Case Study: An African American Child Suffering from Depression.

Answer

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 It is also clear that the boy has proven to be antisocial since he is withdrawn from his peers in class.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: Bupropion

            The use of Bupropion SR (Wellbutrin SR®) is considered as one of the decisions that can be considered for the patient.  Bupropion SR is considered as an effective medication to be considered for the case of the patient because it is an antidepressant 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. However, this option is not considered as effective in the case of the patient as a result of his age. Anti-depressants are not recommended for children aged less than 8 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 Bupropion SR can be effective in counteracting the symptoms of major depressive disorder, it is not recommended in the case of the patient (Howland, 2008).

            Making the decision of the use of Bupropion SR 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 Bupropion among children. Therefore, to observe safety, this medication may not be administered. Culture will influence the style of communication and hence should be considered when interacting with the patient to avoid misunderstanding or conflict.

Decision 2: Fluoxetine

            Fluoxetine 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 serotonin reuptake inhibitors. 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. Fluoxetine 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). 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. This is based on the fact that African Americans are known to respond well to psychosocial interventions other than medications (Yasuda, Zang & Huang, 2008).

Decision 3: Amitriptyline

            Amitriptyline 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. Amitriptyline was identified based on its effectiveness in treating low mood. 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). Amitriptyline 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 Amitriptyline, I hope to address the patient’s low mood to ensure that he overcomes his depressive state. 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 regulatory requirements, may influence the chosen treatment plan. For instance, the Food Drug and Administration (FDA) has not approved the use of Amitriptyline among children despite the effectiveness of the medication. Therefore, my treatment plan may change to ensure that I provide the patient with the recommended medication for his age. Cultural factors is also an example of an aspect to be considered. Culture influences communication and hence I will ensure that I rely on the use of desirable means of communication for the patient to understand the medication being administered.

Conclusion

            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 Bupropion 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. Fluoxetine 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. Fluoxetine is recommended because it is not only effective but also safe for the 8-year-old patient. Amitriptyline 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.