Description
Week 4: Therapy for Patients With Major Depressive Disorder (MDD)
Mood disorders can impact every facet of a human being’s life, making the most basic activities difficult for patients and their families. This was the case for 13-year-old Jeanette, who was struggling at home and at school. For more than 8 years, Jeanette suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues.
As a PNP working with pediatric patients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.
This week, as you examine antidepressant therapies, you explore the assessment and treatment of three populations: pediatrics, adults, and geriatrics. The focus of your assessment tool, a decision tree, will specifically center on one of the most vulnerable populations, pediatrics. Please remember, you must also consider the ethical and legal implications of these therapies. You will also complete a Quiz on the concepts addressed throughout this module.
LEARNING OBJECTIVES
Students will:
- Assess patient factors and history to develop personalized plans of antidepressant therapy across the lifespan
- Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric, adult, and geriatric patients requiring antidepressant therapy
- Synthesize knowledge of providing care to pediatric, adult, and geriatric patients presenting for antidepressant therapy
- Analyze ethical and legal implications related to prescribing antidepressant therapy to patients across the lifespan
Learning Resources
Assignment: Assessing and Treating Pediatric Patients With Mood Disorders
When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders.
TO PREPARE FOR THIS ASSIGNMENT:
- Review this week’s Learning Resources, including the Medication Resources indicated for this week.
- Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy.
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)
- Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient.
Decision #1 (1 page)
- Which decision did you select?
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #2 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Decision #3 (1 page)
- Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
- What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
- Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/t... papers submitted must use this formatting.
Explanation & Answer
Attached. Please let me know if you have any questions or need revisions.
Running head: MAJOR DEPRESSIVE DISORDER
Therapy for Patients with Major Depressive Disorder
Student’s Name
Institutional Affiliation
1
MAJOR DEPRESSIVE DISORDER
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Therapy for Patients with Major Depressive Disorder
Depression is a common challenge to many people across the world and many factors are
associated with it. Most of the people who suffer from depression-related illnesses can have
symptoms like withdrawing from others, they may lack temper control and they may feel sad all
the time. However, psychologists assist such people to recover and change their lives. For
children suffering from major depressive disorder (MDD), the pediatric nurse practitioner (PNP)
uses strategies that are suitable for the specific needs of the children. The case study in this
analysis involves an African American boy aged 8. He has signs of depression and complains of
feeling sad. The analysis of his tests and results shows that he needs help to improve his
condition (Poznanski & Mokros, 1996). The focus of the PNP is to provide guidance and
solutions on how the boy can be helped. All options should consider the outcomes and the
possible side effects that may result from the treatment process.
Different therapies could be used in this case. The PNP should first identify if the MDD
is caused by social, psychological, developmental, or underlying growth issues. The other
important aspect of the treatment process is to understand that some of the MDD patients may
have different symptoms depending on age, race, and other demographic features. The
medications are also absorbed into the body differently and this means some medications may
not be suitable for both adults and children. The race of a person could also have some impacts
on the way the medication is applied (Assari & Caldwell, 2017). The above factors are among
the major considerations when giving medication to the patient. The purpose of the research
study is to determine the most appropriate treatment method to use, based on the primary and
clinical data about the patient.
MAJOR DEPRESSIVE DISORDER
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Decision 1
Selective Serotonin Reuptake Inhibitors (SSRIs)
The use of SSRIs is one of the most effective solutions to MDD in children. The
antidepressants are effective in helping in the breakdown of the serotonin in the brain, which
results in higher amounts of the neurotransmitter. Serotonin plays a major role in appetite,
moods, emotions, and digestion (Carhart-Harris & Nutt, 2017). The use of the SSRIs will
improve moods, appetite, and ensure better sleeping patterns. In a patient suffering from MDD,
the level of serotonin is usually low and this could lead to the sad feeling expressed in the patient
in the case. Some of the options of SSRIs that could be administered include fluoxetine (Prozac)
and citalopram (Celexa). The options are better than the serotonin-norepinephrine reuptake
inhibitors (SNRIs) because they have fewer side effects. The use of fluoxetine may have side
effects that include diarrhea, dry mouth, heartburn, and nausea (Fung et al., 2019). As for
citalopram, some of the side effects include nausea, fatigue, blurred vision, lack of appetite, and
sweating.
Citalopram is not recommended for children under the age of 18 years. Fluoxetine is the
recommended treatment for children aged 8 years and more and it is a major treatment used for
children with MDD (Reyad, Plaha, Girgis, & Mishriky, 2020). The patient in this case is aged 8
and so it can be used. The primary data that informed this decision includes the symptoms that
have been observed already, the age of the patient, and the clinical information about the drugs.
For example, the use of Citalopram could lead to extreme worry, panic attacks, agitation, and
suicidal thoughts. The target of this treatment process is to improve the moods, appetite, and
other symptoms of MDD. The ethical consideration is based on the principle of nonmaleficence
MAJOR DEPRESSIVE DISORDER
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that requires the doctors to not harm the patients. The ethical communication plan to the patient
and the guardians will be transparent and clear, for them to understand the rationale of the
treatment method chosen.
Decision 2
Atypical Antidepressants
The second decision is to use the atypical antidepressants to help the patient recover from
his MDD. The atypical antidepressants are strong and reliable and this makes them a good option
for treating MDD. The most effective of them is vortioxetine. The pharmacokinetic (PK) and
pharmacodynamic (PD) of the drug show that it is effective in controlling the way the brain
works towards fighting with the MDD. The drug is well absorbed orally and has a lag time of
0.781h. The maximal plasma concentration (Cmax) for a single dose is achieved after 7 to 11
hours post-dose time. The steady-state mean values are 9, 18, and 33 ng/mL after doses of 5gm,
10gm, and 20gm respectively (Chen, Højer, Areberg, & Nomikos, 2018). The above clinical
pharmacokinetics could be affected by the presence of food. The drug does not affect the nervous
system in negative ways. The drug is also suitable for children aged between 7 to 11 years and so
it is suitable for the patient in this case.
The other options that could be used include trazodone and mirtazapine. The two drugs
are used to serve relatively the same impacts and roles as the above one. However, they are
stronger and could affect the nervous system of the child. Therefore, they are not used in children
aged below 18 years. The main factors that were considered in making this decision were the age
and sex of the patient. According to Vilibić, Osmak, Tomljenović, Kolarić, & Jukić (2017), the
application of trazodone and mirtazapine should consider the age and sex of the patient among
MAJOR DEPRESSIVE DISORDER
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other factors like age. Therefore, the primary clinical data about the age and sex of the patient
helped in making this decision. This decision aims to reduce the depression symptoms in the
patient and it is based on the ethical principle of beneficence to the patient because it is the right
thing to do.
Decision 3
Tricyclic antidepressants
The use of tricyclic antidepressants in treating MDD is an effective and reliable option
because it has many advantages and few risks. Om of the most effective type of tricyclic
antidepressants is imipramine. The pharmacokinetics and pharmacodynamics of the imipramine
show that it is absorbed into the body easily and does not harm the nervous system of the patient.
It is metabolized in the liver by the cytochrome P450 (CYP) enzymes. It is also metabolized by
CYP2C19, CYP1A2, and CYP3A4 to enable its absorption into the body stream (Hardainiyan,
Kumar, Nandy, & Saxena, 2017). The patien...
