Therapy for Patients with Major Depressive Disorder

According to psychiatrist Fernando of Johns Hopkins Department of Psychiatry and Behavioural Sciences, the prevalence of mood disorders in the United States is far higher than one can imagine. Irrespective of the socioeconomic status, about 21.3% of children experience a mood disorder. In line with the National Alliance on Mental Illness, the most common mood disorders are bipolar and depression (Gordon et al. 2014). Whenever a mood disorder is not detected and treated, the child can be at risk of conditions like substance use disorder and disruptive behavior. Adolescents and children suffering from mood disorders do not express similar symptoms as adults; therefore, parents may fail to detect the problem in their children. Treatment of mood disorders ranges based on particular signs and symptoms of depression. Proper treatment requires a full assessment of mental health history, and pharmacological interventions should form part of the treatment plan.

Summary of the patient's case scenario.

An 8-year-old male patient of African American child reports to the hospital with depression signs. He complains of sad feelings, regular irritation, and lack of appetite, and the mother reports he is withdrawn from classmates. After an assessment, the overall mood is established to be sad; however, the child has clear speech, alert and oriented. He also refused auditory or visual hallucinations. There was no paranoid or delusional thought process established. Insight and judgment seemed to be per the age. He accepts that he usually imagines himself dead and what it would mean. However, he denied active suicidal thoughts. The PMHNP report recorded the child's depression rating score at 30. An indication of substantial depression.

Decision #1

Which decision did you select?

Sertraline 25mg by mouth daily.

Why did you select this decision?

25 mg of Sertraline (Zoloft) is given as the initial dosage. The drug is administered at a lower dosage because whenever antidepressants are used for the first time, they tend to increase anxiety (Stahl, 2014). The drug treats severe Panic Disorder, Obsessive-Compulsive Disorder, Depressive disorder, Premenstrual Dysphoric Disorder, Posttraumatic Stress Disorder, and Social Anxiety Disorder. The drug can administer with other medications or alone and belongs to the Antidepressants class of drugs (Gordon et al. 2014). Studies show that Sertraline has indicated a response rate of 50-70 percent in treating depression in children. Moreover, Sertraline enhances mood by restoring serotonin balance in the brain mainly.

Why did you not select the other two options provided in the exercise?

Daily Paxil 10 mg by mouth and Wellbutrin 75mg by mouth twice daily.

Paxil is a commonly used prescription drug for treating depression in children. The drug is a potent 5-HT receptor inhibitor. It is also slightly metabolized by cytochrome P450 (2D6) (Stahl, 2021). It has successfully treated panic disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and depression (Stahl, 2014). However, studies have found the drug to be an inherent risk of suicide, and any patients taking the drug should be screened for suicide attempts (Lorberg et al., 2019). Following the current assessment state of our patient, this drug is considered unsafe.

Wellbutrin, on the other hand, may result in behavior changes like depressed moods, suicidal thoughts, agitation, or hostility. These side effects, particularly suicidal thoughts, are much higher in children (Stahl, 2014). Thus, our reason for avoiding administering it is following the fact that our patient has already indicated signs of attempting suicide.

What were you hoping to achieve by making this decision?

Sertraline aims to induce serotonin balance in the brain, hence addressing the depression challenge by enhancing the patient's mood (Stahl, 2021). Nevertheless, the patient returned to the hospital...

…following action should be to seek psychotherapy to supplement the medication in use (Stahl, 2021). The decision is prompted by ethical consideration that a patient has already presented a positive response to medication whose dosage cannot be increased (Stahl, 2014). Psychotherapy is therefore recommended as a complement to provide more positive outcomes.

Explain how ethical considerations may impact your treatment plan and communication with patients.

Ethical consideration, in this case, would limit the increase of sertraline dose to 75 mg even if it could further lead to a further reduction of symptoms. Ethics do not allow practitioners to administer drugs beyond the standard dose (Stahl, 2014). Also, communication to the patient's family on the exact truth about their son's medicinal situation must be made compassionately (Stahl, 2021). For instance, they must be informed that further medication without psychotherapy may not bear further fruit.

Conclusion

Children can sometimes express irritability as part of their developmental process. However, parents should be careful to watch some critical signs like isolation from peers or classmates, complaining about receiving hate from other children, and feeling of being rejected. Such signs are, in most cases, early indicators of anxiety (Gordon et al., 2014). Caregivers, teachers, and parents should therefore be conversant with what a typical teen behavior looks like to prevent any future health disorders.

On the other hand, 25 mg of Sertraline (Zoloft) was given as the initial dosage. The drug is administered at a lower dosage because whenever antidepressants are used for the first time, they tend to increase anxiety. Also, increasing the dose to daily admission of Sertraline to 50 mg by mouth was appropriate for the patient, for it is the standard dose for children (Stahl, 2021). Finally, continuing with Sertraline 50 mg daily intake was ethically informed since the patient had already…