Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression

African American Child

 

Decision Point One


Begin Zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

Decision Point Two
Select what the PMHNP should do next:


Increase dose to 37.5 mg orally daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Depressive symptoms decrease by 20%. Client reports feeling a little bit better
Decision Point Three
Select what the PMHNP should do next:


Maintain current dose
Guidance to Student
At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.
Increase to 50 mg orally daily
Guidance to Student
At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.
Change to a different SSRI
Guidance to Student
At this point, sufficient symptom reduction has not been realized. Should either increase dose or consider different SSRI. At 8 weeks post-initiation of therapy, there should have been a significant (as defined as 50%) decrease in symptoms. This would be considered an adequate trial of antidepressant and change in dose or to a different agent would be appropriate.
Increase dose to 50 mg orally daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Depressive symptoms decrease by 50%. Cleint tolerating well
Decision Point Three
Select what the PMHNP should do next:



Maintain current dose
Guidance to Student
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.
Increase to 75 mg orally daily
Guidance to Student
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.
Change to a SNRI
Guidance to Student
At this point, sufficient symptom reduction has been achieved. This is considered a “response” to therapy. Can continue with current dose for additional 4 week to see if any further reductions in depressive symptoms are noted. An increase in dose may be warranted since this is not “full” remission- Discuss pros/cons of increasing drug dose with client at this time and empower the client to be part of the decision. There is no indication that the drug therapy should be changed to an SNRI at this point as the client is clearly responding to this therapy.
Change to Prozac 10 mg orally daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • No change at all in symptom
Decision Point Three
Select what the PMHNP should do next:


Increase to 20 mg
Guidance to Student
The client has been on a sub therapeutic dose of Prozac- low dosing is appropriate for up to the first week of therapy in an attempt to minimize side effects, but after that, a therapeutic dose should be achieved. Therefore, increasing to 20 mg orally daily is appropriate. There is no indication to change to another SSRI or SNRI as the client has not had an adequate trial of this medication at a therapeutic dose. - should stick with one antidepressant for a sufficient trial of therapy at optimized dose- frequent changes not recommended at sub-therapeutic doses.
Attempt a different SSRI
Guidance to Student
The client has been on a sub therapeutic dose of Prozac- low dosing is appropriate for up to the first week of therapy in an attempt to minimize side effects, but after that, a therapeutic dose should be achieved. Therefore, increasing to 20 mg orally daily is appropriate. There is no indication to change to another SSRI or SNRI as the client has not had an adequate trial of this medication at a therapeutic dose. - should stick with one antidepressant for a sufficient trial of therapy at optimized dose- frequent changes not recommended at sub-therapeutic doses.
Attempt Selective Serotonin Norepinephrine Reuptake Inhibitor (SNRI) therapy
Guidance to Student
The client has been on a sub therapeutic dose of Prozac- low dosing is appropriate for up to the first week of therapy in an attempt to minimize side effects, but after that, a therapeutic dose should be achieved. Therefore, increasing to 20 mg orally daily is appropriate. There is no indication to change to another SSRI or SNRI as the client has not had an adequate trial of this medication at a therapeutic dose. - should stick with one antidepressant for a sufficient trial of therapy at optimized dose- frequent changes not recommended at sub-therapeutic doses.