Psychopharmacologic Approaches to TreatmentPsychopharmacologic Approaches to Treatment Student’s Name
Date Psychopharmacologic Approaches to Treatment
The case study of an African-American who is suffering from depression describes the various decisions required to provide treatment to mood disorders. Mood disorders are common among Africa-American communities and thus effective treatment is required. The first decision was to determine that Zoloft is a safe and reliable medication in the treatment of depressive symptoms (Mansouripour & Kumar, 2019). The second and third decision was to maintain the prescription of the medication since it triggered positive outcomes. Provision of treatment to depressive patients involves ethical considerations meant to reduce the side effects of the drug. Psychopharmacologic approaches are necessary for treatment of depression using various decisions to improve positive outcomes and reduce side effects.
Choices for decision 1: The first decision involves prescribing Zoloft 25mg orally daily, Wellbutrin 75mg orally BID and Paxil 10mg orally daily.
My decision: The best decision as a PMHNP who is treating pediatric patients is to prescribe Zoloft 25mg orally daily (Oliveira et al., 2018). The first choice will be prescribed and examined after the first two weeks.
Reasons for selecting Zoloft: Zoloft 25mg orally daily is an evidence-based antidepressant medication. The drugs affect the brain this altering the behavior and mood of a child. The medication is categorized among therapeutic drugs called SSRI or selective serotonin reuptake inhibitors (Stahl, 2013). Zoloft is a recommended drug for depressive symptoms. The approval of the drugs is based on the ability of the medication to trigger fewer side effects, especially among depressive children. Additionally, random-control trials have indicated that the drug is safe for long term use without habit-forming addictive effects (Stahl, 2013). FDA states that it is safe to prescribe lower doses to pediatric patients to reduce the risk of overdose or severe side effects. For instance, a high dosage of Zoloft causes suicidal thoughts among patients (Gordon & Melvin, 2014). The prescription of the drugs should be based on body weight to prevent high plasma levels. As a PMHNP, I expect that the drug will work effectively to promote positive behavior, promote full recovery, and reduce depressive symptoms.
I did not opt for Paxil since the medication is not safe for children. The drug can trigger withdrawal symptoms when the medication is stopped. The drug has other negative effects on a child such as suicidal thoughts (Strawn et al., 2017). For example, statistics indicate that children are likely to commit suicide when they start taking the medication or when the dose is increased. It is thus not safe for children and adolescents (Strawn et al., 2017). Consequently, due to the negative effects of the drug it has not been approved by FDA until today.
I did also not choose Wellbutrin although is it an antidepressant drug. FDA has indicated in their previous reports that the drug is not safe for children due to the increased suicidal thoughts and behavior upon taking it (Strawn et al., 2017). Random-control trials and systematic reviews have also found that the drug is not safe for children with psychiatric disorders. FDA also reports that the medication is likely to cause epileptic seizures compared to other psychotic drugs (Strawn et al., 2017). The possibility of epileptic seizures increases upon administration or an increase in the dose. Wellbutrin also causes a change in heart rhythm which can severely affect the health condition of children as well as adults. However, little evidence is available showing that Wellbutrin is effective for ADHD patients.
Outcome: The client returned to the health center after four weeks. The patient did not present any change in depressive symptoms. One of the reasons for the lack of evidence in therapeutic changes that may take time between 2-4 weeks or the dose should be increased.
Expectations: The expected outcome was a significant decrease in depressive symptoms. For example, I expected to hear from the parents that the child has improved in terms of going to school, playing and interacting with peers, eating food and sleep (Magellan Health, Inc, 2013). Another expectation was that the drug should be safe and therapeutically beneficial to the patient with minimal side effects.
Choices for Decision #2: The second decision was made after the patient returned to the clinic after four weeks. One of the activities is to assess if the patient had shown changes in the depressive symptoms. For example, the expectation was to learn that the basic depressive symptoms such as appetite and sleep had improved.
The second decision was to increase the Zoloft to 50mg orally daily. The purpose of increasing the dosage is derived from evidence-based practice that Zoloft can be increased to enhance effectiveness (Lorberg et al., 2019). Additionally, it is important to realize that some depressive symptoms may not occur within a short time such as 4 weeks. In the second decision, the patient will stay for another 4 weeks taking an increased dosage. FDA also warns patients and clinicians that they should not prescribe Zoloft medication in large doses at the beginning (Lorberg et al., 2019). The purpose is to reduce the risk of adverse side effects. Therefore, the expectation is to realize a significant reduction in depressive symptoms and suppress them significantly.
One of the second thoughts in the treatment plans is to change the drug. However, it is not necessary to change the drug since Zoloft has been named among the proven medication among depressive children. Therefore, perhaps if the dosage increases the depressive symptoms such as lack of sleep or appetite. It is thus important to stick with the drug and evaluate the effectiveness after increasing the drug (Lorberg et al., 2019). If the drug does not present any outcome after the second visit, it would be necessary to reevaluate the suppressive statements and probably seek treatment using different drugs. The second lead to a decision that also pertains to the delivery of custom care to patients.
Decision #3 is based on the outcome of decision #2. The outcomes of decision #2 indicated that the prescription of a higher dose was effective in significantly reducing the symptoms. According to the records, the symptoms of depression reduced by 50 percent in the fourth week of taking Zoloft 50mg orally daily. For instance, the parent reported that the patient had improved interaction with peers, appetite, and sleep.
Decision #3 is thus to maintain the prescription of Zoloft 50mg orally daily for another set of four weeks. The purpose of the prescription is to continue reducing the negative behaviors associated with depression (Stahl, 2013). Another reason why the drug should not be maintained is that the drug is not causing negative side effects associated with Zoloft. For instance, an increase in Zoloft dose is likely to increase suicidal thoughts among patients (Oliveira et al., 2018). The suicidal thoughts can translate into real actions leading to physical harm or death. However, despite the absence of the negative side effects it is essential to keep the patient at close monitoring (Gordon & Melvin, 2014). The clinician should also communicate with the parent or guardian to inform them about the risks of taking a higher dose of Zoloft.
FDA recommends that patients of depression should not take higher doses of Zoloft at the beginning of treatment (Gordon & Melvin, 2014). The reason is that patients react differently to treatment causing varying side effects. Decision #3 will thus involve maintaining the dose at 50mg orally daily.
The expected outcomes were realized since the depression symptoms were reduced by 50 percent. The expectations and the outcomes were similar since the medication had positive results. Notably, the similarities in the expectations and outcomes were evident through improved sleep, eating habits and interaction with peers (Gordon & Melvin, 2014). Clinicians will recommend to the patient to continue taking the medication and come back for further examination and review after another four weeks.
Ethical Approaches to Treatment
Prescription and treatment of pediatric patients involve various ethical issues that will impact treatment and communication to patients. For example, FDA recommended that patients below 18 years should not decide to take Zoloft without the approval of a parent or guardian (Stahl, 2013). If the medication is provided without proper communication and approval, it would amount to unethical behavior.
Patients with depressive symptoms should not take higher doses in the initial prescription. According to FDA clinicians should prescribe lower doses to reduce the risk of severe side effects such as suicide (Lorberg et al., 2019). For instance, if a patient dies after prescription of Zoloft, a clinician will be held responsible for the amount of drug they prescribed. The prescription should be accompanied by close monitoring of the patient. Clinicians are thus required to communicate to the parent or guardian about the expected side effects of the drug (Lorberg et al., 2019). The awareness will ensure parents keep watch on the child and take appropriate action when necessary.
FDA requires pharmaceutical companies to always warn patients and clinicians about the side effects of the drug. For instance, FDA requires companies to place a warning message on the packaging boxes of the medication (Lorberg et al., 2019). The warning message should indicate that the drug should be used with precaution to limit the suicidal side effects.
Clinicians have an ethical and moral responsibility of communicating the African-American patients or their children the importance of medication. Despite the expected side effects, African-Americans should seek treatment and come back for follow-up clinics (Oliveira et al., 2018). The purpose of communication is to counter a growing perception among the African-American communities that depression requires only a spiritual solution. Although the community will engage in praying to a higher power and ask for healing, they should find a healthcare center to seek treatment.
Treatment of mood disorders using psychopharmacologic approaches requires various decisions. All the decisions are aimed at improving the quality of health of a patient. Initially, the decisions are meant to determine the best drug for the patient. Subsequent decisions including decision #2 and #3 are meant to determine whether to continue with the treatment or not. In the case study of an African-American with depressive symptoms, Zoloft was the best medication available for treatment. The medication was increased to 50mg orally daily and the outcome was positive. However, despite the positive outcome, clinicians should prescribe the drug keeping in mind the ethical considerations. Clinicians should understand the FDA's ethical requirements of the prescribing Zoloft and communicate to patients or guardians. References
Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. DOI:10.1111/jpc.12655
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. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Retrieved from https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf
Magellan Health, Inc. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. Retrieved from http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf
Oliveira, A. S., Martinez-de-Oliveira, J., Donders, G. G., Palmeira-de-Oliveira, R., & Palmeira-de-Oliveira, A. (2018). Anti-Candida activity of antidepressants sertraline and fluoxetine: effect upon pre-formed biofilms. Medical Microbiology and Immunology, 207(3-4), 195-200.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Strawn, J. R., Dobson, E. T., & Giles, L. L. (2017). Primary pediatric care psychopharmacology: focus on medications for ADHD, depression, and anxiety. Current Problems in Pediatric and Adolescent Health Care, 47(1), 3-14.