Case study
The client is an 8-year-old African American male child who arrived at the emergency room with his mother. The client exhibited signs of depression and complained that he felt sad. According to the parent, his appetite had reduced significantly, and he was occasionally irritable. Besides, his teacher noted that he had withdrawn from participating in classroom activities. Nonetheless, the client had undergone and achieved all developmental milestones within the appropriate ages. Therefore, a laboratory examination of WNL and a psychiatric evaluation were recommended. According to the mental examination, the client is alert, oriented, goal-directed, spontaneous, coherent, has clear speech, and denies experiencing any visual or auditory hallucinations. Besides, the client’s insight and judgment resonate with his age, and he does not exhibit any paranoid or delusional thoughts or behavior. Although he does not actively contemplate suicide, he occasionally views himself as dead and wonders how it would feel if he was not alive. On the Children’s Depression Rating Scale, the client scored 30, indicating that he had major depression.
Introduction
Considering the above outcomes, the client/patient needs to undergo treatment to reduce the depression symptoms. The patient’s progress and response to the interventions throughout the treatment period will be measured using the CDRS scale, which was employed in the initial examination. The CDRS scale is an ideal instrument to measure depression symptoms among children aged six and twelve years. The scale consists of 17 symptom dimensions, of which there are one to seven items. According to Plener et al. (2012), CDRS scores range from 17 to 113, and any score below 28 signifies minor depression. Alternatively, all scores greater than or equal to 40 indicate significant depression. In this sense, the therapy’s main purpose is to achieve a 50% reduction of the symptoms and a score of less than 28 on the CDRS scale in 8-12 weeks. Before the treatment process commences, I will examine the patient’s health records and inquire if his family has a history of depression. Besides, I shall analyze his health records and check whether the client suffers from any other psychological illness and the interventions previously applied, if there are any. Lastly, since Loberg et al. (2019) pointed out that antidepressants are associated with numerous side effects, including suicidal ideation, I will ensure that the medication and the doses prescribed were safe to the client.
- Decision 1
In the prescription, I recommend the client to begin by taking Zoloft 25mg daily orally. According to Sanchez et al. (2014), Zoloft is the brand name used for Sertraline, an SSRI and a first-line intervention primarily used to treat depression among patients aged six and twelve years. Serotonin is among the neurotransmitters that relay messages between the brain’s nerve cells/neurons. SSRIs increase serotonin levels in the brain by limiting the uptake of Serotonin into the neutrons. Increased Serotonin levels in the brain reduce sadness and anxiety, and it is in this way that SSRIs treat depression and other psychological illnesses (Lewis et al., 2019).
- Factors influencing decision 1
Despite that there were other interventions like Paxil and Wellbutrin, there are several reasons why I recommended the patient to take Zoloft 25mg. Paxil and Zoloft are some of the most common SSRIs used to treat depression, anxiety disorders, and OCBD (Bushnell et al., 2016). Whereas Zoloft contains Sertraline, Paxil contains Paroxetine which is also an effective antidepressant. Typically, these SSRIs act similarly and exhibit the same side effects like nausea, headaches, diarrhea, and sexual dysfunction. Nevertheless, pharmacological studies show that Zoloft (Sertraline) is more tolerable and has less severe side effects than Paxil (Paroxetine) (Lewis et al., 2019). For instance, according to Sanchez et al. (2014), 18% of patients treated with Paroxetine are likely to experience blurred vision compared to 2% of those using Sertraline (Loberg et al., 2019). From this perspective, Zoloft was a more viable option because the client could tolerate it better and experience less critical side effects.
Like Zoloft, Wellbutrin is an effective antidepressant, although it belongs to a different class of drugs called Dopamine Reuptake Inhibitors. Wellbutrin is commonly prescribed as a smoking cessation aid and also the first-line therapy for anxiety disorder. Wellbutrin is the brand name for Bupropion which is the main compound in the drug. Although Bupropion is rarely used in treating pediatric depression, vast and recent studies show that it is more effective and has fewer side effects than SSRIs like Zoloft and Paxil (Huecker et al., 2021). Regardless of its efficacy, I could not recommend Wellbutrin because one of its most prominent side effects is lack of appetite. According to Patel et al. (2016), Bupropion decreases food intake leading to weight loss, hypoglycemia, and the risk of seizures. As per the case study, the client’s appetite had reduced significantly, and thus, prescribing Wellbutrin would further worsen the situation. Besides, research establishes that Bupropion is mostly used for patients within my clients’ age when other antidepressants fail or when the patient suffers from other mental illnesses like ADD (Kweon & Kim, 2019).
- Achievement
As stated, I chose to prescribe Zoloft 25mg over Paxil 20mg and Wellbutrin 75mg due to the factors discussed above. In prescribing Zoloft, I safeguarded the client from possible adverse side effects that would have occurred if I had recommended Paxil. On the other hand, I avoided prescribing Wellbutrin since the patient was already experiencing a lack of appetite that would further escalate if he had taken the medication.
- Ethical considerations
Observably, the patient is an eight-year-old boy and therefore not in a position to make any meaningful decisions concerning treatment. This situation limited his autonomy as a patient as he did not fully understand his condition and could not decide which intervention was most effective. On the other hand, since the client is a child, there would be no confidentiality since I would share all the information concerning the therapy with his mother.
- Decision 2
After prescribing a daily dose of Zoloft 25mg, the client returned to the clinic after four weeks and reported that the symptoms stemming from his condition had not waned. Due to this situation, I increased the daily dosage to 50mg to check whether the symptoms would reduce in the following weeks.
- Factors influencing decision 2
The lack of change signified that the initial prescription had a dismal impact on the illness. In this light, I increased the Zoloft dosage from 20mg to 50 mg to increase its efficacy, although I could have increased the dosage to 37mg or opted to change to Prozac. My decision to increase the dosage relied on two prominent reasons. Firstly, most pharmacological studies indicate that the standard Sertraline dose for treating depression is 50mg, which should be increased by 25mg according to the patient’s progress. Although I had begun prescribing a lower dose, increasing the dosage to 37.5 mg would bear no changes in patient outcomes. Even with the concern about increased side effects stemming from the dosage increase, it is critical to acknowledge that the increased dosage is by only 25mg, and it is within medical guidelines and recommendations. Alternatively, if I had switched to Prozac, the patient would have experienced adverse withdrawal symptoms and, much worse, mood disorders stemming from the abrupt discontinuation of the medication. According to Keks et al. (2016), health providers should gradually cease prescribing a particular antidepressant for two weeks until the patient’s body and brain adjust to the change. Although abrupt cessation is sometimes unavoidable, it threatens the patient’s physical and psychological health (Keks et al., 2016).
- Achievement
By increasing the dosage to 50mg, I adhered to informed recommendations that ensure safety in the Sertraline prescription. More importantly, I wanted the client to receive the standard dosage while increasing the medication’s efficacy. On the other hand, not changing to Prozac enhanced the consistency of the treatment and safeguarded the patient from withdrawal symptoms and adverse reactions that would have presented as a result of switching to another type of medication.
- Ethical considerations
Like in the first scenario, the patient’s autonomy was limited since he could not decide whether to increase the dose to 37.5mg, 50mg, or switch to another type of medication. As a provider, I was also in a dilemma since no guarantee increasing dosage or switching to another drug would help reduce the depression symptoms without causing harm to the client. Much worse, it was hard to imagine how the parent would react and how the client would cope with more severe side effects stemming from the increased dose.
- Decision 3
After increasing the Sertraline prescription to 50mg, the client returned to the clinic after four weeks and reported feeling better. As per the Children’s Depression Scale ratings, the client’s symptoms had reduced by 50. Such an outcome indicated that the previous dosage was effective, and thus I decided to maintain the dosage at 50mg for four more weeks until the patient recovers fully.
- Factors influencing decision 3
As stated, the previous dosage yielded positive and satisfactory results. In this case, I decided to maintain the current dose instead of increasing it to 75mg or switching to an SNRI. Firstly, the 50% symptom reduction had proven that the current dose effectively eradicated the depression symptoms. Thus it would be a good time to examine if we could attain full recovery without increasing the dose. Although increasing the dose would enhance efficacy, it would be was unnecessary since the patient had been on the current dose only for four weeks. If the symptoms persisted, the Sertraline dose would be increased to 75 and a maximum of 200mg as per the prescription guidelines. Alternatively, switching to an SNRI was unnecessary since Zoloft had already reduced the symptoms by 50%. Such change could only occur if the current medication could not mitigate the symptoms(Bowman & Daws (2019). Moreover, switching to an SNRI would have interrupted the treatment process, and the patient would experience withdrawal symptoms which would adversely affect his brain.
(iii) Achievement
There was a significant reduction of symptoms after the dosage increment to 50mg. Such a change indicated that the patient was better and was responding well to the therapy. In this case, it was not unnecessary to increase the dosage to 75 mg without checking if the present Sertraline dose would reduce all the symptoms. On the other hand, switching entirely to other medicines would increase the risk of withdrawal symptoms and drug reactions (Fava & Cosci., 2019). Generally, decision 3 ensured therapy consistency and safeguarded the patient from more acute side effects, withdrawal symptoms, and unnecessary transitions into new types of medication (Bowman & Daws, 2019).
- Ethical considerations
. As in other scenarios, the patient could not make any meaningful contributions or decisions on treatment. In these circumstances, his autonomy was limited, and therefore, he relied on my judgment as a health provider. Although I asked him to decide on dosage maintenance or increase, I would ultimately select the most suitable intervention since the child could not understand the ramifications of such choices. On the other hand, patient-provider confidentiality was also affected because I shared all the details concerning the therapy with the client’s parent.
This paper examined treatment options for an 8-year-old African American male suffering from significant depression. The selected treatment process involved administering varied doses of Zoloft (Sertraline) throughout 12 weeks. The chosen intervention is effective in treating depression and other mental illnesses. Compared to the different treatment options (Paxil and Wellbutrin), Zoloft was more viable since its side effects are less severe than Paxil (Sanchez et al., 2014). Although Wellbutrin could also make a suitable intervention, I could not recommend it since it would exacerbate the client’s lack of appetite. As per the outcomes, the initial doses could not reduce the symptoms, and hence they had to be increased gradually and accordingly to enhance dose efficacy. In the first course of therapy, the client began with a daily dose of Zoloft 20mg taken orally. After a month, the patient experienced no change, and the depression symptoms persisted. This situation prompted a dosage increase from 20mg to the standard dose of 50 mg. After four weeks, half of the symptoms had decreased, and the patient had begun recovering. I maintained the dose at 50 mg to check whether there would be more positive changes. Any changes would present within 2-4 weeks, and if not, the dosage would increase further, or another intervention would be applied. I wanted to maintain consistency throughout the therapy because switching to other medications would expose the already depressed patient to adverse experiences. Lastly, increasing the dose at the recommended intervals was the best decision since the patient’s body, and brain adjusted and reacted accordingly.
References
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