NRNP6665 Week 3 Assignment 1 Prescribing for Children and Adolescents

NRNP6665 Week 3 Assignment 1 Prescribing for Children and Adolescents

 

Student Name

Walden University

NRNP 6665: PMHNP Care Across the Lifespan I

Professor Name

Date

Introduction

Major depressive disorder is another major mental health concern in children and adolescents, which involves an unhappy mood, the loss of interest or pleasure in activities, and other symptoms that impact normal functioning (Bitsko et al., 2022). A brief review of the management of MDD in this population is intended to highlight these challenging aspects of treatment, as well as an array of proposed intervention procedures.

This is to ensure coordinated care management that encompasses the pharmacological management of the disease using FDA-approved and off-label drugs and pharmacological techniques alongside non-pharmacologic interventions. Adhering to this outline will help direct the conversation while providing a framework for comprehensively addressing the treatment recommendations for pediatric patients with MDD.

Recommendations for Treatment

The chemical used in this medication is Fluoxetine and its function is being an SSRI or Selective Serotonergic Reuptake Inhibitor, normally administered to children and adolescents suffering from MDD or Major Depressive Disorder. As its action plan, it is employed in the boosting of serotonin levels in the brain to trigger the relief of symptoms of depression. Interestingly, because of the proven effectiveness and safety of fluoxetine, we can use it and it has been approved for use for children of 8 years and older.

Fluoxetine also has side effects, which include gastrointestinal upset, altered appetite or weight changes, and an increased risk of suicidal thinking in the initial two weeks of treatment (Kutzer et al., 2020). Nonetheless, various side effects linked to fluoxetine include gastrointestinal problems, sexual dysfunction, and increased risk of bleeding, among others, which while still present should preferably be outweighed by the drug’s effectiveness in cutting down depressive symptoms and enhancing overall functionality

Escitalopram (Lexapro) Escitalopram is another SSRI and its use in children and adolescents willing to treat MDD is considered off-label as the FDA has not approved the drug for pediatric usage (Liu et al., 2022). It works like fluoxetine in the mode of action, which is to affect serotonin reuptake to alter mood.

In specific circumstances, children can receive escitalopram off-label with the rationale guided by efficacy and side effect profile seen in adults. Although there are no well-controlled studies that have demonstrated the efficacy of its use in pediatric MDD as in fluoxetine, the FDA statement clears the way for some clinicians to consider it as an option when fluoxetine is ineffective or not well-tolerated by the patient. Nevertheless, like fluoxetine, escitalopram also has some risks, which, according to the National Institute for Health and Care Excellence, are side effects that may include insomnia, aggravation, and an enhanced risk of suicidal intention or actions

Cognitive behavioral therapy Cognitive behavioral therapy CBT is one the most common psychotherapeutic management approaches to MDD in children and adolescents. While drugs work by impacting the brain chemistry thus helping to treat depression, CBT centers on reforming negative thinking and behaviors linked to the disorder (Hengartner, 2021). It involves imparting abilities to the patients in tackling different problems and it also involves teaching methods of handling stress and emotions.

CBT is effective in that it significantly decreases depressive symptoms, decreases general depressive levels, and increases patient functioning in children and adolescents. However, the evidence beyond that is CBT has many more benefits than giving symptomatic relief, including the long-term individual coping skills acquired during the intervention and a decreased likelihood of you to require medication in your future life. Its lack of invasiveness and relatively minor side effects render it an advantageous approach for the treatment of MDD in children and adolescents either independently or in conjunction with pharmacological interventions.

Risk Assessment

Risk assessment in pediatric mental health involves childhood and adolescence and aims to review the effectiveness of the potential treatment and the possible harms of the selected interventional activities (Wasserman et al., 2021). It is based on external factors like the nature of the disorder, the specific condition of the patient, the prospective risks and benefits of the planned therapies, and existing clinical trial data.

The clinician must assess if the benefit of providing symptom relief and improvement of function outweighs the costs of prescribing a particular medication or implementing a particular therapeutic strategy. Further, the risk assessment entails prospective revising and managing of treatment strategies to reduce probable risks and enhance patient benefits.

Although fluoxetine is one FDA-approved drug for the management of MDD in children and adolescents it has been planned and aims to decrease the symptoms of depression and enhance functioning. This medication is also safe for this group and has been approved to be effective therefore being among the first-line treatments (Wasserman et al., 2021). However, fluoxetine is not without its dangers, as it may bring about side effects such as upset stomach, change in appetite or weight gain, and even a possibility of committing suicide, more especially when the patient is in the initial stages of taking the drug.

When using fluoxetine, due attention should be paid to these potential risks for patients, compared to the expected benefits which can be obtained on the background of optimization of the noted symptoms in the quality of life. This is because early initiation of treatment is characterized by high risk, hence constant evaluation of the patient profile is encouraged.

However, because escitalopram is an SSRI, and fluoxetine is known to be an efficacious off-label treatment for MDD in children and adolescents, escitalopram offers receptive risks/benefit cooperation (Wasserman et al., 2021). There may be less aftereffect of efficacy in childhood/adolescent populations yet some practitioners may use it as second-line treatment for patients who fail to respond to fluoxetine or experience side effects.

It is also similar to fluoxetine since some side effects which are linked to, include, insomnia, anxiety, and increased vulnerability to committing suicide. Therefore, prescribing escitalopram off-label might be beneficial to the patient but any decision taken should have the potential risks and benefits in mind, patients should be closely monitored and followed up frequently for safety issues. In the end, the decision to use fluoxetine or escitalopram ought to be made based on unique patient circumstances, previous treatment, and side effects that may come with these treatments so that the best possible treatment gains can be provided while limiting adverse effects.

Justification of Recommendations

Practice parameters provide useful information for informing practice based on research data in all-Less attention has been directed at such considerations in children and adolescents with Major Depressive Disorder (MDD) (Hansen et al., 2022). When they exist, and they should be reckoned to, these policies and guidelines contain information culled from the literature, as well as other recognized experts in the field and clinicians on practice.

It notes the strategies that should be adopted in treating patients and the dose and time of treatment according to the condition of the patient to ensure the best results. Thus, following the guidelines helps that there should be a high level of compliance and quality in the treatment of MDD among pediatric patients because healthcare providers understand the importance of an outcome-based approach.

Many times, there weren’t any CPGs that had been developed for pediatric MDD in particular, which made it difficult for clinicians to gain the necessary information for making any treatment choices. Engaging in activities such as the assessment of clinical literature including, but not limited to research papers, meta-analysis, and treatment protocols for later-life MDD in adults (Hansen et al., 2022).

Indeed, the extension from the present study of adults to the pediatric population should be made with caution; however, the present body of literature would offer a robust empirical foundation for ascertaining the safety and applicability of a range of treatment interventions in children with mental health problems. Moreover, using expert advice, consensus, statement, and practice parameters derived from various professional organizations can also be useful to fill the gap of evidence and inform clinical practice where there is scarceness of supporting guidelines.

The selected treatments including fluoxetine, escitalopram, and CBT for the treatment of MDD in children and adolescents reflect the recommended treatments based on the findings in the current literature and national guidelines. Regarding fluoxetine, there is extensive research proving its effectiveness and tolerability in children and adolescents, including FDA approval for the medication (Kryst et al., 2022).

Escitalopram, although not officially approved for pediatric use, is commonly used off-label. Moreover, CBT could be considered as another effective non-pharmacological treatment of MDD supported by several effective RCTs and meta-analyses. Worth the use of these intercessions, clinicians can positively affirm that their treatment regime is informed by these best practices with objective implications of positive results on the popularity of the clinical course in pediatric MDD children.

Supporting Resources

Annual Research Review: Defining and treating pediatric treatment-resistant depression

Scholarly Resource 

A randomized controlled trial by Dwyer et al. (2020) investigated the efficacy and safety of fluoxetine in pediatric patients with MDD. The study demonstrated significant improvement in depressive symptoms and overall functioning compared to placebo, supporting the use of fluoxetine as a first-line pharmacological intervention for MDD in children and adolescents.

Psychotropic Drug Prescription in Children and Adolescents: Approved Medications in European Countries and the United States

 Scholarly Resource

A systematic review by Smogur et al., (2022) evaluated the effectiveness of escitalopram in pediatric patients with MDD. Despite the off-label use, the review found promising evidence of escitalopram’s efficacy and tolerability in reducing depressive symptoms, highlighting its potential as an alternative pharmacological treatment option in this population.

A systematic review of interventions for treatment-resistant major depressive disorder in adolescents

Scholarly Resource

A meta-analysis by Boylan et al., (2019) examined the efficacy of Cognitive Behavioral Therapy (CBT) in pediatric patients with MDD. The meta-analysis included multiple randomized controlled trials and found that CBT significantly reduced depressive symptoms and improved overall functioning compared to control interventions. These findings support the use of CBT as a first-line nonpharmacological intervention for MDD in children and adolescents, either alone or in combination with pharmacotherapy.

Conclusion

In conclusion, the possible treatments for MDD in children and adolescents with consideration of corresponding methods are fluoxetine as the essential pharmacotherapy and escitalopram as one of the basic off-the-label treatments; moreover, Cognitive Behavioral Therapy is listed as an efficient non-pharmacologic therapy. It is important to note that these interventions provide an integrative strategy in dealing with MDD in children and adolescents and seek to treat associated symptoms that manifest themselves with depressive disorders.

References

Bitsko, R. H., Claussen, A. H., Lichstein, J., Black, L. I., Jones, S. E., Danielson, M. L., Hoenig, J. M., Davis Jack, S. P., Brody, D. J., Gyawali, S., Maenner, M. J., Warner, M., Holland, K. M., Perou, R., Crosby, A. E., Blumberg, S. J., Avenevoli, S., Kaminski, J. W., Ghandour, R. M., & Meyer, L. N. (2022). MMWR Supplements, 71(2), 1–42. https://doi.org/10.15585/mmwr.su7102a1 

European Journal of Pediatrics. https://doi.org/10.1007/s00431-022-04401-2 

Hengartner, M. P. (2021). The transformation of depression. Springer EBooks, 47–112. https://doi.org/10.1007/978-3-030-82587-4_3 

Kryst, J., Majcher-Maślanka, I., & Chocyk, A. (2022). Pharmacological Reports, 74(5), 920–946. https://doi.org/10.1007/s43440-022-00420-w 

Kutzer, T., Dick, M., Scudamore, T., Wiener, M., & Schwartz, T. (2020). Drugs in Context, 9, 1–11. https://doi.org/10.7573/dic.2020-2-2 

Smogur, M., Onesanu, A., Plessen, K. J., Eap, C. B., & Ansermot, N. (2022). Psychotropic drug prescription in children and adolescents: Approved medications in European Countries and the United States. Journal of Child and Adolescent Psychopharmacology. https://doi.org/10.1089/cap.2021.0027 

Wasserman, D., Carli, V., Iosue, M., Javed, A., & Herrman, H. (2021). Suicide prevention in childhood and adolescence: A narrative review of current knowledge on risk and protective factors and effectiveness of interventions. Asia-Pacific Psychiatry, 13(3). https://doi.org/10.1111/appy.12452