Nursing Question
Case study : 8-year-old Asian female with a diagnosis of severe depressive disorder presents to the office with a report of worsening symptoms. She has never taken psychotropic medication before.
 
Classification of Medication: Selective Serotonin Reuptake Inhibitors (SSRIs)
 
Rationale for Choice: SSRIs are often considered the first-line treatment for pediatric depressive disorders due to their favorable safety profile and efficacy in children. They work by increasing the levels of serotonin, a neurotransmitter associated with mood regulation, in the brain.
 
Chosen Medication: Fluoxetine (Prozac)
 
Recommended Starting Dose and Frequency:
 
• Fluoxetine (Prozac): 5 mg once daily in the morning, with the possibility of increasing to 10 mg after 1-2 weeks based on response and tolerability.
 
How the Medication Works: SSRIs like Fluoxetine help alleviate symptoms of depression by blocking the reabsorption (reuptake) of serotonin in the brain, thereby increasing serotonin levels.
 
 This helps regulate mood and alleviate depressive symptoms.
 
Duration of Treatment: The patient should continue taking Fluoxetine as prescribed by the healthcare provider. Improvement in symptoms may take several weeks, and it is important to continue treatment even if feeling better.
 
Common Side Effects:
 
1. Nausea
 
2. Headache
 
3. Insomnia
 
4. Decreased appetite
 
5. Weight changes
 
Urgent/Emergent Considerations: In rare cases, SSRIs can increase the risk of suicidal thoughts or behaviors, especially in children and adolescents. Any sudden changes in mood or behavior should be reported immediately to the prescribing healthcare provider.
 
Directions for Taking the Medication:
 
• Take Fluoxetine orally, with or without food, as directed by your healthcare provider.
 
• Swallow the capsule whole with a glass of water. Do not crush or chew it.
 
 What to Do If a Dose Is Missed:
 
• If a dose is missed, take it as soon as remembered. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to catch up.
 
Medications/Supplements to Avoid:
 
• Avoid taking MAOIs (monoamine oxidase inhibitors), herbal supplements (St. John’s Wort), and over-the-counter medications like cold or allergy medicines without consulting your healthcare provider.
 
Foods to Avoid:
 
 • There are no specific foods to avoid with Fluoxetine. However, maintaining a healthy diet can support overall well-being. Follow-Up Visit Date:
 
• Please return for a follow-up visit approximately 2 weeks from the start of treatment. This visit will allow to assess your response to the medication, monitor for any side effects, and make any necessary adjustments to your treatment plan.
 
Legal and Ethical Considerations:
 
• Prescribing medications to pediatric patients involves careful consideration of legal and ethical guidelines, ensuring that the benefits of treatment outweigh potential risks. Informed consent from the caregiver is essential, and confidentiality and privacy of patient information must be upheld.
 
Social Determinants of Health Considerations:
 
• Financial Hardship: If cost is a concern, discuss options such as patient assistance programs or generic alternatives to make treatment more affordable.
 
• Transportation Barrier: Offer resources for transportation assistance, such as public transit options or community services that provide transportation to medical appointments.
 
Why Social Determinants of Health Matter:
 
• Financial hardship and lack of transportation can significantly impact a patient’s ability to access and adhere to treatment, ultimately affecting health outcomes. Addressing these factors is crucial for ensuring equitable healthcare delivery and improving patient outcomes.