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.
Need a high-quality paper urgently?
We can deliver within hours.
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.
Stuck? Let Us Help You
Completing assignments can sometimes be overwhelming, especially with the multitude of academic and personal responsibilities you may have. If you find yourself stuck or unsure at any point in the process, don’t hesitate to reach out for professional assistance. Our assignment writing services are designed to help you achieve your academic goals with ease.
Our team of experienced writers is well-versed in academic writing and familiar with the specific requirements of the NURS 6630 Assessing and Treating Vulnerable Populations for Depressive Disorders assignment. We can provide you with personalized support, ensuring your assignment is well-researched, properly formatted, and thoroughly edited. Get a feel of the quality we guarantee – ORDER NOW.
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 1st-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 1st-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.
FDA- Approved | FDA Not-Approved |
SSRI-Fluoxetine & Lexapro | TCAs- Imipramine, Nortriptyline, & Amitriptyline |
Nausea, headache, insomnia, anorexia, diarrhea, dry mouth, anxiety, drowsiness, and nervousness | dry mouth, constipation, difficulties passing urine, drowsiness, dizziness, weight gain, and excessive sweating |
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
- Fluoxetine 10 mg orally once a day.
- Lexapro 10 mg orally once a day.
- 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