For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.

Assignment 1: Prescription for Children and Adolescents | NRNP 6665 PMHNP CARE ACROSS LIFESPAN 1 | Walden University

The following is a brief introduction to the topic:

Major Depressive Disorder is an extremely common mental disorder that can affect children and teenagers, leading to significant emotional distress and functional impairment. Treatment of MDD is complex in children and adolescents. Various pharmacological or nonpharmacological treatments are available. However, some interventions may be used outside of the label, with a lack of evidence for their safety or efficacy. It is important for a PMHNP to understand the treatments available for MDD among children and adolescents, as well as the associated risks and benefits. The purpose of this paper is to examine FDA-approved and non-FDA approved pharmacological treatment options for MDD among children and adolescents.

FDA-Approved Pharmacological Therapies

The FDA has approved only two classes of antidepressants for use in children and adolescents with MDD: selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). SSRIs are approved to treat children and teens with MDD. These include fluoxetine, sertraline and escitalopram. Duloxetine, also known as Cymbalta, is the SNRI that has been approved to be used in this group. The drugs work by increasing levels of norepinephrine and serotonin in the brain. This reduces symptoms of depression.

Non-FDA approved pharmacological treatments

Off-label, a number of pharmacological therapies are used to treat MDD among children and teenagers. Tricyclic antidepressants, bupropion and mirtazapine are some of the most commonly used pharmacological treatments for MDD in children and adolescents. The use of these medications in this group is linked to significant risks including suicidal behavior and ideation, weight gain, and cardiovascular side effects.

Nonpharmacological Treatments

Children and adolescents with MDD can be treated non-pharmacologically using psychotherapy, CBT, interpersonal therapy and family therapy. For mild-to-moderate MDD, psychotherapy may be the first treatment. It can also be combined with medication for more severe MDD or those who are resistant to treatment. CBT concentrates on identifying negative thinking patterns and behavior that lead to depression and changing them. IPT is a form of psychotherapy that focuses on improving interpersonal and social functioning, as well as reducing stress and conflict. Families are often treated with family therapy to help address the dynamics of their families that can worsen or contribute to MDD symptoms in adolescents and children.

The conclusion of the article is:

Treatment of MDD is best done by evaluating the potential risks and benefits. Although FDA approved only a few drugs to be used in this group, the FDA allows for numerous off-label medications. These drugs, however, are associated with serious risks and the efficacy or safety of these medications is not fully established. Other nonpharmacological therapies, like psychotherapy and CBT are available. They can also be used with pharmacological intervention. PMHNPs must have an understanding of MDD treatments in adolescents and children. They should also consider the risks associated with each type of treatment.

Referrals

American Psychiatric Association. (2013). Diagnostic and statistical manual for mental disorders, 5th ed.).

Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Ghalib, K., Laraque, D., Stein, R. E. K., … Glance, J. (2015). Guidelines for Adolescent Depression in Primary Care (GLAD PC) Part II. Treatment and ongoing care. Pediatrics, 136(5), e1084-e1106.

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