The patient in the described scenario is an 8-year-old African American boy who comes to the emergency room with his mother. He is displaying depressive symptoms. The mother claims that the instructor claimed the patient was socially detached from classmates in class, had a decreased appetite, and occasionally became irritable. The patient complained of feeling depressed. The client met all developmental milestones at the proper ages. The results of laboratory tests are typical.
The youngster was sent for assessment in psychiatry. The patient is oriented, clear, alert, coherent, spontaneous, and goal-directed. Sadness was the self-reported mood. Throughout the clinical interview, the affect was a little muted, although appropriate smiles were made at certain times. Hallucinations, both audible and visual, are denied. There were no signs of paranoid or delusional thinking. It seems that understanding and judgment are age appropriate. He acknowledges that while he does occasionally consider death and what it might be like to be dead, he is not advocating actual suicidal thoughts.
I selected the first treatment option as Zoloft 25 mg orally daily for depression.
Reason for Decision 1#
Adults, toddlers, and adolescents can all develop major depressive illness. Researchers have found that it is suitable for doctors to administer an SSRI in addition to supportive treatment or a course of psychotherapy for children and adolescents with persistent moderate to severe depression or anxiety symptoms and have an obvious functional impairment (Hengartner, 2020).
In the described situation, the patient displays functional impairment, such as a youngster who isolates himself from classmates, a decreased appetite, and sporadic episodes of irritability. The first step for a child or an adolescent with mild depressive and/or anxiety symptoms should be supportive treatment that includes psychoeducation, sleep hygiene, practical problem-solving, including self-help materials, along with family and/or school interventions if needed.
The recommended medication enhances mood, sleep, appetite, and energy levels while also potentially reviving enthusiasm in everyday activities. It could lessen anxiety, dread, unwelcome thoughts, and panic attacks. Additionally, it could alleviate the need to engage in repetitive behaviors that interfere with day-to-day functioning (compulsions include hand washing, counting, and checking). A selective serotonin reuptake inhibitor is what sertraline is known as (SSRI). It functions by assisting in the brain’s natural chemical (serotonin) balance restoration.
Reason for Not Selecting the Other Two Decisions
The reason Paxil 10 mg was not used is because Medicines and Healthcare Products Regulatory Agency (MHRA) does not recommend prescribing paroxetine, an antidepressant sold under the brand name Seroxat, to children or teenagers. Due to a potentially elevated risk of suicidal thoughts and attempts related to the medication, the FDA advised against Paxil usage in children under the age of 18 (Hengartner, 2020).
Few studies have tested bupropion on kids and teenagers, among them that of Kweon and Kim (2019). Bupropion’s efficacy and safety have, however, hardly ever been researched in children. As a result, there is not enough data to support the use of bupropion in children (Kweon & Kim, 2019).
Intended Achievement with Decision 1#
Before the following appointment, the expectation was that the depressive symptoms would lessen and the performance would improve. In a study by Gebauer-Bukurovx et al. (2019) involving 36 epileptic kids who also had depressive disorders, the depressive symptoms of every patient improved following Zoloft prescription. There was only one Zoloft user who experienced stomach issues. With complete remission, these problems got better.
Impact of Ethical Considerations on the Treatment Plan and Communication with the Patient
Informed parental agreement to begin taking depression medication is the first ethical factor to be taken into account. The FDA claims that Zoloft is an off-label antidepressant drug for youngsters. Any person thinking about giving a child, adolescent, or young adult Zoloft or another antidepressant must weigh the danger against the therapeutic need (Lai et al., 2018). In individuals over the age of 24, short-term trials did not demonstrate an increase in the risk of suicidality compared to placebo; however, in adults 65 and older, there was a decrease in risk.
Suicide risk is raised by a number of mental diseases, including depression (Lai et al., 2018). When starting antidepressant medication, patients of all ages should be adequately
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