Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.

Decision Tress for Depression

Introduction to the Case

An 8-year-old African American was brought to the emergency room by his mother for medical assessment and treatment. The patient was exhibiting depression signs. According to the patient, he experiences sad feelings. His mother notes that the patient’s teacher reported that he is withdrawn in school and is not interacting with his classmates. The patient has also lost his appetite and is often irritated. His body appearance shows that he is well developed and has reached all milestones and his development is appropriate to his age.

His physical exam shows that the patient healthy, physically. The patient’s vital signs are within normal limits and lab tests are normal. The patient was referred to a psychiatrist for a further mental evaluation. His mental exam shows that he knows where he is, what time is it, and who I am. He reports that he experiences a sad mood. He has been smiling often in some moments during the interview though he has a blunt affect. He denies hallucination symptoms. He also denies having delusional and paranoid thinking.

The patient notes that he has not thought of committing suicide but often thinks about himself as dead. He also reports that he sometimes thinks of the meaning of being dead. The Children’s Depression Rating Scale (CDRS) and the child scored 30. The purpose of this assignment is to make treatment decisions that will help the patient improve his depression by 50% as per CDRS within 12 weeks of treatment.

Decision One

My first decision was that he begins Zoloft 25mg orally daily. I selected the decision due to the following reasons. First, Locher et al. (2017) note that SSRIs are safe and effective in treating adolescents with mental problems, such as depression and anxiety. Zoloft is an SSRI and thus is safe and effective in treating the patient.

Second, a study conducted by Fann et al. (2017) found that Zoloft is an effective antidepressant that can completely treat a patient with depression within 12 weeks of treatment. The authors also noted that the has positive long-term effects on people with depression. Another randomized control trial by Duffy et al. (2019) found that Zoloft can reduce depressive symptoms in people with depression within 12 weeks, thus improving the patients’ quality of life.

I avoided Paxil because it is more likely to heart problems compared to Zoloft. A study by Guo et al. (2019) found that some antidepressants can make patients taking them to experience some cardiovascular problems. When ranking the medications, the authors ranked Zoloft above Paxil in terms of safety. I also avoided Wellbutrin because the medication does not belong to the SSRI class. SSRI medications are considered the more effective and safe drugs for the treatment of patients with depressive symptoms (Locher et al., 2017).

Womersley et al. (2017) report that SSRIs are the first line of treating depression and other mental conditions. My hope was to improve the patient’s mental health by 50% within 12 weeks (Duffy et al., 2019). The ethical considerations that may have impacted this treatment plan are patient autonomy and informed consent. Molina‐Mula et al. (2019) note that patients have the decision to make their decisions regarding their care. In this instance, the patient’s mother has the responsibility to decide for him because he is a minor. My next steps will be based on the mother’s decision.

Decision Two

In four weeks, the patient was brought back for follow-up care. His symptoms have not reduced. Thus, I decided that he should change the dosage. As a result, I selected the decision that the patient’s dosage is increased to 50mg orally daily. I selected this decision because Cheung et al. (2018) note that nurses should take specific steps in an instance where the initial treatment produces partial or no improvement.

The initial treatment did not produce significant clinical benefits, hence I decided to increase the dosage to 50mg. I also selected the decision because Hieronymus et al (2016) note that Zoloft 50mg can decrease symptoms in people with depression. The authors also note that dosage should be decided based on the individual patient’s response to medication.

I avoided the first decision because according to Hieronymus et al (2016), Zoloft 50mg can decrease symptoms in people with depression. The authors also the Zoloft dosage of 50mg has been recommended by the FDA. I avoided the last decision because compared to Zoloft, Prozac because can cause negative effects on the patient’s cardiovascular system (Guo et al.,