Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample

Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample

Depression is a common mental health problem among children that often goes unrecognized. Thapar et al. (2015) explain that depression in children is associated with a family history of depression and struggles with performance in school. Appropriate pharmacological and non-pharmacological interventions should be implemented to minimize the adverse effects of depression on children and adolescents’ growth and development, including improving their relationships with peers and families. This paper will explore examples of FDA-approved and off-label drugs and pharmacological interventions necessary for depression management in children and adolescents. It will also examine the risks and benefits of FDA-approved and off-label drugs. The last part will explore clinical practice guidelines for depression treatment in children and adolescents.(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

FDA Approved Drug, Off-Label Drug, and Non-Pharmacological Intervention

The FDA has approved various drugs for treating depression in children, such as Prozac (fluoxetine) (Davey et al., 2019). It is a selective serotonin reuptake inhibitor (SSRI) effective in treating and managing major depressive disorder in children and adolescents. Its side effects include headaches, appetite loss, sedation, poor coordination, and restlessness. Consequently, an off-label drug for depression treatment in children is Sertraline (Zoloft), a selective inhibitor of presynaptic serotonin reuptake (Poweleit et al., 2019). Its side effects include sweating, constipation, dizziness, and trouble sleeping. Lastly, Wright et al. (2019) observe that mindfulness-based cognitive therapy (MBCT) is a non-pharmacological method of depression treatment in children. It requires a 90-minutes of 12 weekly therapy sessions focusing on improving the self-regulation of emotions by developing mindful attention and decentralization from thoughts and feelings. It also constitutes skill development for the activities learned during the session, with written session materials and homework practice assignments provided to the children (Wright et al., 2019).(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

Risks and Benefits of FDA-Approved and Off-label Drugs

The FDA-approved drugs are associated with benefits, such as a clear illustration of the side effects, enabling users to make appropriate choices before using them. Darrow et al. (2020) illustrate that the FDA conducts risk assessments on drugs to ensure their benefits outweigh the risks. Besides, the drugs contain FDA approval labels describing the drug’s benefits and risks, including procedures for managing the risks. Such approaches are integral in reducing the adverse effects of drugs and increasing the potential for positive treatment outcomes. However, FDA-approved drugs are associated with risks, such as lobbyists’ interference with the approval process, reducing the potential to disclose the drug’s side effects and eventual poor patient outcomes (Darrow et al., 2020). Additionally, inadequate funding and oversight of the FDA increase the risk of insufficient evaluation of the drug’s risks and benefits, increasing the potential of poor patient outcomes.(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

Consequently, van der Zanden et al. (2021) argue that off-label drugs are also beneficial since they can be used as alternatives in cases where FDA-approved drugs are inaccessible or unavailable for treating the patient’s condition. However, off-label drugs are often risky, primarily due to the unavailability of adequate evidence to support their use (van der Zanden et al., 2021). Off-label drugs such as dopamine expose users to the risk of addiction, which may contribute to adverse patient outcomes. Therefore, off-label drugs should be used cautiously and according to a physician’s direction to mitigate their side effects.(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

Clinical Practice Guidelines for Depression

The American Psychological Association (APA) recommended clinical practice guidelines for depression treatment in children in 2019. The guidelines require psychologists to consider each element of evidence-based practice in psychology (EBPP) in making treatment decisions for patients diagnosed with depression (APA, 2021). EBPP is integral in informing treatment decisions since they have rigorously been evaluated and their efficacy ascertained. Besides, the psychologist should also consider informed consent in selecting the type of treatment to administer. It is essential to adequately explain the treatment concepts, including the benefits and risks of the treatment process, to enhance the patient’s decision-making capacity.(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

Additionally, psychologists should only proceed with treatment administration if they possess the skills and knowledge necessary for the treatment process and refer patients to competent psychologists for better treatment (APA, 2021). Competency is crucial in achieving positive treatment outcomes since the psychologist is well-informed about the problem and its treatment procedures, making it easy to adequately navigate the risks involved in the treatment process. Lastly, APA (2021) illustrates that the psychologist should regularly assess the patient’s treatment progress based on the EBPP policies. Regular progress assessment is necessary to determine the strategies to improve the patient’s response to treatment, especially if they are not progressing well with the treatment process.(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

Conclusion

The impacts of depression in children and adolescents can be mitigated through pharmacological and non-pharmacological interventions. The pharmacological interventions include FDA-approved medications like Prozac (fluoxetine) and off-label medications like Sertraline (Zoloft). The non-pharmacological intervention can include mindfulness-based cognitive therapy (MBCT), which involves 12 weeks of 90-minute therapy sessions on self-regulation training. The FDA-approved drugs are beneficial since they have undergone extensive evaluation and strict regulations to determine whether their benefits outweigh the risks. However, the drugs are prone to insufficient regulation due to medical manufacturers’ lobbyists and FDA underfunding, posing potential patient risks.(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

On the other hand, off-label drugs are also suitable alternatives where FDA-approved drugs are ineffective or unavailable. However, they pose serious health risks to patients due to inadequate evidence-based research on their efficacy. Notably, the APA expects psychologists to comply with specific practice guidelines when treating depression in children and adolescents. They include compliance with EBPP guidelines, informed consent, competency standards, and regular assessment of patients’ progress during treatment based on EBPP policies. Strict compliance with recommended clinical practice guidelines can guarantee positive depression treatment outcomes among patients. (Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

References

 APA (2021). Decision-Making Within Evidence-Based Practice in Psychology: Using the APA Clinical Practice Guideline for the Treatment of Depression in Children and Adolescents(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample). https://www.apa.org/depression-guideline/decision-aid-children-adolescents.pdf

Darrow, J. J., Avorn, J., & Kesselheim, A. S. (2020). FDA approval and regulation of pharmaceuticals, 1983-2018. Jama, 323(2), 164-176. doi:10.1001/jama.2019.20288(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

Davey, C. G., Chanen, A. M., Hetrick, S. E., Cotton, S. M., Ratheesh, A., Amminger, G. P., … & Berk, M. (2019). The addition of fluoxetine to cognitive behavioral therapy for youth depression (YoDA-C): a randomized, double-blind, placebo-controlled, multicentre clinical trial. The Lancet Psychiatry, 6(9), 735-744.(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)https://doi.org/10.1016/S2215-0366(19)30215-9

Poweleit, E. A., Aldrich, S. L., Martin, L. J., Hahn, D., Strawn, J. R., & Ramsey, L. B. (2019). Pharmacogenetics of sertraline tolerability and response in pediatric anxiety and depressive disorders. Journal of Child and Adolescent Psychopharmacology, 29(5), 348-361(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample).https://doi.org/10.1089/cap.2019.0017

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s Child and adolescent psychiatry (6th ed.). Wiley Blackwell.(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample)

van der Zanden, T. M., Mooij, M. G., Vet, N. J., Neubert, A., Rascher, W., Lagler, F. B., … & de Wildt, S. N. (2021). Benefit‐risk assessment of off‐label drug use in children: the bravo framework. Clinical Pharmacology & Therapeutics, 110(4), 952-965(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample). https://doi.org/10.1002/cpt.2336

Wright, K. M., Roberts, R., & Proeve, M. J. (2019). Mindfulness-based cognitive therapy for children (MBCT-C) for prevention of internalizing difficulties: A small randomized controlled trial with Australian primary school children. Mindfulness, 10, 2277-2293(Prescribing for Children and Adolescents-A Comprehensive Nursing Paper Sample).https://doi.org/10.1007/s12671-019-01193-9