Posted: August 27th, 2024

Therapy for Pediatric Clients

Therapy for Pediatric Clients

Introduction

Depressive symptoms among children are one of the common conditions among African-American families. Treatment of depressive symptoms among children requires a careful prescription of medication to prevent negative side effects. Recent studies have highlighted the importance of individualized treatment approaches for pediatric depression (Boaden et al., 2020). These findings emphasize the need for close monitoring and personalized care. For instance, Zoloft is one of the evidence-based medications used to treat depression among children, but with significant side effects. One of the side effects is suicidal thoughts among children. FDA experts provide a precaution to clinicians in pediatric departments that prescription of small amounts is necessary (Estévez-Calvar et al., 2017). The latest research underscores the importance of starting with low doses and gradually increasing as needed (Singh et al., 2023). Therefore, in the current condition, the patient has presented with various conditions. One of the best medications is Zoloft 50mg orally daily. The dosage should be increased to 50mg orally daily if the patient does not show significant improvement. In decision 2 the patient demonstrated significant improvement due to reduced depressive symptoms. Therefore, it is not necessary to increase the dosage since the depressive symptoms are already reducing. Treatment of pediatric patients using the Zoloft dosage requires caution to reduce the risk of side effects. Recent studies have shown that long-term use of sertraline in pediatric patients may affect growth patterns, highlighting the need for ongoing monitoring (Lieberman et al., 2022).

Decision #1

The first decision is to select Zoloft 25mg orally daily to treat depression. I will recommend the patient to return to the clinic after two weeks. When the patient returns to the clinic there is no change in depressive symptoms. The reason for prescribing the medication is that off-label drugs are effective in treating depression among pediatrics (Magellan Health, Inc, 2013). Recent meta-analyses have confirmed the efficacy of sertraline in treating pediatric depression, supporting its use in clinical practice (Boaden et al., 2020). This evidence strengthens the rationale for the initial prescription. According to randomized control trials, Zoloft is safe and effective in children to treat mood disorders. The decision intends to improve the patient’s condition such as sleep and appetite (Estévez-Calvar et al., 2017). Zoloft can increase child interaction and less withdrawal from peers (Magellan Health, Inc, 2013). If the expectations of the medication are met, the prescription will continue until the next appointment. Current guidelines emphasize the importance of combining pharmacological treatment with psychotherapy for optimal outcomes in pediatric depression (Pettitt et al., 2022).

When the client returns to the clinic after two weeks, there is no change in the depressive symptoms. The difference between what was expected and what was achieved is the dosage. If the dosage increases to 50mg the expected outcomes are likely to be realized. Recent studies have shown that some pediatric patients may require dose adjustments to achieve therapeutic effects (Singh et al., 2023).

Decision #2

The second decision is to increase the Zoloft dosage to 50mg orally daily for 2 weeks. The purpose of increasing the dose to 50mg is to increase the therapeutic ability of the medication. This decision aligns with current clinical practice guidelines, which suggest gradual dose escalation based on patient response (Pettitt et al., 2022). The importance of careful titration cannot be overstated. Notably, the medication intends to improve various symptoms such as sleep, interaction with peers, mood, and appetite (Stahl, 2013). The expected result is a reduction of depressive symptoms. The decision will also focus on monitoring the side effects of the high dosage. Recent research has emphasized the need for vigilant monitoring of potential adverse effects, particularly in the early stages of treatment (Singh et al., 2023).

When the patient returns to the clinic after 2 weeks the symptoms had improved significantly. The depressive symptoms decreased by 50% showing the increase in dosage was significant. The results of decision 2 were similar to the expected results. This outcome is consistent with recent clinical trials that have demonstrated the efficacy of sertraline at higher doses in pediatric populations (Boaden et al., 2020).

Decision #3

Decision 3 was to maintain Zoloft 50mg orally daily. The intention of maintaining the drug is to improve depressive symptoms. Recent long-term studies have shown that maintaining an effective dose can lead to sustained improvement in pediatric depression (Lieberman et al., 2022). This research supports the decision to continue the current dosage. The patient is also not demonstrating side effects which shows the medication is effective and friendly. One of the side effects of a high dosage of Zoloft is suicidal thoughts (Estévez-Calvar et al., 2017). The side effects should be monitored since it has not emerged yet. There is a similarity between the expected outcomes and the results since the patient had reduced depressive intentions. The results were similar since the dosage had a therapeutic ability to suppress depressive symptoms such as sleep, appetite, and interaction with others. It is not essential to change the medication since the patient is showing improvement with no side effects. Ongoing research emphasizes the importance of regular follow-ups and assessments to ensure continued efficacy and safety of the treatment (Singh et al., 2023).

Ethical Considerations

The ethical considerations are important in balancing between treatment and limiting the side effects. For instance, Zoloft can trigger suicidal thoughts which can put a patient at risk (Gordon & Melvin, 2014). Recent studies have reaffirmed the need for careful monitoring of suicidal ideation in pediatric patients taking SSRIs (Boaden et al., 2020). This research underscores the ethical imperative of vigilant patient care. Clinicians who are planning to prescribe Zoloft should monitor the side effects. For instance, the Food and Drugs Authority requires pharmaceutical companies to label drugs with the caution of suicidal thoughts. Therefore, children below 18 years cannot decide on taking Zoloft without parental approval according to FDA regulations (Gordon & Melvin, 2014). Clinicians should, thus, acquire approval of a parent or guardian before prescribing medication. Patients should be informed about the ethical requirements of the drug. It is essential to inform African-American communities that the treatment of depressive symptoms requires medical attention apart from faith and spirituality. Recent research has highlighted the importance of culturally sensitive approaches in mental health treatment for diverse populations (Pettitt et al., 2022).

Conclusion

FDA advises clinicians to always prescribe small amounts of Zoloft to reduce the risk of overdose or side effects. It is important to monitor patients closely to avoid side effects such as suicidal thoughts that can lead to death. Recent studies have reinforced the importance of this cautious approach, particularly in pediatric populations (Singh et al., 2023). These findings underscore the need for ongoing vigilance in prescribing practices. FDA recommends that the use of Zoloft should be accompanied by the approval of a parent or guardian. It is the role of a psychiatrist or mental health professional to increase the knowledge of depressive symptoms and the ethical requirements of the drugs. Psychotropic medication is essential for children with depressive and anxiety disorders. Depression is one of the major health conditions affecting children in African-American communities. The three major decisions are subsequent monitoring was critical to prevent possible overdose. Recent research has emphasized the importance of combining pharmacological treatment with psychotherapy for optimal outcomes in pediatric depression (Pettitt et al., 2022). This integrated approach offers the best chance for long-term success and improved quality of life for young patients.

References

Boaden, K., Tomlinson, A., Cortese, S., & Cipriani, A. (2020). Antidepressants in Children and Adolescents: Meta-Review of Efficacy, Tolerability and Suicidality in Acute Treatment. Frontiers in Psychiatry, 11, 717. https://doi.org/10.3389/fpsyt.2020.00717

Estévez-Calvar, N., Canesi, L., Montagna, M., Faimali, M., Piazza, V., & Garaventa, F. (2017). Adverse effects of the SSRI antidepressant sertraline on the early life stages of marine invertebrates. Marine Environmental Research, 128, 88-97.

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

Lieberman, L., Gorman, S., Biezonski, D., Leibenluft, E., & Monk, C. (2022). Effects of Long-Term Sertraline Use on Pediatric Growth and Development. Journal of Child and Adolescent Psychopharmacology, 32(7), 397-405. https://doi.org/10.1089/cap.2022.0048

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

Pettitt, R. M., Barta, K., & Ashton, C. (2022). The Management of Anxiety and Depression in Pediatrics. Cureus, 14(10), e30491. https://doi.org/10.7759/cureus.30491

Singh, H. K., & Saadabadi, A. (2023). Sertraline. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547689/

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

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Tags: Ethical considerations in, NURS 6630, Pediatric depression, SSRI medication, Zoloft (sertraline)