Assessing and Treating Vulnerable Populations for Depressive Disorders
When someone has a depressive disorder, they frequently feel gloomy and uninterested in things (Watson et al., 2020). Most persons with depressive illnesses also have anxiety or other related mental health issues. The quality of life for those who experience these mental health issues may be significantly impacted. Although some subtle distinctions between these terms may not be immediately obvious, depression and depressive disorder are commonly used interchangeably.
Causes and symptoms of depressive disorder
Rao (2013) asserts numerous potential reasons for depressive disorder. Biologically, some of them include genetics: (hormonal fluctuations, brain chemistry and mood disorders). Genetics: If you have a family history of depression or were exposed to trauma as a newborn or young child, this may be the root of your sadness. People’s responses to stress may also be important in this. Biologically, mood problems, brain chemistry changes, and hormonal changes can cause depression. These conditions are most frequently associated with bipolar disorder or menstruating women (American Psychiatric Association, 2013). The signs of depression can take many different forms. For instance, continuous depression, losing interest in activities, weight changes (gain or reduction), excessive sleeping, insomnia, exhaustion, and lack of vitality. In order to find out if you may have this disease and seek treatment options from your doctor, you can use the signs of depression.
How is adolescent depression detected, and why is this group regarded as vulnerable
Adolescents frequently have mood issues. They impact over 6 million young people annually and are one of the main causes of disability worldwide. Because many mental health conditions do not have obvious symptoms, it can be difficult to spot young people at high risk for developing these illnesses. Since the method of diagnosing these youth has varied over time, depression may occasionally be misdiagnosed. Some people are classified as at risk because their psychiatric symptoms do not fit the standard adult diagnostic criteria or because they do not exhibit outward indicators of fear or anxiety that others can notice (such as youngsters with traumatic pasts) ( Magellan Health, 2013). Some are regarded as in danger because they are abused or have a genetic tendency. Nevertheless, some young people are in danger because they combine a number of these variables, making them more susceptible to mental health issues.
Options for depression medication treatment, including risks vs. rewards and adverse effects in teenagers
There are three main categories of depression pharmaceutical treatments that can be used either alone or in conjunction with talk therapy (Howland, 2008a). They include atypical antipsychotic medications, tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs) (AADs). Since the 1960s, tricyclic antidepressants have been recommended for treating depression. When treating moderate to severe depression, they can be taken either alone or in conjunction with psychotherapy. Norepinephrine and serotonin are increased in synapses by the action of the TCAs, which prevents their reuptake. TCAs may also have an impact on the limbic system, a region of the brain that governs emotions and mood.
Drugs known as selective serotonin reuptake inhibitors (SSRIs) were first developed to treat obsessive-compulsive disorder (Howland, 2008b). In controlled trials, they have also been given for depression over the past 20 years. They function by boosting serotonin’s actions in the brain and raising its synaptic release. They also affect serotonin receptors in the hypothalamus, pituitary, enteric neurons, and limbic system, among other areas of the brain. While treating depression, SSRIs are typically more successful than TCAs, and common adverse effects of SSRIs include sleepiness, sensitivity to light, and nausea.
The way atypical antipsychotic medications (AADs) function is by lowering serotonin levels in the brain. This is accomplished by preventing its uptake into brain receptor sites, and it has been used to treat a variety of illnesses, including schizophrenia, Alzheimer’s disease, and depression (Howland, 2008b). Increased risk of type 2 diabetes, heart disease, and weight gain are some of the unfavorable outcomes of using AAD. This might be connected to how they interact with particular genes that can affect metabolism. In order to alleviate the symptoms of depression, mood-elevating medications like trazodone are also employed. However, due to the possibility of dependency developing after repeated use, they are not commonly prescribed.
FDA clearances for adolescents, a particularly vulnerable population
Tricyclic antidepressants were the first group of antidepressants to receive FDA approval. According to research conducted by the US Food and Drug Administration, patients with depression responded better to antidepressants that contained three different active ingredients: an MAO (monoamine oxidase) inhibitor, a tricyclic antidepressant, and a tetracyclic antidepressant, which blocks the release of norepinephrine and epinephrine, respectively (n.d.).
The SSRI/SNRI category of antidepressants was the second generation. Tricyclic Antidepressants, or TCAs, are another name for SSRI/SNRI antidepressants. According to the US Food & Drug Administration, the initial generation of SSRIs was prescribed for mild to moderate depression (n.d.). They have been reported to be more successful at treating depression and have fewer negative effects than tricyclic antidepressants. They include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and escitalopram, which are all SSRIs (Lexapro).
The newest family of antidepressants, known as SNRIs or serotonin and norepinephrine reuptake inhibitors, is the third generation of antidepressants (Baek et al., 2016). They include the antidepressants milnacipran (Savella), venlafaxine (Effexor), duloxetine (Cymbalta), and levomilnacipran (Fetzima or Buspar). This class of antidepressants has a very low risk of producing mania and is useful for treating the irritability, agitation, and anger linked to bipolar disorder.
pharmaceutical considerations for prescription medicine instances
Amitriptyline, Bupropion, and citalopram are a few of the drugs that may be recommended to teenagers with depressive disorders. Amitriptyline, a tricyclic antidepressant (TCA), is one of them (Fava & Papakostas, 2016). Anxiety and nerve pain may be effectively treated with this medication. Atypical antidepressants, like Bupropion, are used to assist in controlling weight and are only available by prescription. They have an appetite-suppressing effect, causing weight loss without reducing caloric intake by lowering active sensations about food.
Considerations relating to the law, ethics, culture, and social determinants of health
The first thing to take into account is confidentiality in accordance with HIPAA standards while thinking about the legal and ethical ramifications of this topic. Before beginning therapy sessions, a parent or guardian must grant a written agreement if the treatment plan calls for sharing information with parents or guardians. Concerns about confidentiality must be discussed in treatment sessions. The presence of parents at the sessions must be agreed upon beforehand if they are to be there. The therapist ought to urge the parents to enquire about the patient’s condition and the proposed course of action.
As required by medical record legislation, confidentiality is the second factor. Medical records for specific minors may include details about other people, such as a child or parent’s diagnosis or treatment options. While weighing ethical consequences, parents’ rights are another crucial factor to take into account. Often, if their children are receiving medical care from a doctor, parents have access to their children’s medical information (Yasuda et al., 2008). Teenagers should keep in mind that their parents may not seek therapy for the same reasons as them if they suffer from depression as well. Parents should also be knowledgeable about the signs of depression and how to support their adolescent if they believe they or their child may be suffering from the illness.
Low socioeconomic level, restricted access to healthcare, and a lack of education in underdeveloped areas, according to Rosengren et al. (2019), are factors in this high frequency. Depending on the cultural setting in which it is experienced, depression can take many different forms and have various effects. The signs of depression may be perceived differently by cultures other than the one experiencing them, which can sometimes cause those suffering from it to enter mental health systems without receiving the treatment that would be most appropriate for them. For instance, in some parts of India, people with depressive disorders may choose to turn to ayurvedic treatments like yoga or meditation rather than receiving medication or psychotherapy, and they may not receive any further treatment.
What should be monitored in terms of test results and concomitant medical conditions, and why should they be?
Particularly with labs, more than one glance at the outcomes is necessary. It may be more difficult to monitor test results for a patient with depression who is an adolescent if you are a doctor than it is to check their cholesterol level (Lorberg et al., 2019). It is crucial to keep an eye on test results in addition to the severity of depressive symptoms because some teenagers may be suffering from deteriorating medical conditions that they are not even aware of. The depressive condition affects both adults and adolescents. Many individuals with depression often experience other health problems, many of which may go untreated.
One such instance is an adolescent with depression who also experiences the worsening of current medical conditions or the emergence of brand-new ones (Ehntholt et al., 2018). Some of these health issues may come and go, but if they are not appropriately managed, others may have a permanent impact on their lives and those around them. Because of this, it is crucial to keep an eye on lab results when treating depressed adolescent patients. Because they reflect a person’s general health, labs in a reference range that show normal readings should be checked frequently, whereas comorbidities call for monitoring the closer they are, too, requiring medical attention.
Where to go next in your neighborhood to find out more about adolescent depression?
The National Alliance on Mental Illness is a group that works to guarantee that all Americans who have mental disorders have access to care and to inform the public about what they can do to support persons who have mental illnesses (World Health Organization, 2019). For individuals who live close to the area where you might be experiencing problems receiving information, the National Suicide Prevention Hotline is a fantastic resource. They offer round-the-clock help for people who are experiencing emotional difficulties and may be prone to suicidal thoughts or impulses, as well as guidance on what to do if one is concerned that someone they know might be in danger of taking their own life.
Provide three examples of how to properly draft a prescription that you would give to a teen patient with depression or send to the pharmacist.
The diagnosis of the patient is a major depressive disorder. We can issue a prescription for either of the following things if we have the patient’s name, birthday, medical record number, and current drugs on hand:
- Sertraline 50 mg once daily by pill
- Fluoxetine 20 mg once daily as a tablet
- Escitalopram 10 mg twice a day in pill form
- Twice a day, take a 5-75 mg dose of venlafaxine.
- Two or three doses of 60 mg of duloxetine each day are OK.
The key finding is that both males and girls experience depressive illnesses in adolescence. Even when they believe they have control over their depression, a significant percentage of teenagers endure serious depressive episodes during their adolescence. A multidisciplinary strategy incorporating all the pertinent professionals, including parents and other career and health professionals with interest in this area, will be necessary to provide the assistance needed. Most essential, treatment should be customized to meet the needs of each patient.
Baek, J. H., Nierenberg, A. A., & Fava, M. (2016). Pharmacological approaches to treatment- resistant depression. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 44–47). Elsevier.
Watson, R., Harvey, K., McCabe, C., & Reynolds, S. (2020). Understanding anhedonia: A qualitative study exploring loss of interest and pleasure in adolescent depression. European Child & Adolescent Psychiatry, 29(4), 489-499.
Ehntholt, K. A., Trickey, D., Harris Hendriks, J., Chambers, H., Scott, M., & Yule, W. (2018). Mental health of unaccompanied asylum-seeking adolescents previously held in British detention centres. Clinical child psychology and psychiatry, 23(2), 238-257.
Fava, M., & Papakostas, G. I. (2016). Antidepressants. In T. A. Stern, M. Favo, T. E. Wilens, & J.Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 27–43). Elsevier.
World Health Organization. (2019). Mental health, disability and human rights: WHO QualityRights core training-for all services and all people: course guide.Rosengren, A., Smyth, A., Rangarajan, S., Ramasundarahettige, C., Bangdiwala, S. I., AlHabib, K. F., … & Yusuf, S. (2019). Socioeconomic status and risk of cardiovascular disease in 20 low- income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. The Lancet Global Health, 7(6), e748-e760.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Howland, R. H. (2008a). Sequenced Treatment Alternatives to Relieve Depression (STAR*D).
Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21-24. https://doi.org/10.3928/02793695-20080901-06
Howland, R. H. (2008b). Sequenced Treatment Alternatives to Relieve Depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(10), 21-24. https://doi.org/10.3928/02793695-20081001-05
Lorberg, B., Davico, C., Martsenkovskyi, D., & Vitiello, B. (2019). Principles in using psychotropic medication in children and adolescents. In J. M. Rey & A. Martin (Eds.), IACAPAP e-textbook of child and adolescent mental health. https://iacapap.org/_Resources/Persistent/a97650fb538f47bb697c47873b0e58d493684a0
Magellan Health. (2013). Appropriate use of psychotropic drugs in children and adolescents: A clinical monograph. http://www.magellanhealth.com/media/445492/magellan- psychotropicdrugs-0203141.pdf
Poznanski, E. O., & Mokros, H. B. (1996). Child depression rating scale-Revised. Western Psychological Services.
Rao, U. (2013). Biomarkers in pediatric depression. Depression & Anxiety, 30(9), 787-791. https://doi.org/10.1002/da.22171
Yasuda, S. U., Zhang, L. & Huang, S. M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417-423.
U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm
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For this assignment, you will develop a patient medication guide for treatment of depressive disorders in a vulnerable population (your choice for one vulnerable patient population to choose from: children, adolescents, older adults, dementia patients, pregnant women or one not listed of your choice!). Be sure to use language appropriate for your audience (patient, caregiver, parent, etc.). You will include non-copyright images and/or information tables to make your patient medication guide interesting and appealing. Limit your patient medication guide to 5 pages. You will create this guide as an assignment; therefore, a title page, introduction, conclusion, and reference page are required. You must include a minimum of 3 scholarly supporting resources outside of your course provided resources.
In your patient guide, include discussion on the following:
- Depressive disorder causes and symptoms
- How depression is diagnosed for the vulnerable population of your choice, why is this population considered vulnerable
- Medication treatment options including risk vs benefits; side effects; FDA approvals for the vulnerable population of your choice
- Medication considerations of medication examples prescribed (see last bullet item)
- What is important to monitor in terms of labs, comorbid medical issues with why important for monitoring
- Special Considerations (you must be specific, not general and address at least one for EACH category; you must demonstrate critical thinking beyond basics of HIPPA and informed consent!): legal considerations, ethical considerations, cultural considerations, social determinants of health
- Where to follow up in your local community for further information
- Provide 3 examples of how to write a proper prescription that you would provide to the patient or transmit to the pharmacy.
Min 5 pages
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