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

African American Child

 

Decision Point One


Begin Wellbutrin 75 mg orally BID

RESULTS OF DECISION POINT ONE

Decision Point Two
Select what the PMHNP should do next:


Change from immediate release to extended release 150 mg orally daily in the morning

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Child’s sleep patterns return to baseline. No change in depressive symptoms
Decision Point Three
Select what the PMHNP should do next:


Change to SSRI
Guidance to Student
The PMHNP can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.
Increase dose to 300 mg orally daily
Guidance to Student
The PMHNP can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.
Maintain current dose for another 4 weeks
Guidance to Student
The PMHNP can continue drug therapy for another 4 weeks, however, it is discouraging that there have been no changes in depressive symptomatology. Increasing the dose to 300 mg orally daily may be appropriate if the child is tolerating the medication well. Changing to an SSRI may also be appropriate, but it may be more prudent to give the Wellbutrin at an appropriate dose for an adequate duration of therapy before switching therapeutic classes.
Give second dose of the day at 1:00 pm in the afternoon

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • No change in sleeping patterns, child is getting more difficult to wake for school
Decision Point Three
Select what the PMHNP should do next:


Change to Wellbutrin XL 150 mg orally daily in the AM
Guidance to Student
It is clear that the side effect after 4 weeks persists, the likelihood of it abating is quite low at this point, indicating that the PMHMP must do something. Administering both tablets of 75 mg in the morning may be an option, but then blood levels are not maintained throughout the day. There is also an increased risk of side effects (including seizure as this drug reduces seizure threshold). The correct answer would be to change the drug to an extended release formulation and administer in the morning.
Change administration to giving both immediate release tablets in the morning
Guidance to Student
It is clear that the side effect after 4 weeks persists, the likelihood of it abating is quite low at this point, indicating that the PMHMP must do something. Administering both tablets of 75 mg in the morning may be an option, but then blood levels are not maintained throughout the day. There is also an increased risk of side effects (including seizure as this drug reduces seizure threshold). The correct answer would be to change the drug to an extended release formulation and administer in the morning.
Counsel parent that the side effect will go away
Guidance to Student
It is clear that the side effect after 4 weeks persists, the likelihood of it abating is quite low at this point, indicating that the PMHMP must do something. Administering both tablets of 75 mg in the morning may be an option, but then blood levels are not maintained throughout the day. There is also an increased risk of side effects (including seizure as this drug reduces seizure threshold). The correct answer would be to change the drug to an extended release formulation and administer in the morning.
Change to Lexapro 10 mg orally daily

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Child is tolerating Lexapro, and is sleeping at night. There is a 40% reduction in symptoms
Decision Point Three
Select what the PMHNP should do next:


Continue current dose
Guidance to Student
At this point, there is no indicating that the PMHNP should change back to Wellbutrin as the child is tolerating the current medication without mention of side effects. Also, the child is experiencing a reduction in symptoms. The PMHNP could also increase the dose to 15 mg orally daily, but the child has only been taking the drug for 4 weeks at this point. It may be more prudent to give the current therapy an additional 4 weeks before making any decisions to change current dose.
Increase dose to 15 mg orally daily
Guidance to Student
At this point, there is no indicating that the PMHNP should change back to Wellbutrin as the child is tolerating the current medication without mention of side effects. Also, the child is experiencing a reduction in symptoms. The PMHNP could also increase the dose to 15 mg orally daily, but the child has only been taking the drug for 4 weeks at this point. It may be more prudent to give the current therapy an additional 4 weeks before making any decisions to change current dose.
Re-attempt Wellbutrin XL 150 mg orally daily
Guidance to Student
At this point, there is no indicating that the PMHNP should change back to Wellbutrin as the child is tolerating the current medication without mention of side effects. Also, the child is experiencing a reduction in symptoms. The PMHNP could also increase the dose to 15 mg orally daily, but the child has only been taking the drug for 4 weeks at this point. It may be more prudent to give the current therapy an additional 4 weeks before making any decisions to change current dose.