NURS 6630 Therapy for Patients With Major Depressive Disorder (MDD)

Sample Answer for NURS 6630 Therapy for Patients With Major Depressive Disorder (MDD) Included After Question

NURS 6630 Therapy for Patients With Major Depressive Disorder (MDD)

 

Mood disorders can impact every facet of a human being’s life, making the most basic activities difficult for patients and their families. This was the case for 13-year-old Jeanette, who was struggling at home and at school. For more than 8 years, Jeanette suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues.

As a PNP working with pediatric patients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.

This week, as you examine antidepressant therapies, you explore the assessment and treatment of three populations: pediatrics, adults, and geriatrics. The focus of your assessment tool, a decision tree, will specifically center on one of the most vulnerable populations, pediatrics. Please remember, you must also consider the ethical and legal implications of these therapies. You will also complete a Quiz on the concepts addressed throughout this module.

Learning Objectives

Students will:

  • Assess patient factors and history to develop personalized plans of antidepressant therapy across the lifespan
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric, adult, and geriatric patients requiring antidepressant therapy
  • Synthesize knowledge of providing care to pediatric, adult, and geriatric patients presenting for antidepressant therapy
  • Analyze ethical and legal implications related to prescribing antidepressant therapy to patients across the lifespan

Learning Resources

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Required Readings (click to expand/reduce)

NURS 6630 Therapy for Patients With Major Depressive Disorder (MDD)
NURS 6630 Therapy for Patients With Major Depressive Disorder (MDD)

 

Baek, J. H., Nierenberg, A. A., & Fava, M. (2016). Pharmacological approaches to treatment-resistant depression. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 44–47). Elsevier.

Fava, M., & Papakostas, G. I. (2016). Antidepressants. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 27–43). Elsevier.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. https://doi.org/10.3928/02793695-20080901-06

Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21–24. https://doi.org/10.3928/02793695-20081001-05

Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019).  Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-textbook of child and adolescent mental health. https://iacapap.org/content/uploads/A.7-Psychopharmacology-2019.1.pdf

Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan-psychotropicdrugs-0203141.pdf

Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale—Revised. Western Psychological Services.

Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787–791. https://doi.org/10.1002/da.22171

Yasuda, S. U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf

 

Medication Resources (click to expand/reduce)

 

U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

 

Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication as this information will be helpful for your review in preparation for your Assignments.

Review the following medications:

  • amitriptyline
  • bupropion
  • citalopram
  • clomipramine
  • desipramine
  • desvenlafaxine
  • doxepin
  • duloxetine
  • escitalopram
  • fluoxetine
  • fluvoxamine
  • imipramine
  • ketamine
  • mirtazapine
  • nortriptyline
  • paroxetine
  • selegiline
  • sertraline
  • trazodone
  • venlafaxine
  • vilazodone
  • vortioxetine

Required Media (click to expand/reduce)

 

Case Study: An African American Child Suffering from Depression
Note: This case study will serve as the foundation for this week’s Assignment.

 

Optional Resources (click to expand/reduce)

 

El Marroun, H., White, T., Verhulst, F., & Tiemeier, H. (2014). Maternal use of antidepressant or anxiolytic medication during pregnancy and childhood neurodevelopmental outcomes: A systematic review. European Child & Adolescent Psychiatry, 23(10), 973–992. https://doi.org/10.1007/s00787-014-0558-3

Gordon, M. S., & Melvin, G. A. (2014). Do antidepressants make children and adolescents suicidal? Journal of Pediatrics and Child Health, 50(11), 847–854. https://doi.org/10.1111/jpc.12655

Seedat, S. (2014). Controversies in the use of antidepressants in children and adolescents: A decade since the storm and where do we stand now? Journal of Child & Adolescent Mental Health, 26(2),

iii–v. https://doi.org/10.2989/17280583.2014.938497

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The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

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Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
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  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource

A Sample Answer For the Assignment: NURS 6630 Therapy for Patients With Major Depressive Disorder (MDD)

Title: NURS 6630 Therapy for Patients With Major Depressive Disorder (MDD)

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 

  1. Fluoxetine 10 mg orally once a day.  
  1. Lexapro 10 mg orally once a day. 
  1. Imipramine 30 mg orally once every bedtime.  

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.