Treatment for Vulnerable Populations for Depressive Disorders

For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources. 5 SOURCES TOTAL PLEASE. 

In your patient guide, include discussion on the following:

  • Depressive disorder causes and symptoms
  • How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable
  • Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
  • Medication considerations of medication examples prescribed (see last bullet item)
  • What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
  • Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
  • Where to follow up in your local community for further information
  • Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy. 

 

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

 

Answer

Depression among Adolescents

The period of adolescence marks a crucial phase in an individual’s life as it encompasses a range of physical, emotional, social, and cognitive changes. It is during this phase that young people start to develop a sense of identity, learn to manage their emotions and relationships and acquire knowledge and skills necessary for adulthood. Adolescents are also known to experience significant growth spurts, hormonal changes, and brain development, which shape their behavior, thoughts, and decision-making abilities. According to the World Health Organization, the universal age range for adolescents is usually between 10 and 19 years, including teenagers (Csikszentmihalyi, 2023). Therefore, this period is a critical time for parents, educators, and caregivers to provide a supportive and nurturing environment that fosters the development of well-rounded individuals. This patient guide includes vital information on the causes of depression, diagnosing depression among adolescents, and treatment strategies for depression among this vulnerable population.

How to Diagnose Depression Among Adolescents?

Major Depressive Disorder (MDD) is a complex and debilitating mental health condition that affects a significant number of adolescents. One of the key signs of MDD is a noticeable decrease in the pleasure or interest that individuals once derived from activities they used to enjoy (Selph & McDonagh, 2019). This loss of interest can be pervasive and can extend to various aspects of their lives, including hobbies, social interactions, and academic pursuits. While a low mood is a common symptom of MDD, it is important to note that adolescents with this disorder may also display signs of irritability and restlessness. These emotional and behavioral changes can often be misunderstood or attributed to typical teenage mood swings, making it crucial for individuals or those around them to be aware of the potential presence of MDD (Zhang et al., 2023). Recognizing the symptoms of MDD is essential to seek appropriate help from qualified mental health professionals. Some of the symptoms that may indicate the presence of MDD in adolescents include an increase in sleep duration, heightened appetite, weight gain, frequent feelings of guilt or worthlessness, persistent fatigue, impaired cognitive function, and preoccupation with thoughts of death or suicide. It is important to emphasize that MDD is a manageable condition, and early intervention can significantly impact the outcome.

When making the diagnosis of a major depressive episode, a set of criteria set by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is used. These criteria are also used to grade the code and the severity of the depressive disorder in the adolescent, as this will also determine the management approach used by the medical specialist. Therefore, determining the diagnosis of depression in adolescents follows the criteria outlined in the DSM-5. Evaluating patients involves conducting interviews, both individually and with their family and/or caregivers, and assessing functional impairment in various areas as well as other psychiatric conditions. According to the DSM-5, a diagnosis of major depressive disorder requires a minimum duration of 2 weeks, during which the individual experiences a depressed mood or loss of interest or pleasure in almost all activities (Beirão et al., 2020). Additionally, at least four additional symptoms from a specified list must be present, such as changes in weight, sleep disturbances, changes in psychomotor activity, fatigue, feelings of worthlessness or guilt, impaired concentration or decision-making abilities, or thoughts of suicide.

It is important to note that in adolescents, a depressed mood can be replaced by irritability or crankiness, which may be overlooked during assessment or by caregivers. This presentation should be distinguished from a pattern of irritability when frustrated. Children diagnosed with disruptive mood dysregulation disorder, a newly recognized condition characterized by persistent irritability and frequent episodes of extreme behavior, often develop unipolar depressive or anxiety disorders as they enter adolescence. The clinical presentation of depression differs between genders, with female adolescents reporting feelings of sadness, loneliness, irritability, pessimism, self-hatred, and eating disorders, while males may present with somatic complaints, reduced cognitive abilities, difficulty making decisions, restlessness, and a loss of pleasure in activities.

Treatment of Depression among Adolescents

The treatment options for depression in adolescence can consist of therapy, medications, or a combination of both. The choice of treatment should be based on factors such as the severity of the condition, the preferences of the patient and their family, associated risk factors, the level of family support, and the availability of each therapy. In the first approach, it is crucial to provide a comprehensive explanation of the therapeutic strategy and involve both the patients and their family members. This ensures close monitoring of progress, adjustment of treatment based on symptoms, and prevention of relapse. Adolescents with moderate to severe depression, substance abuse issues, psychiatric disorders, suicidal thoughts, or resistance to treatment should be referred for specialized evaluation. The treatment process can be divided into three phases: acute (aiming to achieve a response and remission), continuation (consolidating the response), and maintenance (preventing recurrences). Each phase should include psychoeducation, a supportive approach, and the involvement of the family.

Commonly prescribed medications for treating depression in adolescents include fluoxetine, escitalopram, sertraline, and citalopram. However, The Food and Drug Administration (FDA) has approved fluoxetine for children aged 8 years and older, as well as escitalopram for those aged 12 years and older, as effective treatments for depression in children and adolescents (Beirão et al., 2020). The primary negative outcomes of these drugs consist of stomach aches, uneasiness, nervousness, fidgetiness, upset stomach, head pain, queasiness, and alterations in sleep routines. Nevertheless, these consequences rely on the dosage and usually diminish over time. Adolescents need to be carefully watched over, and if they start having thoughts of suicide while undergoing treatment, parents should promptly seek help. This could involve adjusting the dosage, switching to a different antidepressant, or even stopping the medication altogether. Depending on the response to treatment, labs can monitor the thyroid function tests to rule out the role of hormonal derangements in derailing treatment outcomes.

Adolescents’ Vulnerability to Depression

Depression happens when behaviors that were once rewarded are no longer reinforced and when there is an excessive amount of avoidance behaviors. It can also occur when there is a lack of positive reinforcement or when positive reinforcements become less effective. In the case of a child with depression, they initially receive a lot of attention, and their behaviors, like crying or expressing guilt, are reinforced by their family and friends. However, as these depressive behaviors increase, the child’s relationship with others becomes negative, and the people who used to be there for them start avoiding them (Bernaras et al., 2019). This avoidance only makes the child’s depression worse. The lack of reinforcement can be explained by factors such as rejection from the mother, less support from parents, or a lower rate of reinforcement given to depressed children by their mothers. It can also be due to the child having low social skills.

Special Considerations and Follow-up

Several studies have established a link between antidepressants and a higher risk of suicidal thoughts. However, it is important to consider the pros and cons of this treatment approach carefully. Adolescents must be closely watched, and if they experience any thoughts of self-harm while on medication, parents should seek immediate help. This could involve adjusting the dosage, switching to a different antidepressant, or even stopping the medication altogether. Owing to the vulnerability of adolescents to depression and the ease of missing depression diagnosis among adolescents, healthcare professionals need education on identifying signs of depression and evaluating at-risk children and young individuals. T raining should cover psychosocial risk factors, including age, gender, family conflicts, bullying, abuse, mental health disorders, substance abuse, and parental depression (National Institute for Health and Care Excellence, 2019). It should also address the impact of traumatic events, multiple risk factors, cultural influences, and factors like homelessness and refugee status. Effective communication skills, such as active listening, should be taught to address situational dysphoria in children and young people. Follow-up in primary care settings such as local clinics and social groups is also important.

Conclusion

Major Depressive Disorder is a severe psychological condition that significantly impacts numerous adolescents. Recognizing the symptoms and seeking assistance from qualified mental health professionals is crucial for effective management and treatment. With early intervention and a supportive network, individuals with MDD can find hope, healing, and a path toward a brighter future. If the patient does not get better after the first treatment for depression, their regular doctor may try different medications or increase the dosage.

Prescription #1

Prescription #2

Prescription #3

AX Clinics

3rd floor, 11th street Atlanta, Georgia

Prescription #: 6923

AX Clinics

3rd floor, 11th street Atlanta, Georgia

Prescription #: 6924

AX Clinics

3rd floor, 11th street Atlanta, Georgia

Prescription #: 6925

Patient Name: AA

Age: 16yrs sex: female

Pat. No: AX4121 Wt. 102pounds

Patient Name: BD

Age: 18yrs sex: male

Pat. No: AX3980 Wt. 115pounds

Patient Name: CW

Age: 14yrs sex: male

Pat. No: AX4200 Wt. 85pounds

Diagnosis: F32.1 Major depressive disorder, single episode, moderate

Diagnosis: F33.2. Major depressive disorder, recurrent, severe without psychotic features

Diagnosis: F32.4Major depressive disorder, single episode, in partial remission

RX

  1. Prozac (Fluoxetine) 10mg PO q24hr X 1 month

RX

  1. Zoloft (sertraline) 25mg PO q24hr X 1 month

RX

  1. Lexapro (escitalopram) 10mg PO q24hr X 1 month

Remarks

  1. Review in 1 month

  2. Stop in case of the development of rash

  3. Don’t double subsequent doses in case of missed doses

Remarks

  1. Review in 1 month

  2. Stop in case of the development of rash

  3. Don’t double subsequent doses in case of missed doses

Remarks

  1. Review in 1 month

  2. Stop in case of the development of rash

  3. Don’t double subsequent doses in case of missed doses

PRESCRIBER: NA

SIGNATURE: 

DATE: 11TH December, 2023

PRESCRIBER: NA

SIGNATURE: 

DATE: 11TH December, 2023

PRESCRIBER: NA

SIGNATURE: 

DATE: 11TH December, 2023

References

Beirão, D., Monte, H., Amaral, M., Longras, A., Matos, C., & Villas-Boas, F. (2020). Depression in adolescence: a review. Middle East Current Psychiatry27(1). https://doi.org/10.1186/s43045-020-00050-z

Bernaras, E., Jaureguizar, J., & Garaigordobil, M. (2019). Child and adolescent depression: A review of theories, evaluation instruments, prevention programs, and treatments. Frontiers in Psychology10, 543. https://doi.org/10.3389/fpsyg.2019.00543

Csikszentmihalyi, M. (2023). Adolescence. In Encyclopedia Britannica. https://www.britannica.com/science/adolescence

National Institute for Health and Care Excellence. (2019). Depression in children and young people: identification and management. https://www.nice.org.uk/guidance/ng134

Selph, S. S., & McDonagh, M. S. (2019). Depression in children and adolescents: Evaluation and treatment. American Family Physician100(10), 609–617. https://www.aafp.org/pubs/afp/issues/2019/1115/p609.pdf

Zhang, X., Yan, Y., Ye, Z., & Xie, J. (2023). Descriptive analysis of depression among adolescents in Huangshi, China. BMC Psychiatry23(1). https://doi.org/10.1186/s12888-023-04682-3

 

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