NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

Walden University NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders – Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

Whether one passes or fails an academic assignment such as the Walden University NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

The introduction for the Walden University NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

After the introduction, move into the main part of the NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

Depression is a prevalent mental disorder not only in the US but globally. It is a leading cause of disability globally and contributes to the general global disease burden. People with significant clinical needs have a higher risk of developing depression and face more challenges managing the diagnosis. The purpose of this assignment is to create a patient medication guide for the treatment of depression in adolescents.  

Depressive Disorder Causes and Symptoms 

Depression is caused by a complex interaction of biological, social, environmental, and psychological factors. Studies consistently show that genetic factors play a role in the development of depressive disorders. Depression is 1.5-3 times more common among individuals with 1^st-degree biological relatives with a history of depression. Individuals who have experienced adverse life events like bereavement, job loss, and traumatic events have a high risk of developing depression (Selph & McDonagh, 2019). Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and the depression itself. High levels of expressed emotion by a family member, marital conflict, and lack of social support predict depression. Furthermore, there is a correlation between depression and physical health (Selph & McDonagh, 2019). Individuals with chronic illnesses and life-threatening diseases tend to have a higher prevalence of depression. 

The primary symptoms of depression include a depressed mood characterized by feeling sad, empty, or hopeless; most of the day, nearly every day, and loss of interest or pleasure in activities. Other clinical manifestations of depression include weight changes, appetite changes, sleep disturbances, psychomotor agitation or retardation, fatigue or low energy levels, feelings of worthlessness, inappropriate guilt, reduced ability to think and concentrate, and suicidal ideations (Beirão et al., 2020). The clinical manifestations cause clinically significant distress or impairment in social, occupational, and other important areas of functioning.  

How Depression Is Diagnosed in Adolescents 

Depression in adolescents is diagnosed based on the clinical manifestations outlined above. Adolescents often present with an irritable mood instead of a depressed mood, present for at least two weeks (Beirão et al., 2020). Adolescents are considered a vulnerable population with regard to depression because it is a major risk factor for suicide. Suicide is the third leading cause of mortality among adolescents in the US. More than 50% of adolescent suicide victims have been reported to have depressive symptoms or diagnosis at the time of death (Petito et al., 2020). Furthermore, adolescents are vulnerable because depression in this population contributes to severe impairments in social and educational functioning. It also increases rates of tobacco use, alcohol and substance misuse, and obesity. Besides, depression in adolescents predicts various mental health disorders in adulthood, like substance-related disorders, anxiety disorders, bipolar disorder, suicidal behavior, physical health conditions, and unemployment (Petito et al., 2020). Therefore, it is crucial to identify and treat depression in adolescents promptly.  

Medication Treatment Options 

Selective serotonin reuptake inhibitors (SSRIs) are the recommended 1^st-line therapy for depression in adolescents. The FDA-approved SSRIs include Fluoxetine and escitalopram (Lexapro). Mullen (2018) explains that Fluoxetine has a faster onset of symptom improvement and time to stabilization. It is also well-tolerated and effective in the treatment of depression in adolescents. However, Fluoxetine has been found to induce mania and trigger suicidal ideation and behavior in adolescents (Patra, 2019). Common SSRI side effects include nausea, headache, insomnia, anorexia, diarrhea, dry mouth, anxiety, drowsiness, and nervousness. Tricyclic Antidepressants (TCAs) are at times used in adolescents with comorbid enuresis, attention deficit hyperactivity disorder (ADHD), and narcolepsy and for augmentation with SSRIs. TCAs commonly prescribed in adolescents are Imipramine, Nortriptyline, and Amitriptyline ((Patra, 2019). TCAs’ side effects include dry mouth, constipation, difficulties passing urine, drowsiness, dizziness, weight gain, and excessive sweating.  

Antidepressants in adolescent depression are chosen based on the evidence base, patient characteristics, developmental level, severity of depressive symptoms, previous response to treatment, chronicity, family history of treatment response, comorbid psychiatric and medical conditions, and patient preferences (Mullen, 2018). When treating adolescents with depression, the SSRI is initiated at the lower end of the therapeutic dose. The dose is increased after four weeks. If a patient has partial or complete remission of depressive symptoms, the same SSRI dose is continued in the continuation phase. If there is minimal improvement in symptoms, the dose is increased. However, if there is no significant improvement in symptoms after 12 weeks or there are intolerable side effects, a change of SSRI is warranted (Patra, 2019). TCAs are started at low doses to minimize adverse effects. In adolescents, TCAs are prescribed in once-daily bedtime doses. 

Monitoring Treatment 

The adolescent patient on SSRIs is assessed for anxiety or panic attacks, social mania/mood lability, functioning, and features of serotonin syndrome. Blood levels are rarely monitored in SSRIs, but they are sometimes checked to rule out toxicity (Patra, 2019). Antidepressants have been linked to an increased risk of suicidality, suicidal thinking, and behavior. Therefore, it is vital to monitor adolescent patients on SSRIs for suicidal thinking and behavior.  

Special Considerations 

Legal considerations surround abuse, neglect, or mistreatment of the adolescent patient. The provider is mandated by law to report suspected cases of physical, sexual, or emotional abuse, as well as cases of neglect and mistreatment, which are common among depressed adolescents (Disla de Jesus et al., 2022). In such situations, legal imperatives are introduced to the clinical situation. Ethical considerations surround beneficence and nonmaleficence. The provider has a moral duty to provide treatment interventions with the best outcomes and the least adverse effects.  

The provider considers the adolescent’s culture when planning depression treatment. The provider considers the adolescents’ cultural beliefs about mental health, practices for mental health issues, and cultural factors that may hinder access to mental health care, like racial discrimination. Social determinants of health (SDOH) factors like health insurance and family income level influence the type of treatment since the provider considers the affordability of treatment to promote adherence (Disla de Jesus et al., 2022). Besides, the provider considers the adolescent’s literacy levels when providing health education on depression and tailoring the health teaching. When recommending community resources for adolescents with depression, the provider considers the patient’s neighborhood and access to these resources.  

Where to Follow Up In Your Local Community 

The National Alliance on Mental Health (NAMI) is an insightful community resource that provides various resources for adolescents with depression. It offers resources to guide you on asking for help, communicating with your friends and parents, and navigating school with depression. You can also access the Mental Health Literacy site if you want adequate information on depression. The site has pdfs, videos, e-books, animations, and online training programs on mental health supported by science and are continuously improved. 

Prescription for Adolescent Patient 

1. Fluoxetine 10 mg orally once a day.  

2. Lexapro 10 mg orally once a day. 

3. Imipramine 30 mg orally once every bedtime.  

Also Read:

Assessing and Treating Patients With Bipolar Disorder

Assessing and Treating Patients With Anxiety Disorders

Treatment for a Patient With a Common Condition

Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis Disorders

WEEK 8 Short Answer Assessment

Assessing and Treating Patients With Sleep Wake Disorders

Assessing and Treating Patients With ADHD

Psychopharmacologic Approaches to Treatment of Psychopathology

Assessing and Treating Patients With Impulsivity, Compulsivity, and Addiction

Conclusion 

Adolescent depression is characterized by irritable mood, loss of interest, weight and appetite changes, sleep disturbances, inappropriate guilt, and suicidal ideations. Adolescents are a vulnerable population in relation to depression since it increases their risk of suicide. Suicide is a leading cause of death among adolescents, and depression contributes to suicide. Besides, depression impairs their education and social functioning. The FDA has approved only two drugs for the treatment of adolescent depression Fluoxetine and Lexapro. TCAs are used in adolescents with comorbid conditions.  

References 

Beirão, D., Monte, H., Amaral, M., Longras, A., Matos, C., & Villas-Boas, F. (2020). Depression in adolescence: a review. Middle East current psychiatry, 27(1), 1-9. https://doi.org/10.1186/s43045-020-00050-z 

Disla de Jesus, V., Liem, A., Borra, D., & Appel, J. M. (2022). Who’s the Boss? Ethical Dilemmas in the Treatment of Children and Adolescents. Focus, 20(2), 215-219. https://doi.org/10.1176/appi.focus.20210037 

Mullen, S. (2018). Major depressive disorder in children and adolescents. The mental health clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275 

Patra, S. (2019). Assessment and management of pediatric depression. Indian Journal of Psychiatry, 61(3), 300–306. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_446_18 

Petito, A., Pop, T. L., Namazova-Baranova, L., Mestrovic, J., Nigri, L., Vural, M., … & Pettoello-Mantovani, M. (2020). The burden of depression in adolescents and the importance of early recognition. The Journal of pediatrics, 218, 265-267. https://doi.org/10.1016/j.jpeds.2019.12.003 

Selph, S., & McDonagh, M. S. (2019). Depression in children and adolescents: Evaluation and treatment. American family physician, 100(10), 609–617. 

Sample Answer 2 for NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

Major depression is a mental disorder among most of the American population. Depression affects health, wellbeing and quality of life of the patients and their families. Psychiatric practitioners should be competent in the assessment, diagnosis, treatment, monitoring, and evaluation of depression. They should be able to select evidence-based treatments for vulnerable populations for their recovery and health. Therefore, this essay examines depression among the elderly populations. It focuses on topics such as causes and symptoms, diagnosis, medication treatment options, monitoring and special considerations.  

Causes and Symptoms of Depression 

Depression among the elderly is attributed to several causes. One of the causes is genetics. An elderly patient born to a family with a history of major depression is at a risk of developing the disorder because of the role of genetics. Chronic illnesses also contribute to the development of major depression. For example, the experiences with health issues such as cancer or chronic obstructive pulmonary disease predispose patients to major depression. The use of alcohol and other drugs can also cause depression. Substance use and abuse may produce side effects, which include major depression. Traumatic experiences in life also cause major depression. Patients with histories such as loss of a significant other, job, or undergoing challenges such as a divorce also increases the risk of developing major depression. Imbalances in the neurotransmitters and hormones in the brain also cause major depression. Imbalances in hormones such as acetylcholine and dopamine predispose individuals to major depression (Trenoweth, 2022). Similarly, any disruption in the levels of neurotransmitters such as serotonin and norepinephrine also cause major depression.  

The elderly patients suffering from major depression experience several symptoms. One of them is feeling sad in most of the days, nearly every day. They also raise a significant decline in their interest or pleasure nearly every day. The patients also report weight gain from increased appetite or loss because of decline in appetite. They also experience slowed thought processes, fatigue, and feel worthless or guilty almost every day. The depressed mood makes it hard for them to concentrate or make decisions. In some cases, patients report recurrent suicidal thoughts, attempts, with or without a plan. A comprehensive history taking reveals that the symptoms are not because of a medical condition, medication use or substance abuse (Trenoweth, 2022). In addition, the symptoms affect the normal functioning of the patients in their environments.  

Diagnosis 

The diagnosis of major depression in the elderly patients require a detailed history taking and physical assessment. History taking provides subjective information about the disorder to the practitioner. The psychiatric nurse asks questions that quantify the existence and severity of a health problem. History taking provides insights into potential causes of major depression such as family history of the disease, substance abuse, a history of depression, and the patient experiencing a traumatic event. Physical examination provides subjective information about the disorder. The practitioner relies on methods such as inspection, palpation, percussion, and auscultation. There are also the use of diagnostic and laboratory investigations in physical assessment. The investigations help rule out other potential causes of major depression symptoms in this population (Alshawwa et al., 2019). Nurse practitioners use both subjective and objective assessments to develop accurate diagnoses of their clients’ problems.  

The elderly are considered a vulnerable population when diagnosing and treating mental health problems. First, they are a vulnerable population because of their increased predisposition to multiple comorbidities. Besides major depression, the elderly people also have a high risk of developing chronic conditions such as hypertension, heart failure, and dementia. The elderly patients are also a vulnerable population because of their decline in productivity. Social and occupational productivity decline with aging. The elderly patients have limited involvement in most of the social and occupational roles. As a result, their access to healthcare and other social opportunities is low, making them a vulnerable population. Aging is also associated with decline in physiological functioning. Accordingly, the elderly patients have reduced functioning of the vital organs such as the liver and kidneys. The reduced functioning alters the normal processes such as drug metabolism and excretion (Saedi et al., 2019). The changes places them at a high risk of drug toxicity in disease management, hence, them being a vulnerable population.  

Medication Treatment Options 

Pharmacotherapy is the gold approach to depression treatment in the elderly patients. The treatment phases are three. They include acute, continuation, and maintenance phase. Prescription of drugs for this population should consider their environmental and social contexts. For example, the availability of adequate social support and socialization improves outcomes in the elderly patients suffering from major depression. Most of the elderly patients have pre-existing comorbid conditions such as diabetes and heart failure (Hoel et al., 2021). As a result, the treatment options for major depression should be considered for safety and quality outcomes.  

Antidepressants are the primary drugs of choice in major depression among the elderly. Tricyclic antidepressants such as amitriptyline, desipramine, and nortriptyline are used in some patients. However, patients should be monitored for cardiac and cognition abnormalities. Selective serotonin reuptake inhibitors have a high preference rate for major depression in the elderly patients because of their safety and efficacy levels. Patients should be monitored closely for falls, insomnia, weight gain, and suicidal thoughts and attempts among patients (Li et al., 2021; Miller et al., 2020). The FDA approved antidepressants for use among the elderly patients with major depression include sertraline, citalopram, venlafaxine, mirtazapine, and bupropion.  

Medication Considerations 

Practitioners can consider several medications for treating major depression among the elderly patients. They include sertraline, citalopram, venlafaxine, mirtazapine, and bupropion. The other options for the disorder are venlafaxine, amitriptyline, desipramine, and nortriptyline (Li et al., 2021; Miller et al., 2020). Practitioners should always weigh the risks and benefits associated with the different classes of medications utilized for major depression.  

Monitoring 

Psychiatric mental health nurse practitioners should monitor patients for the side effects associated with the prescribed medications. The use of antidepressants have side effects such as dizziness, constipation, nausea, insomnia, headache, and sexual dysfunction. Patients should be informed that these side effects improve over time. It is important to monitor patients for any cognitive or cardiac abnormalities with the use of tricyclic antidepressants. The risk of falls is also high with the use of antidepressants. Fall risk assessment should be undertaken before prescribing antidepressants to mitigate the risk. Laboratory investigations for serum electrolytes should also be undertaken. Drugs such as selective serotonin reuptake inhibitors increase the risk of hyponatremia due to the development of syndrome of inappropriate antidiuretic hormone secretion. The risk of suicide with antidepressants is also elevated. Follow-up should seek to establish if the patient has developed suicidal thoughts, plans, or attempts (Krause et al., 2019; Perini et al., 2019). Weight changes should also be monitored with the use of antidepressants. Excessive weight gain may predispose the elderly to comorbidities such as diabetes, cardiovascular complications, and fractures.  

Special Consideration and Follow-Up 

Some special considerations influence the choice of treatment for major depression in the elderly patients. As identified initially, most of the elderly patients also suffer from comorbid conditions and decline in physiological processes. The risk of harm during the treatment is high. Psychiatric mental health nurse practitioners must ensure the use of evidence-based treatments that align with the patients’ needs. The focus should be on ensuring quality and safety of the treatment, hence, benevolence and non-maleficence. The treatment of major depression in this population may also demand care coordination. Care coordination requires sharing of information among the different healthcare providers involved in disorder management. As a result, practitioners must ensure data privacy and confidentiality. They should seek informed consent from the patients before sharing any information with the healthcare providers, hence, the protection of autonomy in the care process. Follow-up care is often after four weeks of the first and subsequent treatments (Kupfer, 2005; Pilotto et al., 2020). Patients can benefit from community resources such  those by the American Psychological Association and the Centers for Disease Control and Prevention.  

Example of Prescriptions 

Po escitalopram 10 mg od  

Po Sertraline 50 mg od 

Po venlafaxine 37.5 mg bd  

Conclusion 

In conclusion, this paper has explored major depression among elderly populations. The elderly populations are considered vulnerable because of changes in their physiological and physical functioning. Safety should be considered when treating this population due to these changes and existence of multiple comorbidities. Antidepressants are largely used for major depression in the elderly patients. Ethical considerations should inform the selected treatments.  

References 

Alshawwa, I. A., Elkahlout, M., El-Mashharawi, H. Q., & Abu-Naser, S. S. (2019). An Expert System for Depression Diagnosis. http://dspace.alazhar.edu.ps/xmlui/handle/123456789/128 

Hoel, R. W., Giddings Connolly, R. M., & Takahashi, P. Y. (2021). Polypharmacy Management in Older Patients. Mayo Clinic Proceedings, 96(1), 242–256. https://doi.org/10.1016/j.mayocp.2020.06.012 

Krause, M., Gutsmiedl, K., Bighelli, I., Schneider-Thoma, J., Chaimani, A., & Leucht, S. (2019). Efficacy and tolerability of pharmacological and non-pharmacological interventions in older patients with major depressive disorder: A systematic review, pairwise and network meta-analysis. European Neuropsychopharmacology, 29(9), 1003–1022. https://doi.org/10.1016/j.euroneuro.2019.07.130 

Kupfer, D. J. (2005). The pharmacological management of depression. Dialogues in Clinical Neuroscience, 7(3), 191–205. https://doi.org/10.31887/DCNS.2005.7.3/dkupfer 

Li, Z., Ruan, M., Chen, J., & Fang, Y. (2021). Major Depressive Disorder: Advances in Neuroscience Research and Translational Applications. Neuroscience Bulletin, 37(6), 863–880. https://doi.org/10.1007/s12264-021-00638-3 

Miller, K. J., Gonçalves-Bradley, D. C., Areerob, P., Hennessy, D., Mesagno, C., & Grace, F. (2020). Comparative effectiveness of three exercise types to treat clinical depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. Ageing Research Reviews, 58, 100999. https://doi.org/10.1016/j.arr.2019.100999 

Perini, G., Cotta Ramusino, M., Sinforiani, E., Bernini, S., Petrachi, R., & Costa, A. (2019). Cognitive impairment in depression: Recent advances and novel treatments. Neuropsychiatric Disease and Treatment, 15, 1249–1258. https://doi.org/10.2147/NDT.S199746 

Pilotto, A., Custodero, C., Maggi, S., Polidori, M. C., Veronese, N., & Ferrucci, L. (2020). A multidimensional approach to frailty in older people. Ageing Research Reviews, 60, 101047. https://doi.org/10.1016/j.arr.2020.101047 

Saedi, A. A., Feehan, J., Phu, S., & Duque, G. (2019). Current and emerging biomarkers of frailty in the elderly. Clinical Interventions in Aging, 14, 389–398. https://doi.org/10.2147/CIA.S168687 

Trenoweth, S. (2022). Understanding Mental Health Practice for Adult Nursing Students. Learning Matters. 

Sample Answer 3 for NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders

Depressive disorders are a source of considerable disease burden to the global population. The disorders affect productivity, lower the quality of life of the affected populations, and cause premature mortalities. Pharmacological interventions are the mainstream treatments for depressive disorders. Nurse practitioners should be aware of the safety, indications, and monitoring of different populations prescribed medications for depressive disorders. Therefore, this essay examines the medications used in treating major depression in children and adolescents, considerations, monitoring, follow-up, diagnosis, and its causes and symptoms.

Causes and Symptoms

Major depression in children and adolescents is an important public health concern since it affects 5% of 12-year-olds and 17% of 17-year-olds in America. Psychological, biological, and environmental factors cause major depression in children and adolescents. Some of the biological risk factors associated with major depression include overweight, female sex, having a family history of depression, early puberty in girls, chronic illness, and polymorphisms that affect dopamine, serotonin, or monoamine oxidase genes. Some of the psychological factors that cause major depression in this population include dysfunctional emotional regulation, body dissatisfaction, low self-esteem, negative thinking, and substance abuse (Boaden et al., 2020; Farley, 2020). Environmental causes of major depression among children and adolescents include bullying, victimization, exposure to traumatic events, parental rejection, and dysfunctional families.

Children and adolescents affected by major depression present to the hospital with a range of symptoms. They include hypersomnia or insomnia, weight gain or loss, difficulty concentrating, lack of interest and pleasure, easy irritability, and feeling sad or hopeless. Patients also report difficulties in making decisions, feeling guilty, and suicidal thoughts, plans, or attempts (Dwyer & Bloch, 2019; Selph & McDonagh, 2019). The symptoms affect the patient’s normal functioning in areas such as academic and social activities.

Diagnosing the Disorder and Why the Population is Considered Vulnerable

Screening tools such as PHQ-A are used in the diagnosis of major depression in children and adolescents. The screening tool helps healthcare providers rate the client’s depressive symptoms and rule out other potential causes such as generalized anxiety disorder and bipolar disorder. Major depression can present with symptoms that are seen in other conditions such as hypothyroidism. As a result, healthcare providers must perform laboratory investigations such as thyroid function tests to rule out other comorbidities. The Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) also guides the diagnosis of major depression in children and adolescents. The DSM-5 manual sets the criteria that must be met for a diagnosis of major depression to be made (Selph & McDonagh, 2019). For example, patients should report symptoms such as being depressed almost every day most of the time, lack of interest and pleasure, changes in appetite and weight, being hopeless or guilty, having difficulties concentrating and making decisions, and symptoms affecting normal functioning.

Children and adolescents are considered a vulnerable population. Firstly, children and adolescents are not mature enough to make safe decisions about issues that affect their health. Children and adolescents rely on others for decision-making and support. As a result, they are at risk of harm and practices that affect their health outcomes. Children and adolescents are also highly vulnerable to social, emotional, and physical changes. Exposure to negative experiences such as abuse, or violence can alter significantly their normal development and progression to adulthood. This makes them a vulnerable group to other health problems based on their environmental exposures. Children and adolescents also have immature body systems and organs. This means that, unlike adults, children and adolescents are prone to harm from medications used for different conditions. Their risk of developing side and adverse effects due to immature organs involved in drug metabolism and elimination is higher than in adults (Farley, 2020). Therefore, they are considered a vulnerable population and caution must be taken when treating mental health problems that affect them.

Medication Treatment Options and Examples

The Food and Drug Administration (FDA) has approved escitalopram and fluoxetine for use in treating major depression in children and adolescents. The guidelines recommend the use of fluoxetine in children who are aged eight years and older while escitalopram is used for patients who are aged 12 years and above. The other FDA-non-approved antidepressants used for treating major depression in this population include paroxetine, sertraline, citalopram, and fluvoxamine (Feeney et al., 2022). Bupropion and mirtazapine might also be considered despite the lack of adequate evidence that supports their use in the population.

Antidepressants have the benefit of managing the depressive symptoms of major depression. The improvement in symptoms results in enhanced functioning, well-being, and quality of life. Antidepressants also reduce the risk of symptom relapse among children and adolescents with major depression. However, practitioners should be aware of the risks associated with antidepressants. They include predisposing patients to suicidal thoughts, plans, or attempts. Patients might also suffer from a negative self-image from weight gain associated with antidepressants (Boaden et al., 2020; Dwyer & Bloch, 2019). Patients and their families should also be educated about anticipated side effects such as insomnia, sedation, sexual dysfunction, gastrointestinal upset, hyperhidrosis, and dry mouth.

Monitoring

Close patient monitoring should be done for children and adolescents prescribed antidepressants. Firstly, children and adolescents should be monitored for suicide risks. Antidepressants are associated with the adverse effect of increasing the risk of suicide in patients. Laboratory investigations such as a lipid panel and complete blood count should be performed periodically. Antidepressants are associated with side effects such as weight gain. Patients should be assessed for cardiovascular risks such as hyperlipidemia with weight gain (Hazell, 2022). Blood pressure and weight should also be assessed regularly, and patients advised on effective interventions to promote healthy weight gain.  

Healthcare providers should also monitor children and adolescents for pediatric behavioral activation syndrome. The syndrome can be diagnosed based on symptoms such as mania, hyperactivity, and agitation. Patients should also be monitored for serotonin syndrome. Serotonin syndrome develops among patients with dual antidepressant therapy (Zhou et al., 2020). Patients with serotonin syndrome present to the hospital with symptoms that include hypertension, diarrhea, sweating, hyperthermia, and tachycardia.

Special Considerations

Several considerations influence drug therapy for children and adolescents diagnosed with major depression. Firstly, ethical considerations influence the selected treatments. Ethical principles such as autonomy and non-maleficence guide the practitioner’s decisions. Autonomy entails protecting a client’s right to self-determination. Healthcare providers ensure informed consent is obtained from the parents and legal custodians of the children and adolescents when treating major depression (Dwyer & Bloch, 2019). They also make decisions that are associated with optimum benefits such as a reduction in symptoms of major depression and minimum risk of patient harm.

 Legal considerations also affect the treatment of major depression in children and adolescents. Healthcare providers must ensure data privacy and confidentiality when treating major depression in children and adolescents. They should ensure that unauthorized parties do not access the patient’s data. Informed consent should be obtained before sharing the information with other healthcare providers. Healthcare providers must also make decisions in the client’s best interest to prevent negligence in their practice. Nurse practitioners should also be aware of the effect of culture on treatment outcomes in children and adolescents with major depression. Cultural practices associated with mental health problems such as stigma and isolation lower treatment utilization and adherence (Zhou et al., 2020). Healthcare providers must advocate the adoption of strategies that address stereotypes related to mental health problems in their communities.

Social determinants of health also influence major depression among children and adolescents. Children and adolescents born to poor families are likely to experience barriers in accessing their needed mental healthcare services due to issues such as cost. Income and education levels also influence the access to and utilization of mental health services by this population (Sokol et al., 2019). Therefore, addressing social determinants of health would result in increased access to mental healthcare services for children and adolescents.

Follow-Up

Antidepressants take between two and six weeks to produce the desired effects in managing depressive symptoms. Therefore, patients should be followed up after two weeks to assess their response to treatment and identify any issues that should be addressed for optimum treatment outcomes. Patients should also be linked with social support groups for mental health problems to help them learn effective ways to cope with their conditions.

Examples of Proper Prescription

Name: L.L.

Age: 12 years

Diagnosis: Major depression

Treatment: Oral sertraline 25 mg OD for two weeks

Refills: none

Follow-up: after two weeks

Name of the prescriber and DEA number:

Name: Y.Y.

Age: 14 years

Diagnosis: Major depression

Treatment: Oral escitalopram 25 mg once daily for two weeks

Refills: none

Follow-up: two weeks

Name of the prescriber and DEA number:

Name: L.A.

Age: 17 years

Diagnosis: Major depression

Treatment: Oral Fluoxetine 25 mg once daily for two weeks

Refills: none

Follow-up: two weeks

Name of the prescriber and DEA number:

Conclusion

 In summary, major depression in children and adolescents is the selected depressive disorder of focus in this assignment. FDA-approved and non-approved antidepressants are used in treating major depression in children and adolescents. Healthcare providers should weigh the benefits and risks of the available treatment. Legal, ethical, and cultural considerations and social determinants of health inform treatment decisions in children and adolescents diagnose with major depression.

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. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00717

Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for Pediatric Patients. Current Psychiatry, 18(9), 26-42F.

Farley, H. R. (2020). Assessing mental health in vulnerable adolescents. Nursing2023, 50(10), 48. https://doi.org/10.1097/01.NURSE.0000697168.39814.93

Feeney, A., Hock, R. S., Fava, M., Hernández Ortiz, J. M., Iovieno, N., & Papakostas, G. I. (2022). Antidepressants in children and adolescents with major depressive disorder and the influence of placebo response: A meta-analysis. Journal of Affective Disorders, 305, 55–64. https://doi.org/10.1016/j.jad.2022.02.074

Hazell, P. (2022). Antidepressants in adolescence. Australian Prescriber, 45(2). https://doi.org/10.18773/austprescr.2022.011

Selph, S. S., & McDonagh, M. S. (2019). Depression in Children and Adolescents: Evaluation and Treatment. DEPRESSION IN CHILDREN AND ADOLESCENTS, 100(10).

Sokol, R., Austin, A., Chandler, C., Byrum, E., Bousquette, J., Lancaster, C., Doss, G., Dotson, A., Urbaeva, V., Singichetti, B., Brevard, K., Wright, S. T., Lanier, P., & Shanahan, M. (2019). Screening Children for Social Determinants of Health: A Systematic Review. Pediatrics, 144(4), e20191622. https://doi.org/10.1542/peds.2019-1622

Zhou, X., Teng, T., Zhang, Y., Giovane, C. D., Furukawa, T. A., Weisz, J. R., Li, X., Cuijpers, P., Coghill, D., Xiang, Y., Hetrick, S. E., Leucht, S., Qin, M., Barth, J., Ravindran, A. V., Yang, L., Curry, J., Fan, L., Silva, S. G., … Xie, P. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: A systematic review and network meta-analysis. The Lancet Psychiatry, 7(7), 581–601. https://doi.org/10.1016/S2215-0366(20)30137-1

NURS 6630 Week 5 De-Prescribing Assignment Sample

Introduction to De-prescribing 

De-prescribing is a crucial intervention in clinical practice aimed at managing polypharmacy and minimizing medication-related harm. This intentional process involves the supervised reduction or discontinuation of medications that are no longer necessary or potentially harmful. Polypharmacy, defined as the concurrent use of multiple medications, is prevalent in various patient populations, including the elderly and those with chronic conditions. De-prescribing can help reduce the risk of adverse drug reactions, improve patient outcomes, and enhance the quality of life. This discussion focuses on four patient scenarios where de-prescribing is considered, detailing strategies and considerations for safely tapering off or transitioning medications. 

Patient 1: A 36-year-old Male on Opioid and Clonazepam 

Concerns of Remaining on Opioid and Clonazepam 

The long-term use of opioid analgesics for chronic pain management is associated with several significant concerns. These include the risk of tolerance, where the patient requires increasingly higher doses to achieve the same level of pain relief, and dependence, where the body adapts to the presence of the drug, leading to withdrawal symptoms upon cessation. Opioid medications also carry a high risk of misuse and addiction. Chronic opioid use can lead to serious side effects such as constipation, respiratory depression, hormonal imbalances, and cognitive impairment (Zhang et al., 2019). Similarly, clonazepam, a benzodiazepine, poses considerable risks when used long-term. These include the development of tolerance and dependence, as well as the potential for withdrawal symptoms, which can be severe. Long-term benzodiazepine use is associated with cognitive decline, increased risk of falls, motor vehicle accidents, and potential worsening of psychiatric symptoms. The combination of opioids and benzodiazepines is particularly concerning due to their synergistic effects on sedation and respiratory depression, significantly increasing the risk of overdose and mortality (Ti et al., 2015). 

Educating the Patient 

Educating the patient about the risks associated with the continued use of opioid and benzodiazepine medications is crucial. The patient should be informed that while these medications provide symptomatic relief, their long-term use can lead to significant health issues. A detailed discussion about the potential for tolerance, dependence, and the increased risk of accidental overdose is necessary. Additionally, the patient should understand the benefits of exploring alternative pain management strategies, such as physical therapy, cognitive-behavioral therapy (CBT), and non-opioid analgesics (Dowell et al., 2016). 

Tapering off Clonazepam 

To minimize the risk of withdrawal symptoms, a gradual tapering approach should be employed for clonazepam. Abrupt cessation of benzodiazepines can lead to severe withdrawal symptoms, including seizures, which can be life-threatening. A common tapering strategy involves reducing the dose by 10-25% every 2-4 weeks, depending on the patient’s response and tolerance (Ashton, 2005). It is essential to monitor the patient closely for signs of withdrawal, such as increased anxiety, insomnia, irritability, and physical symptoms like tremors and palpitations. Adjustments to the tapering schedule should be made based on the patient’s feedback and clinical judgment. 

Alternative Medication for Panic Attacks 

For the treatment of panic attacks, SSRIs (Selective Serotonin Reuptake Inhibitors) are often recommended as first-line treatments. These medications, including sertraline and escitalopram, have been shown to be effective for panic disorder with a more favorable safety profile compared to benzodiazepines (Bhattacharya et al., 2022). SSRIs are generally started at a low dose to minimize side effects, with sertraline typically initiated at 25 mg daily and gradually titrated up based on patient response and tolerability. 

Legal, Ethical, or Social Consideration 

One significant ethical consideration in the treatment plan is obtaining informed consent. The patient must fully understand the risks and benefits associated with continuing versus discontinuing the medications. It is also important to consider the social support available to the patient. Involving family members or caregivers can provide the necessary encouragement and monitoring during the tapering process. Ensuring that the patient has access to resources, such as support groups or counseling services, can also aid in the successful transition away from long-term benzodiazepine use (Reeve et al., 2018). 

Patient 2: A 42-year-old Female on Alprazolam 

Withdrawal Symptoms from Alprazolam 

Alprazolam, like other benzodiazepines, can cause a range of withdrawal symptoms if discontinued abruptly or tapered too quickly. Common withdrawal symptoms include increased anxiety, insomnia, restlessness, irritability, and muscle tension. These symptoms are often the result of the body’s adaptation to the medication, leading to a rebound effect when the drug is removed (Brett & Murnion, 2015). More severe withdrawal symptoms can include hallucinations, psychosis, and seizures, which are medical emergencies requiring immediate attention. The patient should be educated about the spectrum of withdrawal symptoms, emphasizing that while some symptoms are common and less serious, others require prompt medical attention. For instance, mild symptoms like anxiety and insomnia can typically be managed with supportive care and reassurance. However, if the patient experiences severe symptoms such as confusion, hallucinations, or seizures, they should seek immediate medical help. 

Conversion to Longer-acting Benzodiazepine 

A longer-acting benzodiazepine, such as diazepam, can be used to facilitate the tapering process. Diazepam’s long half-life provides a more stable blood concentration, reducing the severity of withdrawal symptoms. The equivalent dose conversion from alprazolam to diazepam involves calculating the total daily dose of alprazolam and converting it to diazepam. Alprazolam 1 mg is approximately equivalent to diazepam 10 mg. For a patient taking alprazolam 1 mg BID (twice daily), the total daily dose would be 2 mg, which converts to 20 mg of diazepam daily, typically divided into two doses. 

Tapering off the Medication 

Tapering diazepam should follow a gradual reduction approach similar to other benzodiazepines. A common strategy involves reducing the dose by 10-25% every 2-4 weeks, closely monitoring the patient for withdrawal symptoms. Adjustments to the tapering schedule should be made based on the patient’s response. In some cases, a slower taper may be necessary to manage withdrawal symptoms effectively. Providing additional supportive measures, such as cognitive-behavioral therapy (CBT) for anxiety, can also aid in the successful tapering of benzodiazepines (Ashton, 2005). 

Patient 3: A 24-year-old Pregnant Female on Lorazepam 

Risks of Continuing Lorazepam During Pregnancy 

Lorazepam use during pregnancy is associated with several potential risks to both the mother and the fetus. First-trimester exposure to benzodiazepines has been linked to an increased risk of congenital malformations, although the absolute risk remains relatively low. Later in pregnancy, benzodiazepine use can result in neonatal withdrawal syndrome, characterized by symptoms such as hypertonia, irritability, and feeding difficulties. Additionally, there is a risk of floppy infant syndrome, where the newborn exhibits hypotonia and respiratory difficulties (McElhatton, 1994). However, untreated anxiety during pregnancy also poses significant risks. Maternal anxiety can lead to poor prenatal care, preterm birth, low birth weight, and increased risk of postpartum depression. It is essential to balance the benefits of effective anxiety management with the potential risks to the fetus when making decisions about medication use during pregnancy (Ding et al., 2014). 

Alternative Medications for Anxiety 

Several alternative medications are considered safer for use during pregnancy. SSRIs, such as sertraline and fluoxetine, are commonly prescribed due to their efficacy in treating anxiety and lower risk profile compared to benzodiazepines. Sertraline, for example, has been shown to be relatively safe during pregnancy, with no significant increase in the risk of congenital malformations (Putnick et al., 2016). Non-pharmacological treatments, such as cognitive-behavioral therapy (CBT), should also be considered. CBT has been demonstrated to be effective for anxiety disorders and does not carry the risks associated with medication. Mindfulness-based stress reduction (MBSR) and other behavioral therapies can provide additional support for managing anxiety during pregnancy (Muzik & Borovska, 2010). 

Tapering off Lorazepam 

If the patient agrees to discontinue lorazepam, a gradual tapering approach is recommended. Tapering should be done slowly to minimize withdrawal symptoms, with dose reductions of 10-25% every 2-4 weeks. The patient should be educated about potential withdrawal symptoms, including rebound anxiety, insomnia, and physical symptoms such as tremors and palpitations. More serious symptoms, such as seizures, should prompt immediate medical attention (Ashton, 2005). 

Risks of Untreated Anxiety During Pregnancy 

Educating the patient about the risks of untreated anxiety is crucial. Untreated anxiety can negatively impact both the mother and the fetus, leading to poor prenatal care, increased risk of preterm birth, low birth weight, and higher likelihood of postpartum depression. It is essential to emphasize the importance of managing anxiety for the well-being of both the mother and the developing fetus (Ding et al., 2014). 

Patient 4: A 71-year-old Male on Clonazepam 

Risks of Benzodiazepines in the Elderly 

Elderly patients are particularly vulnerable to the side effects of benzodiazepines. These medications can cause cognitive impairment, increasing the risk of confusion, memory problems, and delirium. Additionally, benzodiazepines can lead to motor incoordination, increasing the risk of falls and fractures, which are significant concerns in the elderly population. The use of benzodiazepines in elderly patients is also associated with an increased risk of motor vehicle accidents due to impaired reaction times and sedation (Oude Voshaar et al., 2006). Given these risks, it is essential to evaluate the need for continued benzodiazepine use in elderly patients and explore safer alternatives for managing underlying conditions such as anxiety or insomnia. The patient and his family should be educated about these risks and the importance of regular cognitive and physical evaluations. 

Evaluating for Side Effects 

Evaluating the patient for side effects involves a comprehensive assessment of cognitive function, mobility, and overall health. Cognitive assessments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), can help identify any cognitive impairment. Additionally, monitoring for fall incidents and reviewing other medications that may contribute to side effects is essential. A comprehensive geriatric assessment, which includes evaluations by a multidisciplinary team, can provide valuable insights into the patient’s overall health and guide the management of medications. This assessment should also consider the patient’s functional status, comorbidities, and social support systems (Oude Voshaar et al., 2006). 

Tapering off Clonazepam 

Tapering off clonazepam should follow a gradual reduction approach similar to other benzodiazepines. A common strategy involves reducing the dose by 10-25% every 2-4 weeks, closely monitoring the patient for withdrawal symptoms. Adjustments to the tapering schedule should be made based on the patient’s response. In some cases, a slower taper may be necessary to manage withdrawal symptoms effectively. Providing additional supportive measures, such as cognitive-behavioral therapy (CBT) for anxiety, can also aid in the successful tapering of benzodiazepines. The patient should be closely monitored for withdrawal symptoms, and alternative treatments for any underlying conditions should be considered (Ashton, 2005). 

Potential Side Effects of Tapering 

Common side effects of tapering include increased anxiety, insomnia, and irritability. These symptoms are often the result of the body’s adaptation to the medication, leading to a rebound effect when the drug is reduced. More serious side effects, such as seizures, should prompt immediate medical attention. The patient and his family should be educated about these symptoms and the importance of adhering to the tapering schedule 

Conclusion  

De-prescribing is a critical process in managing long-term medication use, particularly for medications with significant side effects and dependency risks such as opioids and benzodiazepines. Each patient scenario requires a tailored approach, considering the individual’s medical history, current health status, and preferences. Education, gradual tapering, and alternative treatments are key strategies in ensuring a safe and effective de-prescribing process. 

References 

Ashton, H. (2005). The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, 18(3), 249–255. https://doi.org/10.1097/01.yco.0000165594.60434.84 

Bachhuber, M. A., Hennessy, S., Cunningham, C. O., & Starrels, J. L. (2016). Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996–2013. American Journal of Public Health, 106(4), 686–688. https://doi.org/10.2105/ajph.2016.303061 

Zhang, V., Olfson, M., & King, M. (2019). Opioid and Benzodiazepine Coprescribing in the United States Before and After US Food and Drug Administration Boxed Warning. JAMA Psychiatry, 76(11), 1208. https://doi.org/10.1001/jamapsychiatry.2019.2563 

Ding, X. X., Wu, Y. L., Xu, S. J., Zhu, R. P., Jia, X. M., Zhang, S. F., Huang, K., Zhu, P., Hao, J. H., & Tao, F. B. (2014). Maternal anxiety during pregnancy and adverse birth outcomes: A systematic review and meta-analysis of prospective cohort studies. Journal of Affective Disorders, 159, 103–110. https://doi.org/10.1016/j.jad.2014.02.027 

Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA, 315(15), 1624. https://doi.org/10.1001/jama.2016.1464 

Putnick, D. L., Bell, E. M., Ghassabian, A., Mendola, P., Sundaram, R., & Yeung, E. H. (2023). Maternal antenatal depression’s effects on child developmental delays: Gestational age, postnatal depressive symptoms, and breastfeeding as mediators. Journal of Affective Disorders, 324, 424–432. https://doi.org/10.1016/j.jad.2022.12.059 

McElhatton, P. R. (1994). The effects of benzodiazepine use during pregnancy and lactation. Reproductive Toxicology, 8(6), 461–475. https://doi.org/10.1016/0890-6238(94)90029-9 

Muzik, M., & Borovska, S. (2010). Perinatal depression: implications for child mental health. PubMed, 7(4), 239–247. https://pubmed.ncbi.nlm.nih.gov/22477948 

Voshaar, R. C. O., Couvée, J. E., Van Balkom, A. J. L. M., Mulder, P. G. H., & Zitman, F. G. (2006). Strategies for discontinuing long-term benzodiazepine use. British Journal of Psychiatry, 189(3), 213–220. https://doi.org/10.1192/bjp.189.3.213 

Reeve, E., Gnjidic, D., Long, J., & Hilmer, S. (2018). A systematic review of the emerging definition of ‘deprescribing’ with network analysis: implications for future research and clinical practice. BJCP. British Journal of Clinical Pharmacology/British Journal of Clinical Pharmacology, 80(6), 1254–1268. https://doi.org/10.1111/bcp.12732 

Brett, J., & Murnion, B. (2015). Management of benzodiazepine misuse and dependence. Australian Prescriber, 38(5), 152–155. https://doi.org/10.18773/austprescr.2015.055 

Bhattacharya, S., Goicoechea, C., Heshmati, S., Carpenter, J. K., & Hofmann, S. G. (2022). Efficacy of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Meta-Analysis of Recent Literature. Current Psycchiatry Reports/Current Psychiatry Reports, 25(1), 19–30. https://doi.org/10.1007/s11920-022-01402-8 

Ti, L., Voon, P., Dobrer, S., Montaner, J., Wood, E., & Kerr, T. (2015b). Denial of Pain Medication by Health Care Providers Predicts In-Hospital Illicit Drug Use among Individuals who Use Illicit Drugs. Pain Research & Management, 20(2), 84–88. https://doi.org/10.1155/2015/868746