., 2016)Treating Pediatric Patients with Mood Disorder . Going from Zoloft to Prozac at this stage would be a bad idea as it has not had enough time to show its effectivenes.
A considerable reduction in the client’s symptoms was what I wanted to achieve. An important idea here is that an already-functioning medication will be more effective at higher doses (Stern et al., 2016).
The evaluation of treatments and the use of such parameters to determine the amount of treatment effect are crucial for my choice and expectation (Lorberg et al., 2019). Using the evidence and my patient’s responses, I did exactly this when I opted for an increase in dosage. When the FDA declared a public health notice in 2003 citing an increase in suicide thoughts among youngsters who were taking antidepressants, it became mandatory to place a “black box” warning on their packaging (Hirsch, 2018). This is an ethical decision that must be made and evaluated when prescribing antidepressant drugs to young patients.
Decision #3: Increase the Dose of Zoloft to 75mg Orally Daily
I made this decision because a 50% decrease in symptoms occurred within four weeks of raising the dosage to 50 mg, and the client is using the medication as prescribed. There is the possibility that increasing the dosage from 50 mg to 75 mg might help alleviate depressive symptoms even more. 25 mg to 200 mg of Zoloft are the most often prescribed dosages for the treatment of depression (Stern et al., 2016). Therefore, it is not uncommon to increase the dose from 50 mg to 75 mg, and this patient may benefit from it.
In light of the typical suggested dose range, I opted not to maintain the dose but to increase it from 50mg to see whether it had a substantial effect. As long as the SSRI is working, I do not believe it’s necessary to switch to an SNRI.
ORDER TODAY
Ethical considerations must be taken into account while prescribing psychiatric medications. The longer and earlier a child is on medication, the greater the influence it has on the development of their brains (Lao et al., 2018). SSRIs, in fact, have been proven to increase the risk of mania and suicidal ideation in several studies (Lao et al., 2018). It is also an ethical matter to consider race and ethnicity. This is because the pharmacokinetic and pharmacodynamic characteristics of each ethnic group have been shown to vary (Baehr et al., 2015)Treating Pediatric Patients with Mood Disorder . Conclusion
Zoloft 25 mg once a day was my first choice. SSRIs have been shown to be really useful to children, so I chose this medication. Because research suggests that most individuals don’t see a decrease in symptoms for four to six weeks, I decided to raise the dosage to 50mg. Considering the client demonstrated a considerable improvement in symptoms, I decided to raise my dose to 75 mg, which has been considered a favorable response to therapy. After four weeks of monitoring, it is recommended that this dosage be kept in place in case further improvements take place. It may be necessary to increase the dose again if full recovery is not achieved; the patient must be told of the advantages and risks of such practice. When the patient is involved in making decisions about the treatment regimen, they are more likely to be satisfied with the outcome. No changes in drug therapy are required as SSRI is an efficient and safe medication, and the client is responding well to it and is on his way to a complete recovery.
References
Baehr, A., Peña, J. C., & Hu, D. J. (2015). Racial and ethnic disparities in adverse drug events: A systematic review of the literature. Journal of Racial and Ethnic Health Disparities, 2(4), 527-536. https://doi.org/10.1007/s40615-015-0101-3
Hirsch, G. S. (2018). Dosing and Monitoring: Children and Adolescents. Psychopharmacology bulletin, 48(2), 34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875361/
Lao, K. S., Chui, C. S., Man, K. K., Lau, W. C., Chan, E. W., & Wong, I. C. (2018). Medication safety research by observational study design. International Journal of Clinical Pharmacy. https://doi.org/10.1007/s11096-016-0285-6
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
Nevels, R. M., Gontkovsky, S. T., & Williams, B. E. (2016). Paroxetine—the antidepressant from hell? Probably not, but caution required. Psychopharmacology bulletin, 46(1), 77. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044489/
Stern, Favo, Wilens, & Rosenbaum. (2016). Antidepressants. In Massachusetts general hospital psychopharmacology and neurotherapeutics (1st ed., pp. 27–43). Elsevier Treating Pediatric Patients with Mood Disorder
Therapy for Pediatric Clients with Mood Disorders An African American Child Suffering From Depression African American Child BACKGROUND INFORMATION The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression. Client complained of feeling “sad” Mother reports that teacher said child is withdrawn from peers in class Mother notes decreased appetite and occasional periods of irritation Client reached all developmental landmarks at appropriate ages Physical exam unremarkable Laboratory studies WNL Child referred to psychiatry for evaluation Client seen by Psychiatric Nurse Practitioner MENTAL STATUS EXAM Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead. The PMHNP administers the Children’s Depression Rating Scale, obtaining a score of 30 (indicating significant depression) RESOURCES § Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale–Revised. Los Angeles, CA: Western Psychological Services. Decision Point One Select what the PMHNP should do: Begin Zoloft 25 mg orally daily Begin Paxil 10 mg orally daily Begin Wellbutrin 75 mg orally BID