Depressed Child
Olayinka1
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
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7 Case Study: Depression Child
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