Photo Credit: Getty Images/iStockphoto Week 4: Therapy for Patients With Major Depressive Disorder (MDD) Mood disorders can impact every facet of a human being’s life, making the most basic activities difficult for patients and their families. This was the case for 13-year-old Jeanette, who was struggling at home and at school. For more than 8 years, Jeanette suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a PNP working with pediatric patients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies. This week, as you examine antidepressant therapies, you explore the assessment and treatment of three populations: pediatrics, adults, and geriatrics. The focus of your assessment tool, a decision tree, will specifically center on one of the most vulnerable populations, pediatrics. Please remember, you must also consider the ethical and legal implications of these therapies. You will also complete a Quiz on the concepts addressed throughout this module. Learning Objectives Students will: • Assess patient factors and history to develop personalized plans of antidepressant therapy across the lifespan • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric, adult, and geriatric patients requiring antidepressant therapy • Synthesize knowledge of providing care to pediatric, adult, and geriatric patients presenting for antidepressant therapy • Analyze ethical and legal implications related to prescribing antidepressant therapy to patients across the lifespan Assignment: Assessing and Treating Pediatric Patients With Mood Disorders When pediatric patients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult patients with the same disorders, they also metabolize medications much differently. Yet, there may be times when the same psychopharmacologic treatments may be used in both pediatric and adult cases with major depressive disorders. As a result, psychiatric nurse practitioners must exercise caution when prescribing psychotropic medications to these patients. For this Assignment, as you examine the patient case study in this week’s Learning Resources, consider how you might assess and treat pediatric patients presenting with mood disorders. To prepare for this Assignment: • Review this week’s Learning Resources, including the Medication Resources indicated for this week. • Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of pediatric patients requiring antidepressant therapy. The Assignment: 5 pages Examine Case Study: An African American Child Suffering From Depression. You will be asked ...

1. Photo Credit: Getty Images/iStockphoto
Week 4: Therapy for Patients With Major
Depressive Disorder (MDD)
Mood disorders can impact every facet of a human being’s life,
making the most basic activities
difficult for patients and their families. This was the case for
13-year-old Jeanette, who was
struggling at home and at school. For more than 8 years,
Jeanette suffered from temper
tantrums, impulsiveness, inappropriate behavior, difficulty in
judgment, and sleep issues.
As a PNP working with pediatric patients, you must be able to
assess whether these symptoms
are caused by psychological, social, or underlying growth and
development issues. You must
then be able recommend appropriate therapies.
This week, as you examine antidepressant therapies, you
explore the assessment and treatment of
three populations: pediatrics, adults, and geriatrics. The focus
of your assessment tool, a decision
tree, will specifically center on one of the most vulnerabl e
populations, pediatrics. Please
remember, you must also consider the ethical and legal
implications of these therapies. You will
also complete a Quiz on the concepts addressed throughout this
module.
Learning Objectives

2. Students will:
• Assess patient factors and history to develop personalized
plans of antidepressant therapy
across the lifespan
• Analyze factors that influence pharmacokinetic and
pharmacodynamic processes in
pediatric, adult, and geriatric patients requiring antidepressant
therapy
• Synthesize knowledge of providing care to pediatric, adult,
and geriatric patients
presenting for antidepressant therapy
• Analyze ethical and legal implications related to prescribing
antidepressant therapy to
patients across the lifespan
Assignment: Assessing and Treating Pediatric
Patients With Mood Disorders
When pediatric patients present with mood disorders, the
process of assessing, diagnosing, and
treating them can be quite complex. Children not only present
with different signs and symptoms
than adult patients with the same disorders, they also
metabolize medications much differently.
Yet, there may be times when the same psychopharmacologic
treatments may be used in both
pediatric and adult cases with major depressive disorders. As a
result, psychiatric nurse
practitioners must exercise caution when prescribing
psychotropic medications to these patients.

3. For this Assignment, as you examine the patient case study in
this week’s Learning Resources,
consider how you might assess and treat pediatric patients
presenting with mood disorders.
To prepare for this Assignment:
• Review this week’s Learning Resources, including the
Medication Resources indicated
for this week.
• Reflect on the psychopharmacologic treatments you might
recommend for the assessment
and treatment of pediatric patients requiring antidepressant
therapy.
The Assignment: 5 pages
Examine Case Study: An African American Child Suffering
From Depression. You will be asked
to make three decisions concerning the medication to prescribe
to this patient. Be sure to
consider factors that might impact the patient’s pharmacokinetic
and pharmacodynamic
processes.
At each decision point, you should evaluate all options before
selecting your decision and
moving throughout the exercise. Before you make your
decision, make sure that you have
researched each option and that you evaluate the decision that
you will select. Be sure to research
each option using the primary literature.
Introduction to the case (1 page)

4. • 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 #2 (1 page)
• Why did you select this decision? Be specific and support your
response with clinically

5. 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 #3 (1 page)
• 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

6. 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.
Conclusion (1 page)
Summarize your recommendations on the treatment options you
selected for this patient. Be sure
to justify your recommendations and support your response with
clinically relevant and patient-
specific resources, including the primary literature.
Note: Support your rationale with a minimum of five academic
resources. While you may use the
course text to support your rationale, it will not count towar d
the resource requirement. You
should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers
submitted include a title page,
introduction, summary, and references. The Sample Paper
provided at the Walden Writing
Center provides an example of those required elements
(available at
https://academicguides.waldenu.edu/writingcenter/templates/gen
eral#s-lg-box-20293632).All
papers submitted must use this formatting.
// Pediatric depression

7. Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives
at the ER with his mother. He is
exhibiting signs of depression.
• Client complained of feeling “sad”
• Mother reports that teacher said child is withdrawn from
peers in class
• Mother notes decreased appetite and occasional periods of
irritation
• Client reached all developmental landmarks at appropriate
ages
• Physical exam unremarkable
• Laboratory studies WNL
• Child referred to psychiatry for evaluation
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed,
spontaneous. Self-reported mood is
“sad”. Affect somewhat blunted, but child smiled appropriately
at various points throughout
the clinical interview. He denies visual or auditory
hallucinations. No delusional or paranoid
thought processes noted. Judgment and insight appear to be age-
appropriate. He is not
Photo Credit: Getty Images/iStockphoto

8. Week 4: Therapy for Patients With Major Depressive Disorder
(MDD)
Mood disorders can impact every facet of a human being’s life,
making the most basic activities difficult for patients and their
families. This was the case for 13-year-old Jeanette, who was
struggling at home and at school. For more than 8 years,
Jeanette suffered from temper tantrums, impulsiveness,
inappropriate behavior, difficulty in judgment, and sleep issues.
As a PNP working with pediatric patients, you must be able to
assess whether these symptoms are caused by psychological,
social, or underlying growth and development issues. You must
then be able recommend appropriate therapies.
This week, as you examine antidepressant therapies, you
explore the assessment and treatment of three populations:
pediatrics, adults, and geriatrics. The focus of your assessment
tool, a decision tree, will specifically center on one of the most
vulnerable populations, pediatrics. Please remember, you must
also consider the ethical and legal implications of these
therapies. You will also complete a Quiz on the concepts
addressed throughout this module.
Learning Objectives
Students will:
· Assess patient factors and history to develop personalized
plans of antidepressant therapy across the lifespan
· Analyze factors that influence pharmacokinetic and
pharmacodynamic processes in pediatric, adult, and geriatric
patients requiring antidepressant therapy
· Synthesize knowledge of providing care to pediatric, adult,
and geriatric patients presenting for antidepressant therapy
· Analyze ethical and legal implications related to prescribing
antidepressant therapy to patients across the lifespan
Assignment: Assessing and Treating Pediatric Patients With

9. Mood Disorders
When pediatric patients present with mood disorders, the
process of assessing, diagnosing, and treating them can be quite
complex. Children not only present with different signs and
symptoms than adult patients with the same disorders, they also
metabolize medications much differently. Yet, there may be
times when the same psychopharmacologic treatments may be
used in both pediatric and adult cases with major depressive
disorders. As a result, psychiatric nurse practitioners must
exercise caution when prescribing psychotropic medications to
these patients. For this Assignment, as you examine the patient
case study in this week’s Learning Resources, consider how you
might assess and treat pediatric patients presenting with mood
disorders.
To prepare for this Assignment:
· Review this week’s Learning Resources, including the
Medication Resources indicated for this week.
· Reflect on the psychopharmacologic treatments you might
recommend for the assessment and treatment of pediatric
patients requiring antidepressant therapy.
The Assignment: 5 pages
Examine Case Study: An African American Child Suffering
From Depression. You will be asked to make three decisions
concerning the medication to prescribe to this patient. Be sure
to consider factors that might impact the patient’s
pharmacokinetic and pharmacodynamic processes.
At each decision point, you should evaluate all options before
selecting your decision and moving throughout the exercise.
Before you make your decision, make sure that you have
researched each option and that you evaluate the decision that
you will select. Be sure to research each option using the
primary literature.
Introduction to the case (1 page)
· Briefly explain and summarize the case for this Assignment.

10. 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 #2 (1 page)
· 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 #3 (1 page)

11. · 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.
Conclusion (1 page)
Summarize your recommendations on the treatment options you
selected for this patient. Be sure to justify your
recommendations and support your response with clinically
relevant and patient-specific resources, including the primary
literature.
Note: Support your rationale with a minimum of five academic
resources. While you may use the course text to support your
rationale, it will not count toward the resource requirement.
You should be utilizing the primary and secondary literature.
Reminder : The College of Nursing requires that all papers
submitted include a title page, introduction, summary, and
references. The Sample Paper provided at the Walden Writing
Center provides an example of those required elements
(available at
https://academicguides.waldenu.edu/writingcenter/templates/gen
eral#s-lg-box-20293632).All papers submitted must use this
formatting.

12. // Pediatric depression
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives
at the ER with his mother. He is
exhibiting signs of depression.
• Client complained of feeling “sad”
• Mother reports that teacher said child is withdrawn from
peers in class
• Mother notes decreased appetite and occasional periods of
irritation
• Client reached all developmental landmarks at appropriate
ages
• Physical exam unremarkable
• Laboratory studies WNL
• Child referred to psychiatry for evaluation
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed,
spontaneous. Self-reported mood is
“sad”. Affect somewhat blunted, but child smiled appropriately
at various points throughout
the clinical interview. He denies visual or auditory
hallucinations. No delusional or paranoid

13. thought processes noted. Judgment and insight appear to be age-
appropriate. He is not
// Pediatric depression
Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives
at the ER with his mother. He is
exhibiting signs of depression.
• Client complained of feeling “sad”
• Mother reports that teacher said child is withdrawn from
peers in class
• Mother notes decreased appetite and occasional periods of
irritation
• Client reached all developmental landmarks at appropriate
ages
• Physical exam unremarkable
• Laboratory studies WNL
• Child referred to psychiatry for evaluation
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed,
spontaneous. Self-reported mood is
“sad”. Affect somewhat blunted, but child smiled appropriately
at various points throughout
the clinical interview. He denies visual or auditory
hallucinations. No delusional or paranoid
thought processes noted. Judgment and insight appear to be age-
appropriate. He is not
// Pediatric depression

14. Therapy for Pediatric Clients with Mood Disorders
An African American Child Suffering From Depression
BACKGROUND INFORMATION
The client is an 8-year-old African American male who arrives
at the ER with his mother. He is exhibiting signs of depression.
· Client complained of feeling “sad”
· Mother reports that teacher said child is withdrawn from
peers in class
· Mother notes decreased appetite and occasional periods of
irritation
· Client reached all developmental landmarks at appropriate
ages
· Physical exam unremarkable
· Laboratory studies WNL
· Child referred to psychiatry for evaluation
MENTAL STATUS EXAM
Alert & oriented X 3, speech clear, coherent, goal directed,
spontaneous. Self-reported mood is “sad”. Affect somewhat
blunted, but child smiled appropriately at various points
throughout the clinical interview. He denies visual or auditory
hallucinations. No delusional or paranoid thought processes
noted. Judgment and insight appear to be age-appropriate. He is
not endorsing active suicidal ideation, but does admit that he
often thinks about himself being dead and what it would be like
to be dead.
You administer the Children's Depression Rating Scale,
obtaining a score of 30 (indicating significant depression)
RESOURCES
§ Poznanski, E., & Mokros, H. (1996). Child Depression Rating
Scale--Revised. Los Angeles, CA: Western Psychological
Services.

15. Decision Point One
Select what you should do:
Begin Zoloft 25 mg orally daily
Begin Paxil 10 mg orally daily
Begin Wellbutrin 75 mg orally BID