Depression is a persistent problem in children and adolescents with recurrent episodes lasting for up to a year. The clinical presentation of Major Depressive Disorder (MDD) includes depressed mood for more than 2 weeks, loss of interest, and, depending on severity, suicidal ideation or attempt (Birmaher & Brent, 2007). Bryant has a history of psychiatric hospitalization, recently lost his father to a heroin overdose, and talks about killing himself.
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From his verbalized suicidal plans, his depression could be described as moderate to severe; therefore, an optimal intervention would be psychotherapy in combination with antidepressant medications. I would use cognitive-behavioral therapy (CBT) to achieve an initial response and prevent recurrent episodes. I would also consider interpersonal psychotherapy (IPT) for this client to resolve life events (death of a father) that accounts for the depressed mood. The program would involve an initial evaluation of current problems. The information for the assessment will be obtained from Bryant, his family, and school.
From the case, the onset of MDD in this patient could be linked to a stressor (death of a significant figure). Suicidal behavior – the main feature of MDD in children – may range from ideation to actual plans to kill oneself (Birmaher & Brent, 2007). For Bryant, the assessed severity of suicidality is high, and thus, CBT or IPT is required to give immediate response and symptom remission. It will entail an initial psycho-educational component, client engagement in identifying critical problems from the adolescent’s perspective, developing treatment goals, and teaching coping tactics for relapse prevention.
The program will start with basic behavioral techniques, namely, activity scheduling, evaluation of Bryant’s responses, thought patterns, and mood, and activation of target behaviors. According to Cuijpers et al. (2014), after 4-5 sessions and with a significant symptom remission, cognitive methods can be utilized to detect maladaptive or distorted thoughts that require restructuring. The aim is to counter negative moods by engaging the child or adolescent in self-monitoring of individual thoughts, emotions, and behavior. However, a child’s developmental aspects, such as metacognition, awareness of emotional states, and self-regulation, differ from those of adults.
Therefore, supportive management to promote participation in therapy and family and school involvement will be used as adjuncts to psychotherapy. School personnel and parents can help monitor the child’s progress and provide appropriate accommodations that would facilitate recovery (Birmaher & Brent, 2007). I believe that outpatient follow-up would be necessary to avoid remission and consolidate the response.
If the client fails to respond to CBT or IPT, antidepressant therapy would be indicated for MDD. There is scientific evidence supporting the efficacy of pharmacological agents such as selective serotonin reuptake inhibitors (alone or in combination with CBT) in treating depression in children and adolescents (Perese, 2012). These drugs are associated with short-time side effects like sleep changes, which, however, subside over time. Due to safety considerations, I would use low doses of these drugs to treat depressive symptoms.
Birmaher, B., & Brent, D. (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46(11), 1503-1526. Web.
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: A meta-analysis. World Psychiatry, 13(1), 56-67. Web.
DeMaso, D. R., Martini, R. M., & Cahen, L. A. (2009). Practice parameter for the psychiatric assessment and management of physically ill children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 48(2), 213-233. Web.
Perese, E. F. (2012). Psychiatric advanced practice nursing. Philadelphia, PA: F. A. Davis Company.