Posted: December 8th, 2022
Depression Rating Scale Assignment Paper
Assessing and Treating Pediatric Clients with Mood Disorders
This case study involves a pediatric client who was diagnosed with depression as manifested by sadness, blunt affect, withdrawal, thinking about death, reduced appetite, irritability and a score of 30 for the Children’s Depression Rating Scale. This assignment will focus on making three decisions on the client’s medication prescriptions. Finally, the ethical aspects likely to affect the client’s treatment will be highlighted.
Decision Point 1
The decision that was chosen is to have the client start Zoloft 25 mg orally. The rationale for selecting this decision is because evidence shows that Zoloft is effective and safe for treating depression in children aged 6 years and above (Locher et al, 2017). Zoloft is an SSRI that works by increasing the level of serotonin within the brain. High levels of serotonin help in improving the mood and hence treating depressive symptoms. This medication was also selected because it has minimal side effects (Stahl, 2013).Depression Rating Scale Assignment Paper
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Paxil 10 mg was not selected because the medication has many side effects such as nausea, dizziness, sleep problems, appetite loss, shaking, blurred vision etc. In addition, Paxil has been shown to increase suicidal thoughts in children with depression (Locher et al, 2017). Similarly, Wellbutrin was not selected because the medication has many side effects such as constipation, reduced appetite, dizziness, sleep problems, drowsiness, headache, dry mouth, or even seizures. In addition, efficacy and tolerability of Wellbutrin in children have not been systematically studied (Locher et al, 2017).
By selecting Zoloft, it was hoped that depression symptoms for the client would reduce. It was also hoped that the client would tolerate the medication and thus he will have no or minimal side effects. This is because Zoloft has been shown to be effective in improving depressive symptoms and is well tolerated in children (Vitiello, 2012).
However, the client did not exhibit any change in depressive symptoms as expected. This can be attributed to the low dosage and therefore reduced efficacy. According to Hieronymus et al (2016), the antidepressant efficacy of SSRIs such as Zoloft is typified by a dose-response relationship.
Decision Point Two
The chosen decision point two is to have the Zoloft dose increased to 50 mg orally. The rationale to choose this decision is that evidence shows that the effect of SSRIs is dose-dependent and therefore higher doses are more effective than lower doses when it comes to pharmacological action (Hieronymus et al, 2016).
The decision to change to Paxil was not selected due to the side effects associated with the medication. The decision to increase Zoloft to 37.5 was not selected because treatment with Zoloft is supposed to start at a dose of 25 mg one time daily and the dosage titrated to 50 mg once time a day after 1 week (Santarsieri & Thomas, 2015).
With this decision, it was hoped that the client would start responding to treatment, which will be manifested by improvement for the depression symptoms. This is because evidence shows that the effect of SSRIs is dose-dependent and therefore it is expected that titrating Zoloft dosage to 50 mg would be more effective than 25 mg and hence the client will manifest symptom improvement (Hieronymus et al, 2016). It was also hoped that the client would be able to tolerate the increased dose and have no or minimal side effects.
There was no difference between the expected outcomes and the actual outcome for selecting this decision. This is because the client exhibited a reduction of depressive symptoms by 50% and he was also tolerating the medication well. The reduction of symptoms is as a result of the medication’s efficacy after upward titration for the medication (Hieronymus et al, 2016).Depression Rating Scale Assignment Paper
Decision Point Three
The chosen decision point three is to have the current dose maintained. The rationale to choose this decision is because the client is showing symptom improvement with the current dose and therefore it should be maintained. This is because the selection of antidepressants such as Zoloft should take into consideration the potential benefits and side effects as well as the treatment responsiveness (Carvalho et al, 2016).
The decision to change to SNRI was not selected because the client is already showing symptom remission with the SSRI which is the first-line treatment for patients with depression. SSRIs are recommended as the first-line treatment because of their efficacy in the treatment of depression and reduced risk of side effects (Stahl, 2014b). The decision to increase Zoloft to 75mg daily was not selected because the client is already showing symptom remission with the current dosage and also tolerating the current dose and hence an increased dose may cause side effects (Stahl, 2013).
By selecting this decision, it was expected that the client would continue showing symptom remission and that he would tolerate the medication with minimal side effects.
The ethical aspects that may influence the client’s treatment include autonomy, confidentiality, and consent. Since the client is a child, the exercise of parental will prevails. Therefore, even if the child does not consent to treatment, the parent’s will to have the client undergo treatment prevails. The client also lacks the capability to make decisions regarding his treatment. Secondly, the therapist should ensure that confidentiality of the client is maintained and only authorized people such as the parents access the information (Hiriscau et al, 2016).
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The first decision was to have the client begin Zoloft 25 mg orally. The decision was selected because evidence shows that Zoloft is effective and safe for treating depression in children aged 6 years and above. The second decision was to increase the Zoloft dose to 50 mg. This is because the efficacy of SSRIs such as Zoloft is dose-dependent. The third decision is to maintain the current dose because the client is already showing symptom remission and he is well tolerating the medication. Ethical issues likely to impact the client’s treatment include autonomy, confidentiality, and informed consent.
Carvalho A, Sharma M, Brunoni A, Vieta E & Fava G. (2016). The Safety, Tolerability, and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychother Psychosom. 2016(85), 270–288.Depression Rating Scale Assignment Paper
Hieronymus F, Nilsson S & Eriksson E. (2016). A meta-analysis of fixed-dose trials reveals dose-dependency and rapid onset of action for the antidepressant effect of three selective serotonin reuptake inhibitors. Transl Psychiatry. 6(6), e834.
Hiriscau E, Nicola S, Wasserman D & Theil S. (2016). Identifying Ethical Issues in Mental Health Research with Minors Adolescents: Results of a Delphi Study. Int J Environ Res Public Health. 13(5), 489.
Locher C, Koechlin H, Zion S, Werener C, Pine D, Kirsch I, Kessler R & Joe K. (2017). Efficacy and Safety of Selective Serotonin Reuptake Inhibitors, Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common Psychiatric Disorders Among Children and Adolescents. JAMA Psychiatry. 74(10), 1011–1020.
Santarsieri D & Thomas S. (2015). Antidepressant efficacy and side-effect burden: a quick guide for clinicians. Drugs Context. 2015(4).
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Vitiello, B. (2012). Principles in using the psychotropic medication in children and adolescents. In J. M. Rey (Ed.), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions.
Depression Rating Scale Assignment Paper
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