Sample Answer for NURS 6630 Discussion: Impact of Ethnicity on Antidepressant Therapy Included After Question
NURS 6630 Discussion: Impact of Ethnicity on Antidepressant Therapy
Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
Required Readings
Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
Optional Resources
Laureate Education (Producer). (2009). Pathopharmacology: Disorders of the nervous system: Exploring the human brain [Video file]. Baltimore, MD: Author.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
Note: The approximate length of this media piece is 15 minutes.
Dr. Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain.
Accessible player
Laureate Education (Producer). (2012). Introduction to advanced pharmacology [Video file]. Baltimore, MD: Author.NURS 6630 – Psychopharmacologic Approaches to Treatment of Psychopathology Essay Assignment
NURS 6630 Discussion: Impact of Ethnicity on Antidepressant TherapyGrading Rubric Guidelines
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A Sample Answer For the Assignment: NURS 6630 Discussion: Impact of Ethnicity on Antidepressant Therapy
Title: NURS 6630 Discussion: Impact of Ethnicity on Antidepressant Therapy
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