NRNP 6665 PMHNP Across the Lifespan I Prescribing for Children and Adolescents

Prescribing for Children and Adolescents

Psychotropic medications are used to treat a range of mental disorders in children and adults. Most psychotropic medications for children and adolescents are prescribed as off-label drugs because of the limited availability of studies with children and adolescents. Off-label medications are either approved for treating another condition other than the one prescribed for or approved for a different age group. One of the conditions in children that mostly calls for off-label psychotropic prescription is a major depressive disorder. The optimal treatment for major depressive disorder in children and adolescents is a combination of psychotherapy and pharmacology (Mullen, 2018). The important factors to consider in the choice of treatment are the safety and efficacy of the medication or nonpharmacological model chosen. The purpose of this assignment is to describe the FDA-approved medication, off-label drug, and nonpharmacological treatment approaches for major depressive disorder in children and adolescents.

FDA-approved and Off-label Medications

The FDA-approved drug for the treatment of major depressive disorder in children and adolescents is Prozac also known as fluoxetine. Fluoxetine belongs to the class selective serotonin reuptake inhibitor (SSRI). SSRIs relieve the symptoms of moderate or major depression by blocking the reabsorption of serotonin into the neurons, allowing high levels of the neurotransmitter into the brain to transmit signals between the brain and the nerves (Neavin et al., 2018). Nevertheless, the drug is only approved for children from 8 years and above. Below 8 years, the medication is used off-label based on a thorough risk versus benefits analysis. The off-label medication often prescribed for major depressive disorder in children and adolescents is Zoloft (Sertraline), which is one of the first-line antidepressants for the treatment of mood disorders. Finally, the nonpharmacological intervention for major depressive disorder in children and adolescents is cognitive behavioral therapy (CBT). CBT is an evidence-based psychotherapy model that focuses on changing thoughts and behavior from maladaptive to positive thought patterns. The strength of CBT is its effectiveness with various populations and a wide range of mental health disorders (Walter et al., 2021).

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Risk Assessment and Practice Guidelines

Risk assessment is a critical requirement before prescribing medication. The medication prescribed to a child or adolescent should

NRNP 6665 PMHNP Across the Lifespan I Prescribing for Children and Adolescents

have maximum therapeutic benefits and safety. When making drug choices for patients, considering individual factors is essential. For instance, the age and weight of the child matters when making prescribing decisions. For example, since off-label drugs do not have dosage details for disorders or age-group they are not approved for; hence, a practitioner relies on the weight of the child to determine the dose that would produce the desired efficacy and remain safe for the patient (van der Zanden, 2021). The assessment focuses on efficacy, safety, tolerability, possible side effects, and potential benefit to the patient. The benefits of FDA-approved medicines are established efficacy and safety backed by evidence. The risks are that the medication might not work as intended or produce unexpected problems. The risks of off-label are that the medication can cause or be ineffective owing to a lack of evidence supporting its efficacy for conditions and groups other than the approved ones (van der Zanden, 2021).

The American Psychological Association, the American College of Adolescent and Child Psychiatry, and the American Academy of Pediatrics provide practice guidelines for major depressive disorder in children and adolescents. The guidelines recommend the use of CBT and other psychotherapies in combination with SSRIs as the intervention approach for children and adolescents with major depressive disorder (Walter & Abright, 2022). The guidelines also show that treatment decisions are based on the best available evidence.

Conclusion

Off-label medications are often used within the pediatric population to treat various conditions including psychotic disorders. A risk versus benefit assessment is necessary to determine the safety and efficacy. FDA-approved medications are backed by evidence proving their safety and efficacy, but the risk is that sometimes the medication may fail to work. Off-label medications address a need but put patients at risk of harm and ineffectiveness.

NRNP 6665 PMHNP Across the Lifespan I Prescribing for Children and Adolescents References

Mullen, S. (2018). Major depressive disorder in children and adolescents. . Mental Health Clinic, 8(6), 275-283. https://doi.10.9740/mhc.2018.11.275.

Neavin, D., Joyce, J., & Swintak, C. (2018). Treatment of Major Depressive Disorder in Pediatric Populations. Diseases, 6(2):48. https://doi.10.3390/diseases6020048.

van der Zanden, T. (2021). Benefit-Risk Assessment of Off-Label Drug Use in Children: The Bravo Framework. Clinical Pharmacology and Therapeutics, 110(4), 952-965. https://doi.org/10.1002/cpt.2336.

Walter, D., Buschsieweke, J., & Dachs, L. (2021). Effectiveness of usual-care cognitive-behavioral therapy for adolescents with depressive disorders rated by parents and patients – an observational study. BMC Psychiatry, 21, 423. https://doi.org/10.1186/s12888-021-03404-x.

Walter, H. J., & Abright, R. (2022). Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. Journal of American Academy of Adolescents and Child Psychiatry, https://doi.org/10.1016/j.jaac.2022.10.001.

As we begin this session, I would like to take this opportunity to clarify my expectations for this course:

Please note that GCU Online weeks run from Thursday (Day 1) through Wednesday (Day 7).

Course Room Etiquette:

It is my expectation that all learners will respect the thoughts and ideas presented in the discussions.
All postings should be presented in a respectful, professional manner. Remember – different points of view add richness and depth to the course!

Office Hours:

My office hours vary so feel free to shoot me an email at [email protected] or my office phone is 602.639.6517 and I will get back to you within one business day or as soon as possible.
Phone appointments can be scheduled as well. Send me an email and the best time to call you, along with your phone number to make an appointment.
I welcome all inquiries and questions as we spend this term together. My preference is that everyone utilizes the Questions to Instructor forum. In the event your question is of a personal nature, please feel free to post in the Individual Questions for Instructor forumI will respond to all posts or emails within 24 or sooner.

Late Policy and Grading Policy

Discussion questions:

I do not mark off for late DQ’s.
I would rather you take the time to read the materials and respond to the DQ’s in a scholarly way, demonstrating your understanding of the materials.
I will not accept any DQ submissions after day 7, 11:59 PM (AZ Time) of the week.
Individual written assignments – due by 11:59 PM AZ Time Zone on the due dates indicated for each class deliverable.

Assignments:

Assignments turned in after their specified due dates are subject to a late penalty of -10%, each day late, of the available credit. Please refer to the student academic handbook and GCU policy.
Any activity or assignment submitted after the due date will be subject to GCU’s late policy
Extenuating circumstances may justify exceptions, which are at my sole discretion. If an extenuating circumstance should arise, please contact me privately as soon as possible.
No assignments can be accepted for grading after midnight on the final day of class.
All assignments will be graded in accordance with the Assignment Grading Rubrics

Participation

Participation in each week’s Discussion Board forum accounts for a large percentage of your final grade in this course.
Please review the Course Syllabus for a comprehensive overview of course deliverables and the value associated with each.
It is my expectation that each of you will substantially contribute to the course discussion forums and respond to the posts of at least three other learners.
A substantive post should be at least 200 words. Responses such as “great posts” or “I agree” do notmeet the active engagement expectation.
Please feel free to draw on personal examples as you develop your responses to the Discussion Questions but you do need to demonstrate your understanding of the materials.
I do expect outside sources as well as class materials to formulate your post.
APA format is not necessary for DQ responses, but I do expect a proper citation for references.
Please use peer-related journals found through the GCU library and/or class materials to formulate your answers. Do not try to “Google” DQ’s as I am looking for class materials and examples from the weekly materials.
I will not accept responses that are from Wikipedia, Business com, or other popular business websites. You will not receive credit for generic web searches – this does not demonstrate graduate-level research.
Stay away from the use of personal pronouns when writing.As a graduate student, you are expected to write based on research and gathering of facts. Demonstrating your understanding of the materials is what you will be graded on. You will be marked down for lack of evidence to support your ideas.

Plagiarism

Plagiarism is the act of claiming credit for another’s work, accomplishments, or ideas without appropriate acknowledgment of the source of the information by including in-text citations and references.
This course requires the utilization of APA format for all course deliverables as noted in the course syllabus.
Whether this happens deliberately or inadvertently, whenever plagiarism has occurred, you have committed a Code of Conduct violation.
Please review your LopesWrite report prior to final submission.
Every act of plagiarism, no matter the severity, must be reported to the GCU administration (this includes your DQ’s, posts to your peers, and your papers).

Plagiarism includes:

Representing the ideas, expressions, or materials of another without due credit.
Paraphrasing or condensing ideas from another person’s work without proper citation and referencing.
Failing to document direct quotations without proper citation and referencing.
Depending upon the amount, severity, and frequency of the plagiarism that is committed, students may receive in-class penalties that range from coaching (for a minor omission), -20% grade penalties for resubmission, or zero credit for a specific assignment. University-level penalties may also occur, including suspension or even expulsion from the University.
If you are at all uncertain about what constitutes plagiarism, you should review the resources available in the Student Success Center. Also, please review the University’s policies about plagiarism which are covered in more detail in the GCU Catalog and the Student Handbook.
We will be utilizing the GCU APA Style Guide 7th edition located in the Student Success Center > The Writing Center for all course deliverables.

LopesWrite

All course assignments must be uploaded to the specific Module Assignment Drop Box, and also submitted to LopesWrite every week.
Please ensure that your assignment is uploaded to both locations under the Assignments DropBox. Detailed instructions for using LopesWrite are located in the Student Success Center.

Assignment Submissions

Please note that Microsoft Office is the software requirement at GCU.
I can open Word files or any file that is saved with a .rtf (Rich Text Format) extension. I am unable to open .wps files.
If you are using a “.wps” word processor, please save your files using the .rtf extension that is available from the drop-down box before uploading your files to the Assignment Drop Box.

Grade of Incomplete

The final grade of Incomplete is granted at the discretion of the instructor; however, students must meet certain specific criteria before this grade accommodation is even possible to consider.
The grade of Incomplete is reserved for times when students experience a serious extenuating circumstance or a crisis during the last week of class which prevents the completion of course requirements before the close of the grading period. Students also must pass the course at the time the request is made.
Please contact me personally if you are having difficulties in meeting course requirements or class deadlines during our time together. In addition, if you are experiencing personal challenges or difficulties, it is best to contact the Academic Counselor so that you can discuss the options that might be available to you, as well as each option’s academic and financial repercussions.

Grade Disputes

If you have any questions about a grade you have earned on an individual assignment or activity, please get in touch with mepersonally for further clarification.
While I have made every attempt to grade you fairly, on occasion a misunderstanding may occur, so please allow me the opportunity to learn your perspective if you believe this has occurred. Together, we should be able to resolve grading issues on individual assignments.
However, after we have discussed individual assignments’ point scores, if you still believe that the final grade you have earned at the end of the course is not commensurate with the quality of work you produced for this class, there is a formal Grade Grievance procedurewhich is outlined in the GCU Catalog and Student Handbook.