Major Depressive Disorder Therapy for Patients

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 He complains of sad feelings, regular irritation, and lack of appetite, and the mother reports he is withdrawn from classmates.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 one month later with no significant change in the depressive signs.

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

Ethical considerations sometimes tend to limit our discretion in administering treatment plans, even though the patient recorded a deep depression level at a score of 30. The first dosage of Sertraline had to remain low to comply with ethical standards. However, the low dosage was likely to induce no significant positive change.

Decision #2

Which decision did you select?

Sertraline 50 mg by mouth daily

Why did you select this decision?

Daily admission of Sertraline to 50 mg by mouth will be appropriate for the patient since the initial dosage of 25 mg failed to achieve the desired results (Stahl, 2021). Sertraline dosage can be titrated up until 200 mg as is deemed appropriate. Increasing the dose enhances brain serotonin balance to reduce depressive signs.

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

Sertraline 37.5 and Prozac 10 mg by mouth daily

Sertraline can also be administered at 37.5 mg daily. However, following the patient's clinical status, this dose was considered therapeutic consideration (Stahl, 2021). Also, Prozac, though very effective in treating depression, is not presently approved for younger children due to reports of increased suicidal conduct (Stahl, 2014). Further, it was considered ethical to continue with the current medication until it can be considered ineffective, even on a higher dosage or upon clearing all depression symptoms.

What were you hoping to achieve by making this decision?

The decision to increase sertraline dosage aims to induce serotonin balance in the brain. Hence, addressing the depression challenge by enhancing the patient's mood. As was advised, the patient reported back one month later with improvement, recording around a 50% reduction in depression symptoms (Stahl, 2014). Even though the signs were not entirely clear, a positive trend was marked.

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

According to ethical standards, children are not allowed to consent to any treatment plan. Therefore, because the patient was a male child, information on treatment, including the anticipated outcome and side effects of administering particular drugs, could only be communicated to the mother. Hence, limiting direct conversation between the patient and the physician. The mother also had to monitor his progress from time to time and report back to the physician.

Decision #3

Which decision did you select?

Maintaining current dose of Sertraline 50 mg

Why did you select this decision?

The decision to continue with the current drug dosage was informed by the improvement experienced by the patient within the last month upon dosage review (Stahl, 2021). It is an excellent clinical practice not to change the treatment plan whenever a patient is experiencing a significant positive change in current drugs (Stahl, 2014). Moreover, the patient's positive response to the current dosage implied it was the optimum dosage to reduce depression symptoms on the patient minus posing adverse effects.

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

Increase dosage to daily Sertraline 75 mg by mouth or Shift to SNRI.

Since the patient had presented the desirable progress outcome of a 50 percent reduction in depression symptoms, there was no need to increase the dosage to Sertraline 75mg (Stahl, 2021). It is an excellent clinical practice not to change the treatment plan whenever a patient is experiencing a significant positive change in current drugs (Stahl, 2014). Besides, the standard Sertraline dosage for children is 50 mg daily for depression and mood disorders. Therefore, increasing the dose past 50 mg may reduce the symptoms but can lead to patient intolerance and adverse effects like suicidal urges (Simon et al., 2015). Moreover, shifting to SNRI could only trigger more adverse effects, leading to new challenges that require fresh medicinal approaches.

What were you hoping to achieve by making this decision?

Ultimately, after the depression was reduced by 50 percent, we anticipated a more positive outcome within the next month, culminating in total symptoms remission. Nevertheless, the expected results were not attained one month later (Stahl, 2021). Also, considering that a 50% reduction in depression symptoms was not in complete remission, it was indicative that the patient had a positive response to medicinal therapy, dismissing the need to change the drug. Subsequently, the 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.