NRNP 6665 Week 3 Assignment 1

• NRNP 6665 Week 3 Assignment 1

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NRNP 6665

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Introduction

Another large mental health issue among children and adolescents is major depressive disorder, characterized by a sad mood, a decrease in interest or pleasure, and other symptoms that affect how they function in their usual lives (Bitsko et al., 2022). In this brief review, some of the difficult management issues and a host of proposed intervention procedures are briefly mentioned. This is to provide coordinated care management, including the pharmacological management of the disease with FDA – approved and off–label drugs and pharmacological techniques, in addition to non-pharmacologic interventions. This outline will facilitate the direction of the conversation and give a structure to discuss the treatment recommendations for children and youth with MDD in a comprehensive manner.

Recommendations for Treatment

The chemical in this medicine is Fluoxetine, and its intended use is in children and adolescents with MDD or Major Depressive Disorder, a medicine known as an SSRI or Selective Serotonin Reuptake Inhibitor. As its action plan, it is employed in boosting serotonin levels in the brain to trigger the relief of symptoms of depression. Interestingly, we can use it, given that it is proven to be effective and safe, and has been approved for use on children aged 8 years and older.

There are side effects associated with fluoxetine, such as gastrointestinal upset, changes in appetite or weight loss, and an increased risk of thoughts of suicide in the first two weeks of therapy (Kutzer et al., 2020). However, there are some side effects associated with fluoxetine, such as gastrointestinal issues, sexual dysfunction, and the risk of bleeding, that remain, but should be balanced with the drug’s effectiveness at reducing depressive symptoms and improving overall functioning.

Escitalopram (Lexapro) Escitalopram is another SSRI, and its use in children and adolescents to treat MDD is considered off-label as the FDA has not approved the drug for pediatric usage (Liu et al., 2022). It acts in the same way as fluoxetine, blocking the reuptake of serotonin to change one’s mood. Escitalopram is used off-label in specific cases based on the efficacy and side effect profile observed in adults.

Although few studies have well-controlled data to support its use in pediatric MDD, like fluoxetine, the FDA statement paves the way for some clinicians to consider it as an alternative when fluoxetine fails or is not well tolerated in the patient. Like fluoxetine, however, escitalopram can come with some risks, side effects that can include insomnia, aggravation, and an increased risk of suicidal thoughts or actions, as detailed by the National Institute for Health and Care Excellence.

Cognitive behavioral therapy CBT is one of the most common psychotherapeutic management approaches to MDD in children and adolescents. CBT does not involve any medication, but rather focuses on changing negative thinking and behaviors associated with depression; that is, how they influence brain chemistry (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 because it significantly reduces depressive symptoms, reduces overall levels of depression, and enhances functioning in children and adolescents.

However, the evidence beyond that is that 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 requiring medication in your future life. The non-invasiveness and low to moderate side effects make it a beneficial treatment for MDD in children and adolescents, either alone or with medication.

Risk Assessment

In pediatric mental health, risk assessment also considers the child and adolescent and is designed to evaluate the effectiveness of the proposed treatment, as well as potential harm from the chosen interventional activities (Wasserman et al., 2021). It is based on external considerations such as the nature of the disorder, the condition of the patient, the therapies planned for the patient, the prospective risks and benefits of the therapies planned for the patient, and existing clinical trial data. Further, the risk assessment involves future revision and management of care plans that minimize potential risks and maximize 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 for its efficacy, making it one of the first-line medications (Wasserman et al., 2021). However, fluoxetine is not without its dangers, as it may bring about side effects such as upset stomach, a 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. Patients should be cautioned about the following potential risks when taking fluoxetine, as compared to the possible benefits that can be achieved while optimizing the mentioned symptoms and improving the quality of life. This is because, if treatment is initiated early, the risk is high, so there is a need for continuous evaluation of the patient profile.

Escitalopram is an SSRI; however, fluoxetine is known to be effective as an off-label medication for MDD in children and adolescents; thus, escitalopram has receptive risks/benefit cooperation (Wasserman et al., 2021). The effect of efficacy is less pronounced in children/adolescents, and some clinicians may use it as second-line therapy in patients when they are not responsive to fluoxetine or have side effects. It is also similar to fluoxetine since some side effects that are linked to it include insomnia, anxiety, and increased vulnerability to committing suicide.

Therefore, prescribing citalopram 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. Ultimately, the choice between fluoxetine and citalopram should depend on individual patient factors, treatment history, and side effects of each medication, to maximize treatment benefits and minimize side effects.

Justification of Recommendations

Practice parameters provide useful information for informing practice based on research data. Less attention has been directed at such considerations in children and adolescents with Major Depressive Disorder (MDD) (Hansen et al., 2022). Where present, these policies and guidelines are based on information gleaned from the literature as well as other recognized experts in the field and clinicians in practice.

It mentions the treatment strategies to be followed and the dose and timings of treatment based on the patient’s condition to achieve the best results. Therefore, adherence to guidelines means that the treatment of MDD in children would have a high level of adherence and quality of treatment, as healthcare providers know about the importance of outcome-based treatment.

Often, the developed CPGs were not specific to pediatric MDD, making it challenging for clinicians to obtain the information they needed for any treatment decision. Participating in activities including but not limited to research papers, meta-analysis, and treatment protocols for later-life MDD in adults (Hansen et al., 2022).

In fact, the generalization of the findings from the current study to children with mental health issues should be approached with caution; however, the current literature would provide a solid empirical basis for determining the safety and applicability of a variety of treatment interventions in children with mental health issues. Moreover, using expert advice, consensus statements, 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 a scarcity of supporting guidelines.

The treatments selected for the treatment of MDD in children and adolescents, namely fluoxetine, escitalopram, and CBT, are the recommended treatments as recommended by the current literature and national guidelines. In the case of fluoxetine, there is a wealth of research that demonstrates its efficacy and tolerability in children and adolescents, including FDA approval of the medication (Kryst et al., 2022).

Escitalopram is not approved for pediatric use but it is used off label. Moreover, CBT could be considered as another effective non-pharmacological treatment of MDD supported by several effective RCTs and meta-analyses. These intercessions, used with good effect by clinicians, can be objectively supported by evidence of positive consequences on the popularity of the clinical course in children with MDD.

Supporting Resources

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

Scholarly Resource

In a randomized controlled trial (RCT) conducted by Dwyer et al. (2020), the effectiveness and safety of fluoxetine have been studied in children who have MDD. The study showed that fluoxetine was effective in reducing depressive symptoms and improving overall functioning compared with placebo, thereby providing evidence for fluoxetine’s effectiveness as a first-line pharmacological treatment for MDD in children and adolescents.

Approved Drugs in Europe and the USA for Psychotropic Drug Prescription in Children and Adolescents.

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

 Scholarly Resource

Smogur et al. (2022) conducted a systematic review to assess evidence of the effectiveness of citalopram in children and adolescents with MDD. Even though it was not approved for this indication, there was some positive evidence of the efficacy and tolerability of citalopram in reducing depression symptoms in this population, suggesting that it may be an alternative pharmacological treatment option.

A systematic review of interventions in the treatment of major depression in children and young people not responding to standard treatment. Systematic review of interventions in treatment-resistant major depressive disorder (TR-MDD) in adolescents.

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

Scholarly Resource

Boylan et al. (2019) conducted a meta-analysis of Cognitive Behavioral Therapy (CBT) for children with MDD. Multiple randomized controlled trials were included in the meta-analysis, with a significant reduction in depressive symptoms and improvement of overall functioning found in CBT relative to control interventions. The results of this study support the application of first-line non-pharmacological treatment, such as CBT, for MDD in the pediatric population, either as a standalone or adjunctive treatment, compared to pharmacotherapy.

Conclusion

Finally, the potential for treatment for pediatric and adolescent MDD, along with appropriate methods of treatment, includes fluoxetine as the most important pharmacotherapy, citalopram as one of the more basic methods of pharmacotherapy, and CBT as an effective 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

Boylan, K., MacQueen, G., Kirkpatrick, R., Lee, J., & Santaguida, P. L. (2019). European Child & Adolescent Psychiatry, 29(4). https://doi.org/10.1007/s00787-019-01341-5

Dwyer, J. B., Stringaris, A., Brent, D. A., & Bloch, M. H. (2020). Journal of Child Psychology and Psychiatry, 61(3), 312–332. https://doi.org/10.1111/jcpp.13202

Fusar‐Poli, P., Correll, C. U., Arango, C., Berk, M., Patel, V., & Ioannidis, J. P. A. (2021). World Psychiatry, 20(2), 200–221. https://doi.org/10.1002/wps.20869

Hansen, J., Hanewinkel, R., & Galimov, A. (2022). 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). Asia-Pacific Psychiatry, 13(3). https://doi.org/10.1111/appy.12452