Depression In an 8-Year-Old Child

Depression In an 8-Year-Old Child

Introduction

Major depressive disorder is a pediatric health problem that can significantly impair social functioning. Many treatment options have been developed to help in managing such cases. These drugs are called antidepressants, just as their name suggests.

For this paper, the patient in the case study is an 8-year-old child with depression. The patient is referred for psychiatric evaluation after he complained of feeling sad. His teachers report that he is withdrawn from his peers. The mother also notes a decrease in appetite and occasional periods of irritation. To manage this patient, various decisions will have to be made. The symptoms can be managed pharmacologically. The choice of medication will mostly be influenced by the fact that the patient is a pediatric patient. Also, how the patient tolerates and responds to the medication will help to determine the best course of action when managing this patient. All these are due mostly to the fact that minimal research has been done when it comes to choosing the best medication for pediatric patients.

Decision 1

Several drugs have been developed over the years for the treatment of depressive disorders. Selective serotonin reuptake inhibitors (SSRI) are generally indicated as the first-line treatment for depression (Charles, 2017). Sertraline (Zoloft), being an SSRI, is, therefore, the best choice for the treatment of this patient. The starting dose would be 25mg PO daily. The mechanism of action of SSRIs is that they inhibit the reuptake of serotonin in the brain, therefore increasing their concentration in the brain and serotonin activity. SSRIs have little to no effect on other brain neurotransmitters, such as norepinephrine and dopamine. Because depression is associated with the depletion of the serotonin levels in the brain, symptoms are greatly improved by SSRIs because they exert their action by countering this effect. SSRIs replace the depleted levels of serotonin in the brain.

Even though paroxetine is an SSRI, it was not chosen because its efficacy and safety have not been established in children. Buspirone was not selected because SSRIs are the first-line choice of antidepressants in children (Charles, 2017). Furthermore, buspirone is not as well tolerated as sertraline. With Zoloft 250 mg, it is expected that the symptoms manifested by the patient will gradually clear away. It is also expected that the children’s depression rating scale score would significantly reduce, therefore indicating an improvement in the symptoms. Zoloft has been shown to be effective in the treatment of depression in children (Walkup, 2017). It is also expected that Zoloft should have minimal side effects, and evidence shows that SSRIs are well tolerated (Locher et al., 2017). The expected outcome isn’t that different because when the patient comes back for a review, he manifests some improvement in the symptoms. This shows that even though it is just a partial improvement, the patient is still responding to treatment.

Decision 2

The chosen second decision is to maintain the patient on the same medication, Zoloft, but to increase the dose to 50mg PO daily. The choice for this decision is mainly attributed to the fact that the children’s depression rating scale score dropped by 50%. This indicates a response to treatment but only partially. This is a positive sign as it shows that the initial medication works, so the most logical thing would be to increase the dose from 25mg to 50mg. This increase will increase the availability of serotonin, which improves symptoms of depression. Evidence supports the increase of the dosage if the initial response to treatment is not satisfactory (Walkup, 2017). Another reason for choosing this decision is due to the fact that the patient tolerates Zoloft well with minimal side effects. With the increase in dosage, it is expected that the symptoms will continue to reduce (Clevenger et al., 2018). The children’s depression rating scale score is also expected to drop significantly.

Increasing the dosage of Zoloft 25mg to 37.5mg was not chosen because it is recommended that the dosage should be increased gradually by 25 MG. This is so as to ensure the patient shows significant improvement in symptoms with few adverse effects. On the other hand, the option to continue the patient on the same dose was not chosen because the patient had only partially responded to this initial treatment. It is, therefore imperative to increase the dosage so as to elicit a more positive response from the patient (Charles, 2017).

The decision to change the drug to Prozac 10mg was not taken because the patient already showed an improvement of symptoms. Changing the drug at this point would not make sense as the period of trial with the current drug is not enough to provide enough evidence that warrants a change.

Decision 3

The third decision is to increase the dose of Zoloft to 75 mg PO daily. This is because the patient is showing an improvement in the symptoms on the current dose. This is indicated by a significant reduction in the children’s depression rating scale score. The subjective data also shows an improvement in the patient’s condition. This shows that the patient is responding adequately to the treatment on the current dose. The patient also does not report any side effects with the medication and is tolerating it well. Clinical guidelines recommend that medication should be titrated according to the patient’s response. The patient responds well to the previous dosage. An increase is warranted because the patient has not shown full remission yet, as only part of the symptoms have improved. (Jakobsen et al, 2017).

The option to change to other alternative medications was not taken because of the satisfactory response to 50 mg. The expectation of increasing the dosage to 75 mg is for the client to improve even more and show a complete response to treatment (Locher et al., 2017). The patient should exhibit no symptoms, and the patient should report this as well. The children’s depression rating scale score is expected to reduce significantly.

Ethical considerations

Ethical considerations for this patient will encompass patient education, informed consent, modification of dosage, proper administration, patient autonomy, and confidentiality. First, it is essential to educate the patient on his condition and what to expect during medication and after. It is at this point that the patient should be enlightened about the potential side effects of the drug. This will help the patient to understand that he might need to stick to a certain medication even if he doesn’t want it.

Secondly, it is important to obtain informed consent from the patient before commencing any treatment. The patient should be aware of all the necessary information before agreeing to treatment. Also, the patient’s privacy should be respected. This means that any information about the patient, his condition, and treatment should be kept confidential and should not be disclosed to anyone without the patient’s permission.

Modification of a dose for any disorder is an ethical consideration. This allows for the appropriate adjustment of doses according to the patient’s condition. Proper administration is also a consideration, as it reminds physicians to follow the instructions recommended for any particular drug. For instance, when increasing the dosage of sertraline, it should be titrated by small margins from the previous dosage. Lastly, the patient holds all the right to accept or decline any treatment, and therefore, patient autonomy should be respected. The patient should be able to accept or decline treatment and should not be coerced. Any decision the patient makes should be respected.

Conclusion.

Major depressive disorder is a pediatric health problem that can significantly impair social functioning. Many treatment options have been developed to help in managing such cases. These drugs are called antidepressants, just as their name suggests. For this paper, the patient in the case study is an 8-year-old child with depression. The first decision to manage this patient was to start him on Zoloft (sertraline) 25mg PO daily. The rationale was that SSRIs are the preferred first-line treatment for depression in pediatrics. (Charles, 2017).  This decision yielded a slight improvement in the patient’s symptoms, and therefore, a second decision had to be made. The second decision was to increase the dosage to 50 mg PO daily. By increasing the dose, a satisfactory response would be elicited. The third decision was to further increase the dose to 75 mg because the patient was responding well to the previous dose, as shown by the reduction in the children’s depression rating scale score and reduced symptoms. Increasing the dose was justified by the fact that the patient only showed partial remission of symptoms.  Finally, there were ethical considerations for the management of this patient, and these included patient education, informed consent, modification of dosage, proper administration, patient autonomy, and confidentiality.

References

Charles, J., & Fazeli, M. (2017). Depression in children. Australian Family Physician, 46(12), 901.

Clevenger S, Devvrat M, Dang J, Vanle B & William I. (2018). The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Ther Adv Psychopharmacology. 8(1): 49–58. Assessing and Treating Clients With Anxiety Disorders Sample Essay.

Jakobsen J, Kumar K, Timm A, Gluud C, Ebert E et al. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry. 17(58).

Locher, C., Koechlin, H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I. & Kossowsky, J. (2017).
Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Psychiatry. 74(10), 1011–1020.

Walkup, J. T. (2017). Antidepressant efficacy for depression in children and adolescents: industry-and NIMH-funded studies. American Journal of Psychiatry, 174(5), 430-437

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The Assignment: 5 pages
Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.

At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature.
Introduction to the case (1 page)