Posted: March 17th, 2023

Therapy for Patients With Major Depressive Disorder (MDD)

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
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Learning Resources

Required Readings (click to expand/reduce)

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Medication Resources (click to expand/reduce)

Required Media (click to expand/reduce)

Optional Resources (click to expand/reduce)
Mood disorders are mental health conditions that can affect every aspect of a person's life. Individuals with mood disorders often experience difficulty in carrying out even the most basic daily activities, which can be challenging for both the patients and their families. One such case is that of 13-year-old Jeanette, who has been struggling with mood disorders for over eight years. Jeanette has been displaying symptoms such as temper tantrums, impulsivity, inappropriate behavior, difficulty in judgment, and sleep disturbances.

As a Pediatric Nurse Practitioner (PNP) working with pediatric patients, it is crucial to assess the root cause of Jeanette's symptoms, whether they are psychological, social, or due to underlying growth and development issues. Based on the assessment, the appropriate therapies should be recommended.

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This week, while exploring antidepressant therapies, PNPs need to consider and understand the assessment and treatment of mood disorders in three different populations: pediatrics, adults, and geriatrics. The focus of the assessment tool, a decision tree, will be on one of the most vulnerable populations, pediatrics.

While examining these therapies, PNPs must also consider the ethical and legal implications of the treatments. Ethical and legal issues that may arise in the treatment of mood disorders in pediatric patients may include obtaining informed consent from parents or guardians, confidentiality and privacy of the patient's medical information, and the potential side effects and risks of the medications.

To ensure that PNPs have a good understanding of these concepts, they will complete a Quiz that will cover the assessment and treatment of mood disorders in pediatrics, adults, and geriatrics, as well as the ethical and legal implications of these therapies. By doing so, PNPs will have the knowledge and tools needed to provide appropriate and effective care to patients with mood disorders.
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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.

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// Pediatric depression
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
African American Child

BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives at the ER with his mother. He is exhibiting signs of depression.

Client complained of feeling “sad”
Mother reports that teacher said child is withdrawn from peers in class
Mother notes decreased appetite and occasional periods of irritation
Client reached all developmental landmarks at appropriate ages
Physical exam unremarkable
Laboratory studies WNL
Child referred to psychiatry for evaluation

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MENTAL STATUS EXAM

Alert & oriented X 3, speech clear, coherent, goal directed, spontaneous. Self-reported mood is “sad”. Affect somewhat blunted, but child smiled appropriately at various points throughout the clinical interview. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. Judgment and insight appear to be age-appropriate. He is not endorsing active suicidal ideation, but does admit that he often thinks about himself being dead and what it would be like to be dead.

You administer the Children's Depression Rating Scale, obtaining a score of 30 (indicating significant depression)

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§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating Scale--Revised. Los Angeles, CA: Western Psychological Services.

Decision Point One
Select what you should do:

Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BID
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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.

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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

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Learning Resources

Required Readings (click to expand/reduce)

Baek, J. H., Nierenberg, A. A., & Fava, M. (2016). Pharmacological approaches to treatment-resistant depression. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 44–47). Elsevier.

Fava, M., & Papakostas, G. I. (2016). Antidepressants. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 27–43). Elsevier.

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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. https://doi.org/10.3928/02793695-20080901-06

Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21–24. https://doi.org/10.3928/02793695-20081001-05

Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-textbook of child and adolescent mental health. https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf

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Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale—Revised. Western Psychological Services.

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. https://doi.org/10.1002/da.22171

Yasuda, S. U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/.../UCM085502.pdf

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Medication Resources (click to expand/reduce)

IBM Corporation. (2020). IBM Micromedex.

https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537

Note: To access the following medications, use the IBM Micromedex resource. Type the name of each medication in the keyword search bar. Be sure to read all sections on the left navigation bar related to each medication’s result page, as this information will be helpful for your review in preparation for your Assignments.

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Review the following medications:

amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine

imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine

Required Media (click to expand/reduce)

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Case Study: An African American Child Suffering from Depression
Note: This case study will serve as the foundation for this week’s Assignment.

Optional Resources (click to expand/reduce)

El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. https://doi.org/10.1007/s00787-014-0558-3

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. https://doi.org/10.1111/jpc.12655

Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2),

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iii–v. https://doi.org/10.2989/17280583.2014.938497

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

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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.

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Upload your draft, tell us your goals, and our editors will refine it—boosting arguments, fixing errors, and keeping your voice. You’ll get a polished paper that’s ready to shine.

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)

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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/templates/general#s-lg-box-20293632).All papers submitted must use this formatting.

By Day 7

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Sample Answer Writing Guide:
ssessing and Treating Pediatric Patients with Mood Disorders

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Introduction

Pediatric patients with mood disorders require careful consideration in selecting medication, monitoring dosage, changing drugs, and observing ethical principles. This paper presents a case study of an 8-year-old African American male presenting with symptoms of sadness, isolation, loss of appetite, and irritability. The paper discusses the first decision to treat the child's depression with Zoloft 25mg tablet daily during bedtime, the rationale for selecting the drug, and the ethical considerations. The second decision is to increase the dosage to Zoloft 50mg tablet daily during bedtime to enhance recovery, the rationale for the decision, and the ethical considerations. Finally, the paper discusses the decision to maintain the medication, frequency, and mode of administration.

Decision One

The first decision is to treat the depression in the child with Zoloft 25mg tablet daily during bedtime. Zoloft is an antidepressant classified under selective serotonin reuptake inhibitors (SSRIs). The drug is effective in treating depression and other mental or mood disorders among children by acting as a mood stabilizer and lessening the severity of symptoms. Addressing sleep disorders among patients with depression improves recovery and prevents relapse. Children require 25mg tablets daily to minimize side effects such as nausea, sleepiness, and drowsiness. Zoloft is FDA-certified for pediatric use.

Two other options, Wellbutrin 75mg and Paxil 10mg, are not effective in treating the patient's condition. The drugs are not FDA-certified for use among children, and Paxil causes anticholinergic effects, making it less preferable. While Wellbutrin is effective, it takes longer to show results than Zoloft.

Ethical and legal issues affect treatment and communication, including informed consent

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and confidentiality. Informed consent entails explaining the benefits and risks of the treatment to the patient and the parent or legal guardian, including the possibility of side effects. The practitioner must obtain informed consent from the parent or legal guardian before starting the medication. Confidentiality is crucial in maintaining the patient's privacy, and the practitioner should ensure that the information discussed with the parent or legal guardian remains confidential.

Decision Two

The second decision is to increase the dosage to Zoloft 50mg tablet daily during bedtime to enhance recovery. The rationale for this decision is that the initial dose of Zoloft may not have been sufficient in addressing the patient's condition. Increasing the dosage can lead to a more significant reduction of symptoms, enhancing the patient's recovery.

However, before making the decision to increase the dosage, the practitioner must evaluate the patient's response to the initial medication. If there are adverse effects or minimal improvement in the patient's condition, an increase in dosage may not be the best decision. Additionally, the practitioner should ensure that the patient is not experiencing any adverse effects of the medication, such as suicidal thoughts or tendencies.

Ethical considerations during the second decision include obtaining informed consent from the parent or legal guardian before adjusting the dosage. Additionally, the practitioner should monitor the patient's progress closely and be ready to adjust the medication or dosage accordingly.

Decision Three

The third decision is to maintain the medication, frequency, and mode of administration. The rationale for this decision is that the patient has shown improvement with the medication, and maintaining the current medication, dosage, frequency, and mode of administration can prevent relapse. Regular follow-up appointments can help the practitioner evaluate the patient's progress and make adjustments where necessary.

Ethical considerations during this decision include maintaining confidentiality and informed consent. The practitioner must ensure that the parent or legal guardian understands the need for regular follow-up appointments and is aware of the importance of continuing with the medication as prescribed.

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Conclusion

Treating pediatric patients with mood disorders requires careful consideration of the medication, dosage, monitoring, and ethical principles. Zoloft is an effective antidepressant for children, and increasing the dosage can enhance recovery. Regular follow-up appointments and maintaining the medication, frequency, and mode of administration can prevent relapse. Ethical considerations include obtaining informed consent, maintaining confidentiality, and monitoring the patient's progress closely.

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