Decision #3 The decision at this point is to increase the Sertraline medication dosage to 75 mg. Reasons For Selecting the Decision

Decision #3 The decision at this point is to increase the Sertraline medication dosage to 75 mg. Reasons For Selecting the Decision

The patient visits the clinic and indicates a considerable improvement of up to fifty percent in the symptoms of depression. Therefore it is important to increase the dosage by a small amount again (Clevenger et al., 2018). Indeed, it is advised that when a patient does not fully respond to the lower dosage of the medication, then it is important to slightly increase the dosage; therefore, the next dosage of the medication was chosen

Why the Other Two Options Were Not Selected.

The patients showed some improvement, and there is no reason why the therapy should be changed as the patient is already responding. In addition, when using an antidepressant to treat a child it is key to titrate it as guided by the possible adverse impacts, concomitant medication, other disorders, and the patient’s age  (Clevenger et al., 2018). In case of adverse impacts, then lower doses are indicated. However, an acute treatment phase need not be prematurely closed if a patient doesn’t fully respond (“American Psychiatric Association,” 2013). The risk of relapse should be eliminated by continuing the medication for up to 4 months.

What I Expected To Achieve.

It is expected that the patient will experience near full relief of the symptoms. This is because there has been an increased dosage of the medication. In addition, the impact of this class of medication may not start immediately but after some time (“American Psychiatric Association,” 2013).

The Ethical Considerations and Treatment Plan

One of the ethical considerations is informed consent to again increase the dosage of the medication to 75 mg. Since the patient is a child, informed consent will have to be given by the mother to enable the treatment plan to continue. Autonomy also impacts this treatment plan as the patient and the mother has the right to choose whether to continue with the medication at raised dosage, and such a decision should be respected (“American Psychiatric Association,” 2013).

Conclusion

The case study explored here is of Jeanette, a thirteen-year-old patient who has been showing signs of struggling both at school and at home. For close to ten years, eight years to be precise, the patient has been suffering from various issues such as sleep issues, difficulty in judgment, inappropriate behavior, impulsiveness, and temper tantrums. Therefore, it was important to prescribe possible step-wise management of this condition for better patient outcomes. As such, Sertraline 25 mg was selected as the first treatment option, which the patient had to take orally daily. The major ethical consideration in this first decision point was informed consent, where the parent needed an informed consent for the start of the plan as well as to keep the patient’s status confidential. The second decision was to increase the dosage to 50 mg as the patient failed to respond to the initial dose. Having responded at this point but not fully, the decision was to increase the dosage to 75 mg, with the major ethical consideration still to obtain informed consent to increase the dosage.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.

Clevenger, S. S., Malhotra, D., Dang, J., Vanle, B., & IsHak, W. W. (2018). The role of selective serotonin reuptake inhibitors in preventing relapse of major depressive disorder. Therapeutic Advances in Psychopharmacology, 8(1), 49-58. https://doi.org/10.1177%2F2045125317737264.

Kweon, K., & Kim, H. W. (2019). Effectiveness and safety of Bupropion in children and adolescents with depressive disorders: a retrospective chart review. Clinical Psychopharmacology and Neuroscience, 17(4), 537. https://doi.org/10.9758%2Fcpn.2019.17.4.537

Naguy, A. (2019). Paroxetine: Into Oblivion? Well, Guess Not. The Primary Care Companion for CNS Disorders, 21(2), 27079. https://doi.org/10.4088/PCC.17l02113.

Yan, T., & Goldman, R. D. (2019). Time-to-effect of fluoxetine in children with depression. Canadian Family Physician, 65(8), 549-551. https://europepmc.org/article/pmc/6693597