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.(Medication-Guide for depressive-disorders Essay-Example)

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.

Medication Guide-Solution

Assessing and Treating Vulnerable Populations for Depressive Disorders

The risk factors and extent of severity for depressive disorders vary with individuals and are primarily determined by the degree of social vulnerability, such as gender, age, comorbidities, and racial and ethnic affiliations. Depending on the extent of severity, some experience impairment and consequent inability to carry out major life activities leading to dependence. Assessing and treating individuals with depressive disorders summarises the broad array of interventions and activities that psychiatrists initiate and sustain to manage patients through all phases of their psychiatric management. The paper assesses depressive disorders in children, recommends pharmacological interventions, and outlines the relevant special ethical, legal, social, and cultural considerations and social health determinants.(Medication-Guide for depressive-disorders Essay-Example)

Depressive Disorder Causes and Symptoms

Depressive disorders are categorized into persistent depressive disorder, premenstrual dysphoric disorder, major depressive disorder, substance/medication-induced depressive disorder, disruptive mood dysregulation disorder, unspecified/specified depressive disorder, and depressive disorders due to another medical condition (American Psychiatric Association [APA], 2019). Disruptive mood dysregulation (DMDD) disorder is a common childhood condition characterized by frequent temper outbursts, extreme anger, and irritability (APA, 2019). Children with DMDD can also experience severe impairment in significant functions that require clinical interventions.

Major depressive disorder (MDD) is the most common depressive disorder in children and is characterized by five depressive symptoms and three levels of severity, including mild, moderate, and severe (Patel et al., 2021). MDD is characterized by discrete episodes lasting at least two weeks or longer with distinct changes in neurocognitive functions, cognition, affect, and inter-episode remissions. These symptoms should be delineated from normal sadness and grief, which cause suffering but do not typically induce MDD episodes. However, the comorbid occurrence of grief and MDD produces severe symptoms and impairment. Persistent depressive disorder (PDD) is a more chronic form of depression and is symptomized by chronic sadness or irritability and additional depressive symptoms lasting at least one year (Patel et al., 2021). PDD and MDD differ because PDD symptoms are less severe and long-lasting. Children with PDD may experience depressed mood and irritability on most days for more than a year or more.(Medication-Guide for depressive-disorders Essay-Example)

How is depression diagnosed for the vulnerable population of your choice? Why is this population considered vulnerable?

The first step in diagnosing depressive disorder involves clinical assessment and examination of cognitive and mental processes. Specific laboratory tests may rule out certain medical conditions causing depressive symptoms. In children, diabetes, anemia, mononucleosis, epilepsy, hyperthyroidism/hypothyroidism, concussion, and Vitamin D deficiency cause depressive symptoms. A psychiatrist should evaluate a child’s psychiatric history to determine the child’s clinical history, including presented symptoms and developmental history. Children with a chronic history of irritability and other mental disorders may also meet the diagnostic criteria for depressive disorders (APA, 2019). The family history of mental illness and home/family environment are potential factors that can likely lead to depression.

Clinical examination of children for potential depressive disorder involves direct interviews with the child in the parent’s presence. The interviews can be open-ended questions, observation of parent-child interactions, and observation of play. Besides the symptoms presented by a child, a mental healthcare provider should rule out other potential causes of depressive symptoms, including learning or neurologic disabilities that affect children’s regular learning and development abilities (APA, 2019). These clinical manifestations are evaluated based on the DSM-5 diagnostic criteria. First, the child must experience at least five or more of the DSM-5 symptoms in two weeks, of which one symptom should be loss of interest/pleasure or depressed mood for most of the day and nearly every day. The most important symptoms include irritability, anger, loss of pleasure, and sadness/hopelessness. At least four other symptoms must accompany the primary symptoms.(Medication-Guide for depressive-disorders Essay-Example)

A mental health provider may use a questionnaire such as Paediatric Symptom Checklist, Children’s Depression Rating Scale-Revised (CDRS-R), or PHQ-9 modified for Adolescents (PHQ-A) to screen for depressive symptoms in children, Table 1. The questionnaires are based on the DSM-5 symptoms and can be administered by a mental health provider, parents, or caregivers for children aged 6 to 12. These questionnaires are easy to administer, are widely accepted, and have high specificity and sensitivity to depressive symptoms. For MDD, the symptoms must be present nearly every day and for most of the day to be diagnosed. The mental health care provider should probe for the accompanying symptoms to avoid underdiagnosis. Symptoms such as sadness may be initially denied but later elicited during the interview from demeanor and facial expression. In cases of somatic complaint, mental health personnel should determine whether such complaints aligns with specific symptoms, including fatigue and insomnia. Other symptoms, including psychomotor disturbances and delusion, are less common but are indicative of severe depression.

Table 1: Diagnostic Tools

Medication treatment options include risk vs. benefits; side effects; FDA approvals for the vulnerable population of your choice

The recommended pharmacological intervention for MDD is selective serotonin reuptake inhibitors (SSRIs). The two drugs currently approved by the Food and Drug Authority (FDA) for MDD are Fluoxetine and Escitalopram, Table 2 (Neavin et al., 2018). Fluoxetine is recommended for ages 8-18 and Escitalopram for ages 12 to 17 (Dwyer & Bloch, 2019). Fluoxetine and Escitalopram reduce depressive symptoms and high remission. Fluoxetine and Escitalopram significantly reduce symptom intensity and are well tolerated but associated with higher risks of headache, suicide, and rashes (Reyad et al., 2021; Ignaszewski & Waslick, 2018). Escitalopram is associated with side effects such as sleepiness, fatigue, mania induction, nausea, and headache. The minimum recommended treatment duration to evaluate efficacy is 4 to 6 weeks. Higher doses are associated with a higher likelihood of responses, and the patients should be monitored weekly for the first month, every fortnight for the second month, and monthly after that.(Medication-Guide for depressive-disorders Essay-Example)

Table 2: Pharmacological Interventions

Medication considerations of medication examples prescribed (see last bullet item)

What is essential to monitor regarding labs and comorbid medical issues? Why is it important to monitor?

Clinicians should monitor the patient weekly for adverse effects. Side effects occur days to a week after starting medication or increasing the dosage (Dwyer & Bloch, 2019). Observe remission within the first two weeks. If side effects do not remit after two weeks, they are unlikely to improve. Clinicians should determine whether lack of remission is attributed to other underlying conditions. Fluoxetine and Escitalopram are contraindicated to individuals taking Monoamine oxidase inhibitors (MAOIs) and pimozide due to potential fatal drug interactions. Fluoxetine and Escitalopram can interact with antiplatelet drugs such as ibuprofen, warfarin, or clopidogrel to cause bleeding/bruising. Fluoxetine can slow the removal of other medications from the body. Clinicians should assess the patient for potential allergic reactions, family/personal history of suicide attempts, diabetes, liver issues, glaucoma, and stomach/intestinal ulcers before taking Fluoxetine or Escitalopram.

A proper prescription for fluoxetine and Escitalopram would be as follow:

Special Considerations (you must be specific, not general, and address at least one for EACH category; you must demonstrate critical thinking beyond the basics of HIPPA and informed consent!):

Legal considerations

The central legal consideration for pediatric patients is informed consent. Dealing with pediatric patients presents clinicians with the challenge of upholding a child’s competence and controlling information. HIPAA protects children from disclosure, but under some circumstances, it permits disclosure to prevent harm, facilitate treatment/payments, and obey legal provisions (Centres for Disease Control and Prevention [CDC], 2022. Clinicians should evaluate the patient’s competence and seek parental inclusion from the patient explaining the benefits and risks. Besides, clinicians must provide safe and acceptable practice through the existing standards.

Ethical considerations

Clinicians should uphold their moral duty to avoid harm and center interventions to meet patients’ needs. MDD has a suicide risk, which can be execrated by pharmacological intervention. Fluoxetine and Escitalopram are known to increase suicide risks among patients, and it is the ethical responsibility to evaluate the risks and initiate appropriate interventions to avoid them (Reyad et al., 2021; Ignaszewski & Waslick, 2018). Besides, clinicians should assess the patient for other side effects and potential threats and establish appropriate mitigation measures.

Cultural considerations

MDD varies across cultures. Clinicians should maintain cultural competence when dealing with children, i.e., interact effectively, and incorporate unique beliefs, behaviors, and needs (APA, 2019). Cultural differences are associated with different expressions of MDD, particularly the impact of somatic symptoms in determining MDD. Mainly, insomnia and fatigue are closely related to culture.(Medication-Guide for depressive-disorders Essay-Example)

Social determinants of health

The primary social health determinant associated with MDD is the patient’s environment. Environmental factors such as adverse childhood experiences are risk factors for MDD (APA, 2019). Clinicians should assess the patient for stressful events, including domestic violence, alcohol, and drug abuse, overworking, and poor sleep patterns.

Where to follow up in your local community for further information

Follow-up should be made to the clinic one week after commencing the SSRI for the first month. For emergencies, call 1-800-985-5990 or 988 (Mental Health America).

Conclusion

Depression in children is a growing health concern in the United States. The growing body of evidence suggests that depression poses a significant risk in the development trajectory of children. The vulnerability of children to depression of characterized by the differences in manifestations. As such, symptom expression by children tends to be ignored since children may not have developed an appropriate emotional expression and insight, making it difficult to express their symptoms. A definitive diagnosis is necessary for appropriate treatment intervention. Clinicians should uphold legal, ethical, and cultural concerns when handling children presenting depressive symptoms, including disclosures, avoiding harm, and incorporating appropriate cultural views. Clinicians should equally consider the environmental risk factors for pediatric depression and incorporate appropriate measures to prevent further risks.(Medication-Guide for depressive-disorders Essay-Example)

References

American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders  (7^th ed.). American Psychiatric Publishing, Inc.

Centers for Disease Control and Prevention. (June 2022). Health Insurance Portability and Accountability Act of 1996 (HIPAA). Available at: https://www.cdc.gov/phlp/publications/topic/hipaa.html (Accessed 23 September 2022)

Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for pediatric patients. Current Psychiatry, 18(9), 26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738970/Neavin, D. R., Joyce, J., & Swintak, C. (2018). Treatment of major depressive disorder in pediatric populations. Diseases, 6(2), 48. https://doi.org/10.3390%2Fdiseases6020048

Dwyer, J. B., & Bloch, M. H. (2019). Antidepressants for pediatric patients. Current Psychiatry, 18(9), 26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738970/

Ignaszewski, M. J., & Waslick, B. (2018). Update on randomized placebo-controlled trials in the past decade for the treatment of major depressive disorder in child and adolescent patients: a systematic review. Journal of Child and Adolescent Psychopharmacology, 28(10), 668-675. https://doi.org/10.1089/cap.2017.0174

Lebrun-Harris, L. A., Ghandour, R. M., Kogan, M. D., & Warren, M. D. (2022). Five-year trends in US children’s health and well-being, 2016-2020. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2022.0056

Malhotra, S., & Sahoo, S. (2018). Antecedents of depression in children and adolescents. Industrial Psychiatry Journal, 27(1), 11. https://doi.org/10.4103%2Fipj.ipj_29_17

Neavin, D. R., Joyce, J., & Swintak, C. (2018). Treatment of major depressive disorder in pediatric populations. Diseases, 6(2), 48. https://doi.org/10.3390%2Fdiseases6020048

Patel, S. M., Crouse, E. L., & Levenson, J. L. (2021). Evaluation of intramuscular olanzapine and ziprasidone in the medically ill. Mental Health Clinician, 11(1), 6-11. https://doi.org/10.9740/mhc.2021.01.006

Reyad, A. A., Plaha, K., Girgis, E., & Mishriky, R. (2021). Fluoxetine in Managing Major Depressive Disorder in Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials. Hospital Pharmacy, 56(5), 525-531. https://doi.org/10.1177/0018578720925384