Case Study: An African American Child Suffering from Depression.
1) Diagnostic and statistical manual of mental disorders [electronic resource] : DSM-5.
2) Sequenced treatment alternatives to relieve depression (STAR*D): part 1: study design.
3) Sequenced treatment alternatives to relieve depression (STAR*D): part 2: study design.
4) Principles In Using Psychotropic Medication In Children And Adolescents
5) Children’s Depression Rating Scale, Revised
6) Biomarkers in pediatric depression
7) The Role of Ethnicity in Variability in Response to Drugs: Focus on Clinical Pharmacology Studies
8) Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now?
9) Do antidepressants make children and adolescents suicidal?
10) Medication resources:
The Case of an African American Child with Depression
Introduction to the Case
Many children have worries and fears while some may feel hopeless and sad from time to time. Although it is considered typical for children to exhibit fears and worries, the extreme or persistent forms of sadness and fears could be as a result of depression or anxiety. According to the Center for Disease Control and Prevention (CDC), this is founded on the fact that depression symptoms fundamentally involve feeling and thought also referred to as the internalizing disorders (CDC, 2020). In the events whereby the child feels persistently hopeless or sad, they are likely to be diagnosed with a mental health case of depression. The feelings of irritability, sadness or hopelessness are some of the primary symptoms that suggest depression (American Psychiatric Association, 2013). Changes in a child’s eating patterns can also suggest depression in that one may eat more or less than the usual amount and may also record a change in his/her energy levels. This paper explores the case of an 8-year-old male with an African American ethnicity. The patient shows signs of depression. Evidently, the patient complains of the feeling of sadness. It is also clear that the boy has proven to be antisocial since he is withdrawn from his peers in class. Additionally, the patient’s appetite has significantly declines as he reports cases of occasional irritation. The findings derived from the patient’s physical exam are also unremarkable. Despite this, the patient has effectively attained all his developmental landmarks at the desired ages. In addition, this paper explores the decision criteria regarding the most effective medication to be administered to the patient. In this case, three decisions will be explored to settle for the most effective one based on the characteristics of the patient. The primary factors to be considered include the patient’s age, the severity of the symptoms, ethnicity and any allergic reactions.
Decision 1: Zoloft
The use of Zoloft 25 mg administered orally is considered as one of the decisions that can be considered for the patient. Zoloft SSRI is considered as an effective medication to be considered for the case of the patient because it is a medication which is well developed to work with the brain (National Alliance of Mental Illness, 2020). The medication is approved in the treatment of cases of major depressive disorder by assisting the patient overcome the recorded symptoms. This was considered as an effective medication that can be considered for patients suffering from major depressive disorder because it is effective in counteracting the patient’s symptoms. The medication is effective for children aged between 6 and 18 years (Seedat, 2014). Notably, the use of antidepressants in children is not recommended because it increases the suicidal rates among the children aged less than 18 years. Therefore, although Zoloft can be effective in counteracting the symptoms of major depressive disorder, it is not recommended in the case of the patient (Howland, 2008).
The use of Bupropion was focused on improving the patient’s mood. Notably, the medication will be focused on preventing the reuptake of serotonin, dopamine, and norepinephrine to ensure that more of them focus on transmitting messages to other nerves (Howland, 2008). Making the decision of the use of Zoloft as an effective medication was focused on counteracting the patient’s symptoms of depressed mood and the changes in the patient’s feeding habits. Notably, the patient’s eating habits was recorded as one of the factors which suggest that the patient is suffering from a major depression (Seedat, 2014). Age and culture should be considered when exploring ethical considerations that can influence the communication and treatment plan among the patients. It is a fact that the FDA has not recommended the use of Zoloft among children. Therefore, to observe safety as guided by the beneficence and nonmaleficence principle, this medication may not be administered. Notably, health professionals are to do what is right for the patients and avoid causing them harm. Culture will influence the style of communication and hence should be considered when interacting with the patient to avoid misunderstanding or conflict, thus abiding by the requirements of the veracity ethical principle.
Decision 2: Praxil
Praxil is considered as the second option of drug treatment which can be considered for the patient. This medication was chosen as a result of its high efficacy in children aged 8 and above when it comes to the treatment of the case of the major depressive disorder (Yan & Goldman, 2019). The efficacy rates of the use of this medication are higher in comparison to the use of other antidepressants. The clinical benefit attached to the use of this medication is the fact that it becomes effective in two weeks in counteracting the symptoms of the patient. In the events whereby no change is experienced in the symptoms of the patient after 4 weeks since the medication was first administered, reevaluation may be a necessary consideration (Yan & Goldman, 2019). Despite the high efficacy rates, it is still advisable that the side effects of the use of the medication should be monitored closely when using this medication.
Option 1 and 3 were not chosen because of their low efficacy rates in counteracting the patient’s symptoms. Praxil was chosen as an effective medication since it would be effective in ensuring an improvement in the symptoms of the patient and doing away with the manifestations of the major depressive disorder over the short-term (Lorberg et al., 2019). I am hoping to ensure that the neurotransmitter serotonin is inhibited from being absorbed in the brain. This will be effective in addressing the case of depression by ensuring an improved mood by guaranteeing that the brain cells can easily transmit messages to each other after the regulation of serotonin (Yan & Goldman, 2019).
Ethical considerations can affect my treatment plan and how I communicate with the patient. For instance, considering the fact that the patient is an African American will prevent the use of medication and consider psychosocial interventions instead if the patient does not consent to the use of drugs for treatment (Sorrell, 2017). This is based on the fact that African Americans are known to respond well to psychosocial interventions other than medications (Yasuda, Zang & Huang, 2008). Veracity principle will also guide how I communicate with the patient in that I will rely on the use of a language that the patient understands despite his young age.
Decision 3: Wellbutrin
Wellbutrin 75mg administered orally is chosen as a treatment alternative for the patient. This is founded on the fact that the medication has a high efficacy rate in countering the major depressive disorder symptoms among children (Howland, 2008). This medication option was also identified because its effects are experienced within a short period. Wellbutrin was identified based on its effectiveness in treating low mood. Moreover, the medication is desirable than tricyclics in handling depression cases. However, similar to all antidepressants, it is associated with the risk of increased suicidal thoughts and hence the patient should be closely monitored if this medication is administered (Howland, 2008). Wellbutrin has a high efficacy rate in the treatment of depression. Most of the patients who relied on its usage recorded a positive outcome without the risk of remission.
Through the administration of Wellbutrin, I hope to address the patient’s low mood to ensure that he overcomes his depressive state. This is done by increasing the amount of serotonin generated by the brain which is a function achieved primarily through the administration of amitriptyline to maintain mental balance (Howland, 2008). Additionally, the medication is also effective in addressing sleep cycle problems and cases of irritability and the difficulty in concentration (Howland, 2008).
Ethical considerations, such as the patient’s consent will be observed. Notably, if the patient does not consent to the administration of medication, alternative treatment options such as psychosocial interventions will be considered (Sorrell, 2017). Veracity is also an ethical consideration in this case. Notably, the care practitioner has the responsibility to ensure that the patient is provided with information about the treatment in a way that he understands, especially due to the cultural variance. A careful means of information administration will reduce medication errors and create trust (Sorrell, 2017).
Conclusively, children diagnosed with major depressive disorder will exhibit several symptoms such as irritability, sadness or hopelessness, which are some of the primary symptoms that suggest depression. In the case study, the patient exhibited symptoms such as the feeling of sadness. It is also clear that the boy has proven to be antisocial loss of appetite and increased irritability. To counteract the patient’s symptoms different medication are recommended. For instance, the use of Zoloft is one of the first lines of treatment which can be implemented in the patient’s case. Bupropion is advisable because it is an antidepressant medication which is well developed to work with the brain. Moreover, the medication has proven to be effective in improving the symptoms of depression among children. Praxil is also a desirable medication to be provided to the patient. This medication has a high efficacy level and is the only antidepressant approved for use in the cases of childhood depression. Zoloft is recommended because it is not only effective but also safe for the 8-year-old patient. Praxil is also recommended despite the fact that the medication is not approved by the FDA. The medication works within a short period and records a high efficacy rate in the treatment of depression among children. Despite the effectiveness of the recommended medication usage, a close monitoring of the patients is necessary since the antidepressants can increase the patient’s suicide desire. Ethical concerns should also be observed when interacting with the patient since they influence the treatment plan and the manner of communication with the patient. For instance, the patient’s culture and age (among others) should be considered before devising a plan of treatment.
American Psychiatric Association, (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Arlington, VA. American Psychiatric Association
Centers for Disease Control and Prevention (CDC), (2020). Anxiety and Depression in Children. https://www.cdc.gov/childrensmentalhealth/depression.html
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Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. In Rey JM, Martin A (eds), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions
National Alliance of Mental Illness, (2020). Bupropion (Wellbutrin). https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Bupropion-(Wellbutrin)
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Yan, T., & Goldman, R. D. (2019). Time-to-effect of fluoxetine in children with depression. Canadian family physician Medecin de famille canadien, 65(8), 549–551.
Yasuda, S, Zang, L. & Huang, S. (2008).The Role of Ethnicity in Variability in Response to Drugs: Focus on Clinical Pharmacology Studies. Clinical Pharmacology & Therapeutics, 84(3), 417-423
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