Background
The client in the present scenario is an 8-year-old African American male who presents with signs of depression. Some of the reported symptoms include; feeling of sadness, occasional irritation, and decreased appetite. The score obtained upon the administration of the Children’s Depression Rating Scale indicates significant depression. This text concerns itself with three decisions relating to the medications prescribed for the 8-year-old.

Discussion

I. Zoloft

Decision Point 1: Begin Zoloft 25 mg orally daily

Studies conducted in the past have indicated that for children and adolescents suffering from depression, Zoloft (Sertraline) happens to be largely effective. According to Hritzak and Culhane (2004), “Sertraline (Zoloft) is effective and generally well tolerated for the short-term treatment of major depressive disorder in both children and adolescents” (17). In essence, Sertraline, which is essentially an SSRI, impacts unbalanced brain chemicals in persons suffering from anxiety disorders, panic disorders, as well as depression. Low serotonin levels are often responsible for depression. Thus, Zoloft comes in handy in the restoration of serotonin levels in the brain.

In the present scenario, I selected a dose of 25 mg daily because the client in this case is an 8-year-old. 50 mg daily happens to be the standard dose for adults. The dose selected in this case would also permit me to raise the dose in the course of time as needed. I would in this case expect a favorable change in depressive symptoms during the next appointment.

The results of decision point one indicate that the client returned to the clinic in 4 weeks and there was no change in the symptoms of depression. In this case, it appears that the 25 mg daily dose was low.

Decision Point 2: Increase dose to 37.5 mg orally daily

The decision to increase the dosage in this case is based on the client’s progress thus far. Depressive symptoms have not changed at all. The age of the client was still taken into consideration in the decision to increase the dosage to 37.5 mg orally/day instead of 50 mg orally once/day. It is expected that the client will be exhibiting favorable change (20%-25%) in depressive symptoms during the next visit.

The results of decision point 2 indicate that there was a 20% decrease in depressive symptoms. Further, the 8-year-old also points out that they feel somewhat better. The present change could be attributed to the increase in dosage of 25 mg orally/day to 37.5 mg orally/day. As it has been pointed out elsewhere in this text, the initial dose selected gave room for an upward variation of dosage in the course of time as necessary – titrating over a period of time to the max dose depending on the outcomes.

Decision Point 3: Increase to 50 mg orally daily

The decision to increase dosage in this case is based on the results of decision point 2 where an increase in dosage from 25 mg orally daily to 37.5 mg orally daily resulted in a 20% decrease in depressive symptoms. It is expected that during the next visit, the client will exhibit a 40%-50% decrease in depressive symptoms.

The results of decision point 3 indicate that there has not been sufficient...…Baumeister, and Tracy, 2016, p. 122). I would expect to see a significant relief in the depressive symptoms when the client returns to the clinic.

The results of the decision part 1 indicate that upon his return to the clinic, it was reported that the 8-year-old experienced difficulty sleeping at night. This outcome, as Milev (2015) points out, could be attributed to the drug’s twice a day dosing. As the author points out, “the twice a day dosing may result in complaints of insomnia and may necessitate discontinuing the medication or adding a sleep promoting agent” (Milev, 2015). In the present case, I will thus consider the extended release 150 mg orally/day (morning).

Decision Point 2: Change from immediate release to extended release 150 mg orally daily in the morning

As it has been pointed out above, the twice (two timed) a day dosing has been associated with insomnia complaints. The decision made in this case is therefore an attempt to normalize sleeping patterns without necessarily interfering with therapeutic gains.

The results of decision 2 indicate that following his return to the clinic, the sleep patterns of the client had returned to baseline. It should however be noted that in as far as depressive symptoms were concerned, there was no change exhibited. Towards this end, I would consider increasing the dosage.

Decision Point 3: Increase dose to 300 mg orally daily

This decision was made as the previous dosage did not result in meaningful decrease in depressive symptoms. Thus, in this case, an increase in dosage (and further monitoring) would be more appropriate than switching to an SSRI.…