AnAfrican American Child Suffering From Depression
AnAfrican American Child Suffering From Depression
Thecase study is about an 8-year-old African-American male who exhibitssigns of depression. The patient complained of feeling sad and themother reported that the child is withdrawn from his peers at school.The child has a poor appetite and occasional periods of irritation.However, it is clear that the patient reached all developmentalmilestones and the physical exam did not reveal any diagnosis. Thechild was referred to psychiatry and was seen by a psychiatric mentalhealth practitioner (PMHNP). The client scored 30 on the children’sdepression rating scale, which indicated significant depression. ThePMHNP made three treatment decisions it is the intention of thispaper to scrutinize the treatment options considering thepharmacokinetic and pharmacodynamics processes.
Thefirst decision chosen was beginning Zoloft 25mg taken orally daily.Zoloft is the brand name for sertraline, which is used asantidepressant medication. Their mechanism of action typicallydescribes them as selective serotonin reuptake inhibitors (SSRIs)with the binding ability towards the serotonin transporter (Finley etal., 2016, p. 208). The treatment works by restoring the balance ofserotonin, which is a natural substance in the brain. The treatmentundergoes an extensive first-pass metabolism, its principal initialpathway of metabolism being N-demethylation. It has a plasmatermination half-life of 62-104 hours (Andre et al., 2016, p.533).The medication was administered at lower doses due to the body weightof the client to avoid excessive plasma levels. After using themedication for a while, it improved the patient’s moods, appetite,and decreased suicidal urges. The high appetite resulted in asignificant weight gain. The expected result was an improvement inmoods since the client registered feelings of sadness. However, thepatient recorded some mood swings while on the medication. Constantchange in moods is a known side effect of Zoloft. Zoloft is notrecommended for children under the age of 18 therefore,consultations were done with the parents, and they were informedabout the risks and the expected benefits of using it. They gave theconsent for treatment despite the low intake of antidepressantmedications among the African-Americans.
Thesecond treatment option was an oral intake of Paxil at 10mg daily. Paxil (paroxetine) is drug recommended for patients with depressionand belongs to a group of drugs called selective serotonin reuptakeinhibitors (SSRIs). The option was selected due to its metabolictolerance and poor toxicity. It is well absorbed from thegastrointestinal tract and undergoes a partly saturated first passmetabolism that decreases the bioavailability at therapeutic dosesclose to 30-60 percent (Jann et al., 2016). Like other SSRIs, 95percent of the medicine binds to the protein, transforms in the liverto inactive metabolites and later secreted. However, its highaffinity to cytochrome p450 isoenzyme CYP2D6 indicates that it is notadvisable to use it with other drugs metabolized by the same enzyme(Willens & Hammerness, 2016). Compared to other antidepressants,Paxil is advantageous due to its high selectivity and poor toxicity.The expected results for the anti-depressant was a change in theclient’s moods with minimal damages to other body organsconsidering that toxin absorption in children is higher due to thesmall surface area of their bodies. The treatment option improved theclient’s moods but did not reduce suicidal thoughtsantidepressants are known to have that effect on patients.
Thethird decision made was to begin an oral administration of Wellbutrinat 75mg daily. The medication has a stimulant effect and is FDAapproved for treating depression. The drug has a chemical structureunlike any other anti-depressant it does not target serotonin butacts on dopamine and norepinephrine, which are brain chemicals(Finley et al., 2016, p. 220). It enhances noradrenergic anddopaminergic neurotransmissions through reuptake inhibition of thedopamine and norepinephrine transporter. Testing of Wellbutrin onchildren is limited however, some studies indicate that 5-6 peopleout of every ten are treated (Andre et al., 2015, p. 536). Theadolescents and children who take Wellbutrin notice an improvement inmoods and more energy after 2-3 months. From research onantidepressants, it is evident that they are almost as effective attreating depression as placebos. The reason this medication waschosen was to increase research on its effectiveness on children.However, the parents were informed that it was rarely used inadolescents and children. The expected result was a change in moods,but it took a long time to achieve. The drug was less effective onthe client than other anti-depressants were. The expected resultvaried with the actual result the client experienced major sideeffects from the medication such as lack of sleep, which ensured thathe was always fatigued.
Insummation, the case study focused on an 8-year old African-Americansuffering from depression. The client was referred to psychiatrysince his physical examinations did not produce significant results.The psychiatric mental health practitioner made three decisions onthe treatment options they included Zoloft taken orally at 25mgdaily, Paxil used orally at 10mg daily, and Wellbutrin applied orallyat 75mg orally. The paper scrutinized the treatment optionsconsidering the pharmacokinetic and pharmacodynamics processes. Zoloft undergoes an extensive first-pass metabolism, its principalinitial pathway of metabolism being N-demethylation. It has a plasmatermination half-life of 62-104 hours. The expected result was animprovement in moods since the client registered feelings of sadness.However, the client expressed some mood swings while on themedication. Paxil was selected due to its metabolic tolerance andpoor toxicity. It is well absorbed from the gastrointestinal tractand undergoes a partly saturated first pass metabolism that decreasesthe bioavailability at therapeutic doses close to 30-60 percent. Theexpected results for the anti-depressant was a change in the client’smoods but with minimal damages to other body organs considering thattoxin absorption in children is higher due to the small body.Wellbutrin has a chemical structure unlike any other anti-depressantit does not target serotonin but acts on dopamine and norepinephrine,which are brain chemicals. Testing of Wellbutrin on children islimited however, some studies indicate that 5-6 people out of everyten are treated. The reason this medication was chosen was toincrease research on its effectiveness on kids.
Andre,K., Kampman, O., Illi, A., Viikki, M., Setälä-Soikkeli, E.,Mononen, N., …&Leinonen, E. (2015). SERT and NET polymorphisms,temperament and antidepressant response.Nordicjournal of psychiatry,69(7),531-538.
Finley,P. R., Le, J., & Lee, K. C. (2016).Antidepressants.In AppliedClinical Pharmacokinetics and Pharmacodynamics ofPsychopharmacological Agents(pp. 205-245). Springer International Publishing.
Jann,M. W., Penzak, S. R., & Cohen, L. J. (Eds.).(2016). AppliedClinical Pharmacokinetics and Pharmacodynamics ofPsychopharmacological Agents.Springer.
Wilens,T. E., &Hammerness, P. G. (2016).Straighttalk about psychiatric medications for kids.GuilfordPublications.