Week 2 Assignment: Assessing and Treating Pediatric Clients with Mood Disorders

Depression is considered an affective disorder due to its effect on the internal emotions and external mood seen by others (Stahl, 2013). Symptoms of depression include generalized sadness which can lead to feelings of guilt, fatigue, anxiety, poor concentration, changes in sleep pattern, increased or poor appetite and social isolation among many others. It is theorized that the cause of depression is due to a deficiency of monoamine neurotransmitters which are responsible for the amount of norepinephrine, serotonin and dopamine in the brain (Stahl, 2013). When treating a patient with depression, medications generally target this deficiency in hopes to provide relief from the symptoms the client is experiencing. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD.
Case Study Information
The case study presented this week consists of an 8-year-old African American male presenting to the emergency department with mom due to increased feelings of sadness, withdrawn behavior in school, decreased appetite and occasional agitated behaviors (Laureate Education, 2016e). While the physical examination and laboratory studies were within normal limits, the mental status exam proved to be normal with reported “sad” mood, blunted affect but appropriately smiled at times and endorses thoughts of passive suicidal ideation (Laureate Education, 2016e). The client scored a 30 on the Children’s Depression Rating Scale, indicating significant depression (Laureate Education, 2016e).
The purpose of this assignment is to consider the 8-year-old client and information and make three decisions concerning medications to prescribe to the client. Each decision offers multiple options to choose from. Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD. The decision will be chosen based on evidence consisting of recent academic resources and research studies along with a rational for why the other two options were not chosen. Each outcome will be discussed based on if it was expected or not and what the next step will be. Lastly, ethical considerations will be discussed and how they may impact the treatment plan for the client and the communication with the client and his family.
Decision One
The first decision point the Psychiatric Mental Health Nurse Practitioner (PMHNP) must choose which medication the client will start. The medications to choose from include Zoloft (sertraline) 25 mg by mouth daily, Paxil (paroxetine) 10 mg by mouth daily, and Wellbutrin (bupropion) 75 mg by mouth twice daily (Laureate Education, 2016e). As the PMHNP caring for this client, Zoloft 25 mg daily would be the first choice of therapy for this patient. Selective serotonin reuptake inhibitors (SSRIs) are known to be the first line of treatment for children with depression (DeFilippis & Wagner, 2014). While sertraline and paroxetine are both SSRIs, sertraline is FDA approved when treating children whereas paroxetine has been found to be affective when treating children with depression, it is not specifically approved by the FDA at this point in time (Stahl, 2014b). Sertraline is approved by the FDA for use in children with depression beginning at the age of six (Stahl, 2013). Additionally, paroxetine is not recommended in use for children due to its short half-life which can lead to withdrawal when the medication is stopped abruptly (Nathan & Gorman, 2015).
The safety and efficacy of bupropion have not been established thus far but it some research that has been done suggests that this medication is effective for treatment of a client with both attention deficit disorder and depression, something that the client in this case study does not exhibit (Stahl, 2014b). Assessing and Treating Clients With Attention Deficit Hyperactivity Disorder – Young Girl With ADHD. Research has also shown that often the placebo effect alone on prescription medications can play a part in reduction of depressive symptoms in both children and adults (DeFilippis & Wagner, 2014).
As a new prescriber, I would most likely make a cautious decision when treating a child for the first time. Due to the fact that sertraline is FDA approved in the treatment of depression in children, I would most likely go with that medication as a primary action for prescribing for this client. The goal of this treatment is to alleviate depressive symptoms in the client while minimizing the risk for side effects of the medication.
When the client returned to the clinic four weeks after starting on Zoloft 25 mg daily, there was no change in the depressive symptoms at all (Laureate Education, 2016e). I am surprised that there was absolutely no change given the fact that the effects can be either medicinal or placebo, with changes seen as early as a week into the medication trial (Nathan & Gorman,