Therapy for Pediatric Clients with Mood Disorders

1 Therapy for Pediatric Clients with Mood Disorders Background Depression and other psychological disorders are common contributors to disease burden globally (Ahmed et al., 2021). These disorders destroy the social life of a person and deplete family resources. Although pediatric depression is not a highly prevalent health issue, it is a critical psychological disorder with deleterious effects on mental health and wellbeing. The etiology of this disorder in the target population is not well understood. However, researchers have identified different trigger factors. Pediatric depression is characterized by depressive mood, sleep problems, fatigue, weight loss, agitation, diminished concentration, and loss of social interest (Patra, 2019).

The DSM-V suggests that pediatric depression be diagnosed among children with at least two symptoms for two weeks. It is difficult to diagnose this condition considering the symptoms mimic other problems and the normal development process in children (Farley et al., 2020).

However, clinicians recommend that parents seek medical advice if the child presents with detectable psychological disturbances.

Buy this excellently written paper or order a fresh one from ace-myhomework.com

2 The problem may progress to uncontainable stages if treatment is delayed. The disorder may even become chronic, with the child experiencing symptoms through adulthood (Koplewicz & Klass, 2016). Selective serotonin reuptake inhibitors comprise the first treatment line for depression (Ahmed et al., 2021). However, these medications are meant for adult populations.

Further, the molecular mode of action is not clearly understood. Therefore, the clinician must determine the medical suitability of antidepressants given to a child. They also include psychotherapy to improve the mental wellbeing of the child.

Case Summary The client is an 8-year-old African American brought by his mother to the ER. His mother noted that the primary pediatrician referred them for further psychiatric evaluation. She reported that the child exhibits signs of depression. He was feeling sad, and the teacher's report revealed that the child was “socially withdrawn.” The child’s appetite has also decreased, and he experiences bouts of irritation. The client has attained all developmental landmarks and does not have noticeable physical abnormalities. The Mental Health Exam revealed that the child is alert, oriented, and coherent. The child’s “affect” is blunted but does not experience hallucinations and paranoid thoughts. His judgment is appropriate, and he does not have suicidal ideations. The Children's Depression Rating Scale indicated a score of 3, reflecting significant depression.

Decision Point One Decision: Begin Zoloft 25mg orally daily Reasoning: Zoloft was started since it is an effective antidepressant. Several studies support using Zoloft to treat depression in different populations. For instance, Mehrotra et al. 92019) noted that Zoloft is more effective than CBT in treating depression for patients undergoing

3 hemodialysis maintenance. Zoloft inhibits serotonin reuptake in the CNS by binding to the sigma-1 receptors at the synaptic junction (Aswal et al., 2018). It leads to increased serotonin levels at the junction, thus, enhancing signal transmission. Serotonin alters emotional processing, stabilizes mood and feelings, and improves well-being and happiness (Ahmed et al., 2021). It increases the cognitive processing of positive information. Significantly, it improves sleep, appetite, and digestion. However, this medication is generally not meant for children, and the nurse started a lower dose to minimize side effects.

4 Rejected Interventions Wellbutrin and Paxil are also effective antidepressants. However, the nurse considered them to be unsuitable for the client. Wellbutrin, for instance, is associated with an elevated risk of insomnia. Sleep problem is a major challenge for persons with depression (Elbe et al., 2019).

Therefore, giving Wellbutrin would increase the child’s problems. Paxil, on the other hand, is linked to appetite problems, sight problems, and drowsiness even at low doses (Elbe et al., 2019).

These symptoms would negatively affect the child’s participation in class.

Target Results The PMHNP intended to achieve remission for the client. The plan focuses primarily on reducing the symptoms and improving the child’s feelings and wellbeing.

Achieved Results The client reported an improved mood during the follow-up, indicating a positive response. He had not developed detectable side effects. This shows that although Zoloft did not produce adverse effects, it partially achieved the expected results. Elbe et al. (2019) noted that Zoloft takes approximately eight weeks to accomplish its full therapeutic effect. Therefore, replacing Zoloft at this point would have been untimely.

Decision Point Two Decision: Increase the dose to 50 mg orally daily Reasoning: Increasing Zoloft dosage was guided by the PMHNP’s decision that a dose increment was a suitable decision at this point. Dold et al. (2017) suggested that if depressive persons do not respond appropriately to initial monotherapy for this condition, a dose increment frequently becomes the next course of action. The double-blind RTC by Dold et al. (2017) revealed higher response rates among patients whose initial doses were increased.

5 Zoloft has proven effective in reducing depressive symptoms for the client. However, a lower dose had not eradicated the symptoms. Clinical guidelines suggest that when dealing with psychotropic drugs for children, the PMHNP should start a low dose and adjust it per the client’s response to treatment (Elbe et al., 2019). Since the client had demonstrated a positive response, dose reduction and replacement were not warranted. Clinical guidelines, however, indicate that dose increment should be gradual to avoid adverse effects (Elbe et al., 2019).

Target Results The PMHNP intended to lower the depressive symptoms by 50% and improve the child’s psychological and social wellbeing. The client was also tolerating well to the medication.

Achieved Results The nurse discovered that the depressive symptoms had reduced by over 50% during the second follow-up. The client did not report severe side effects since the nurse only made a slight dose increment.

Decision Point Three Decision: Increase Zoloft dose to 75mg.

Reasoning: Replacing Zoloft with an SNRI was impractical, considering the client responded well to the treatment. Unfortunately, this therapy had only achieved 50% of the expected outcomes. Increasing the dose by 25mg would elevate the chances of attaining 100% improvement. The client did not report significant side effects.

Target Results The PMHNP wanted to attain 100% remission.

6 Achieved Results 75mg Zoloft eradicated all depressive symptoms in the client. The child’s mood improved remarkably, and he started participating in social activities at school. As highlighted by Elbe et al. (2019), the therapeutic dose for a child had been attained.

Ethical Consideration Treating and managing pediatric depression are guided by ethical standards that all PMHNP’s must follow. As Bloch and Green (2021) denoted, nurses must inform their clients of their condition adequately, consistent with the principle of autonomy. This approach to treatment allows the patient to make informed medical decisions. In pediatric cases, the parent can decide on the child’s behalf. Considering pediatric depression is treated with off–label drugs, the nurse, must sufficiently inform the parent on the benefits and potential effects of these medications.

Additionally, the care provider must conduct patient education to improve awareness and compliance with therapy. The principle of beneficence requires care providers to provide treatment suitable to the client's health needs. Therefore, the nurse must ensure the medication selected is beneficial to the child. Non-maleficence, on the other hand, as clarified by Bloch and Green (2021), ensures that patients are not given chemical compounds that could cause harm.

The nurse comprehensively assesses the client’s health needs and weighs them against available treatment options to determine the most suitable approach.

Conclusion Although pediatric depression is a relatively uncommon condition, it is not rare. It affects children leading to poor academic performance, decreased concentration, low energy, and decreased participation in social activities. The child might also experience decreased appetite and sleep problems. Clinicians treat pediatrics with lower doses of SSRI antidepressants. These

7 drugs are produced for adults, but children can tolerate them at lower doses. The nurse performs dose adjustment according to the client’s response to treatment. The dose is increased if the medication does not generate adverse effects and falls short of the targeted therapeutic outcomes.

Notably, the care provider must identify and comply with applicable ethical standards to deliver quality care and avoid legal suits.

8 References Ahmed, N., Bone, J. K., Lewis, G., Freemantle, N., Harmer, C. J., Duffy, L., & Lewis, G. (2021).

The effect of sertraline on emotional processing. Psychological Medicine, 1-8. https://doi.org/10.1017/S0033291720004985 Aswal, N., Singh, S. K., & Kamarapu, P. (2018). Study on antidepressant drug to cure depression. J Formul Sci Bioavailab, 2(121), 2577-0543. http://dx.doi.org/10.4172/25770543.1000121 Bloch, S., & Green, S. A. (2021). Psychiatric ethics. Oxford University Press.

Dold, M., Bartova, L., Rupprecht, R., & Kasper, S. (2017). Dose escalation of antidepressants in unipolar depression: a meta-analysis of double-blind randomized controlled trials.

Psychotherapy and Psychosomatics, 86(5), 283-291. https://doi.org/10.1159/000477770 Elbe, D., Black, T. R., McGrane, I. R., & Procyshyn, R. M. (2019). Clinical handbook of psychotropic drugs for children and adolescents. Hogrefe Publishing Farley, A., Gallop, R., Brooks, E., Gerdes, M., Bush, M., & Young, J. (2020). Identification and management of adolescent depression in a large pediatric care network. Journal of Developmental & Behavioral Pediatrics, 41(2), 85-94. https://doi.org/10.1097/dbp.0000000000000750 Koplewicz, H., & Klass, E. (2016). Depression in Children and Adolescents. Routledge.

Mehrotra, R., Cukor, D., Unruh, M., Rue, T., Heagerty, P., Cohen, S., ... & Hedayati, S. (2019).

Comparative efficacy of therapies for the treatment of depression for patients undergoing maintenance hemodialysis: A randomized clinical trial. Annals of Internal Medicine, 170(6), 369-379. https://doi.org/10.7326/M18-2229

9 Patra, S. (2019). Assessment and management of pediatric depression. Journal of Psychiatry, 61(3), 300. https://dx.doi.org/10.4103%2Fpsychiatry.IndianJPsychiatry_446_18