Depressed Child

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depressedchild6630.pdf

Running Head: CASE STUDY: AN AFRICAN AMERICAN CHILD SUFFERING FROM DEPRESSION

Case Study: An African American Child Suffering from Depression

Lorna Isaac

NURS 6630

February 29, 2020

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2 Case Study: Depression Child

Case Study: An African American Child Suffering from Depression

In the scenario of an 8-year-old African American male showing signs of depression, the

pt is feeling sad, with symptoms of withdrawing from peers, decreased appetite, occasional

irritation, and a somewhat blunted affect. Patient states he does think about himself being dead.

The patient scored 30 on the Children's Depression Scale, signifying significant depression.

Decision 1

The first medication course chosen was Zoloft 25mg. Many providers, myself included,

would want to start a patient of this age on a low dose due to the patient’s need for more

development. For treatment, in this case, Zoloft is an off-label drug. This means it is not

approved by the Food and Drug Administration (FDA) to manage conditions in children or

adolescents; however, it is used because randomized controlled trials (RCTs) have proven the

benefits outweighed the risks. Research shows that Zoloft is safer and is the better choice to treat

mood disorders in children (IACAPAP, 2016). Four weeks after starting this medication, I expect

to see some kind of improvement in patient symptoms such as improved appetite, improved

affect, more socialization, and better concentration, etc. If no improvement and no adverse

effects, then this could indicate the patient is just not on the appropriate therapeutic dose and this

should be adjusted, or the medication has not had enough time to fully take effect (National

Alliance on Mental Illness, 2017).

Decision 2

Upon returning to the clinic for a four-week follow-up, the patient reports no

improvement in symptoms at all, so the expected result was not attained. No adverse effects are

noted, however, so the same medication will be increased. The new dose will be Zoloft 50mg PO

QD. Once this decision is made, the family/patient should be educated on the new dose, risks,

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3 Case Study: Depression Child

expected outcomes, goals, when to call or come back in, etc. The patient should be monitored

closely for suicidal ideations, etc. (National Alliance on Mental Illness, 2017). The difference in

the expected result and actual result is more than likely due to the low dose the patient was

initially given, but the dose increase should remedy this situation. The expected result would be

that the patient will have a reduction in depressive symptoms. If this is the actual outcome, it

would be evidenced in increased peer interaction, better quality sleep patterns, and improved

appetite and academic performance (American Psychiatric Association, 2018). If this is not the

outcome, then again, the therapeutic dose may not be achieved or possibly the medication is not

the right one for this particular patient.

Decision 3

When the patient arrived for the next 4-week follow-up, depressive symptoms were

improved by 50%, and the patient is tolerating the medication well. Pt is responding well to

therapy so the current dose should be maintained. This decision was made to see if there is an

additional reduction in symptoms. Keeping patients on the lowest therapeutic dosage would be

ideal, especially considering patient age, and this would keep the risk of suicidal tendencies

lower. An increased dose may be needed in the future if symptoms do not continue to improve,

but this is not expected. At this time, there is no need to make any changes to the current

medication or plan of care. Discussing this and the possibility of an increased dose with the

patient will help make the patient feel empowered and keep him from feeling discouraged if the

lower treatment does not further reduce symptoms. (National Alliance on Mental Illness, 2017).

If the dose does need to be increased and some unwanted symptoms do occur, it may be possible

to treat these symptoms and allow the pt the continue with the same medication.

Ethical considerations

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4 Case Study: Depression Child

The side effect of suicidal behaviors or ideation is the most important purpose for

monitoring these types of patient’s so closely when an antidepressant is prescribed (Mitchell et

al., 2014). Knowing this, providers who are considering the treatment of antidepressants must

consider the risk of this side effect compared to the clinical need for the antidepressant. The

ethical concerns can be classified as a combination of thought analysis and principles of treating

this condition.

Suicidal tendencies are a common side effect with most any antidepressant medication.

This is the reason the FDA requires all pharmaceutical companies to add this caution to the labels

(Sondheimer, 2010). The FDA regulation also prohibits children under the age of 18 years old

from making their own treatment decisions with antidepressants without parental consent

(Sondheimer, 2010). Because of this, the parent must understand the proposed treatment so that

permission can be obtained. In some instances, such as harm to others, the consent of the parent

is not needed. This treatment would be an off-label use of Zoloft, so this would constitute a

greater need for education of patient and parent so unwanted effects can be avoided or quickly

detected.

Due to the lack of knowledge and understanding surrounding mental illness, many people

believe it is a personal weakness, punishment handed down by God, or merely an act put on by

the sufferer. This makes it more difficult for the victim to seek treatment or adhere to treatment.

In addition to this, many medications take weeks to take effect, which makes adherence to a real

problem. Many people will stop taking the medication when they do not see improvements

quickly. Research shows that the adherence rate is 34% to 38% for SNRIs and approximately

25% for SSRIs in the year after initiation with about 30% of patients discontinued

their medication within 30 days (Liu et al., 2011).

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5 Case Study: Depression Child

African Americans are at a much higher risk of experiencing mental health problems than

the general population (African Americans, 2018). Not only are African Americans 20% more

likely to suffer from these types of conditions, but they also experience more severe forms

because of unmet needs and other barriers as well as being at an increased risk of being exposed

to factors that can trigger mental health issues (African Americans, 2018).

Conclusion

The FDA recommends the least amount of medications possible be prescribed to reach a

therapeutic dose to help reduce the risk of overdose, either deliberate or accidental. Close

monitoring by all parties involved in care is imperative for any child taking any kind of

antidepressant. The legalities in treating this population have increased due to the uptick in

national awareness. As a PMHNP consistently reading the latest research to understand the best

treatments as well as any legal or ethical issues that may arise.

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6 Case Study: Depression Child

References

African Americans. (2018). Retrieved February 29, 2020, from https://adaa.org/african-

americans

American Psychiatric Association (2018). Practice guideline for the treatment of patients with

the major depressive disorder (3rd ed., pp. 152). Arlington (VA): 1 American Psychiatric

Association (APA). 2 Retrieved from

https://www.guideline.gov/summaries/summary/24158?

1 American Psychological Association. (2016). 1 Psychotropic Medications for Children and

Adolescents. Retrieved from:

1 http://www.apa.org/pi/families/resources/child-medications.pdf.

Anxiety and Depression Association of America. (2016). 1 Anxiety and Depression in

Children. Retrieved from:https://adaa.org/living-with-anxiety/children/anxiety-and-

depression International Association for Child and Adolescent Psychiatry and Allied

Professions.

Bennet, N. (2016). 5 Legal and ethical issues related to the prescription of psychiatric medication

to children (and teens). Retrieved from https://www.ohsu.edu/xd/health/for-healthcare-

professionals/telemedicine-network/for-healthcare-providers/ohsu-echo/upload/Legal-

and-Ethic-issues-treating-C-and-A-mental-health-Bennett-N-2016.pdf

De Vries, Y. A., De Jonge, P., Kalverdijk, L., Bos, J. H., Schuiling-Veninga, C. C., & Hak,

E. (2016). 5 Poor guideline adherence in the initiation of antidepressant treatment in

children and adolescents in the Netherlands: choice of antidepressant and dose. European

Child & Adolescent Psychiatry, 25(11), 1161-1170. Retrieved from https://web-b-

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7 Case Study: Depression Child

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