GUIDELINES FOR ADOLESCENT DEPRESSION TREATMENT 2

Guidelines for Adolescent Depression Treatment

Type of agency
Pediatric primary care agency
My role in the agency
Nurse practitioner
Client’s name and demographics
The client’s name is Kevin Carter, a sixteen-year old white high school student.
Client’s problem
Kevin Carter suffers from depression. The depression is manifested by symptoms such as
suicidal ideation, excessive sleep, extremely low energy, melancholy, low self-esteem, and
irritability.
Intervention goals
The intervention methods used have both long term and short term goals. In the long term, the
goal is to significantly reduce the client’s symptoms of depression so that they do not again
interfere with his normal functioning.
In the short term there are multiple goals that the intervention measures seek to achieve.
The first one is that Kevin Carter and his family develop a plan that will ensure that he does not
harm himself. This plan will be formulated on the first day of treatment. Secondly, in addition to
the extracurricular activities that Kevin Carter is currently involved in, he will be required to
participate in an another extracurricular activity, preferably a sporting a activity. This
involvement should start immediately and continue for at least the next five months. The third
short term goal is that Kevin reports no suicidal thoughts for the next three consecutive weeks.
Fourth, Kevin Carter will learn important skills for coping with his condition. These skills

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include emotional regulation skills as well as problem solving skills. His mastery of these skills
will be measured by his homework assignments. He will also demonstrate these skills during
regular therapy sessions that we will be having with him after every two weeks. The mastery and
use of these skills should be done for four months after the start of the treatment. Lastly, Kevin
Carter will learn how to identify negative thoughts that may come to his mind and negatively
influence his actions. He will learn how to replace such thoughts with more positive ones. He
will practice these skills for two consecutive weeks. Evaluation of his practice will be done
through his demonstration of the skills during practice sessions as well as a checks of his
homework assignments. Kevin Carter should have mastered the skills within two weeks of
treatment and regularly use them for the next four months after start of the treatment.
Needs
While the client has no other medical needs apart from depression, we may need to coordinate
our intervention measures and activities with a child and adolescent mental health specialist. The
mental health specialist will evaluate our intervention measures and make suggestions, if any, on
what better can be done to bring about faster and more effective change in Kevin Carter’s
condition. If the intervention measures that we have adopted do not work, we may need to refer
Kevin Carter to a mental health agency for further examination of Kevin’s condition, and
reassessment of his diagnosis and treatment.
Crisis
The client is not in a crisis situation as his depression is relatively mild.
Recommendations
The management of Kevin Carter’s condition, including the treatment methods employed is
based on the following recommendations.

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Organize clinical settings that reflect integrative care model’s best practices
In the past treatment of depression used the traditional method which involved healthcare
providers working autonomously to treat patients. That method has been found to be ineffective
in treatment of depression (Baum et al., 2018). It has been replaced with integrative care
approach which involves teams of healthcare providers working together to deliver evidence-
based interventions. In the case of depression these teams include primary care providers,
psychiatrists, and behavior therapists (Baum et al., 2018). Studies have found that such a
multidisciplinary approach to depression treatment and management that is patient-centred is far
more effective than the previous approaches where one provider managed and treated the
condition alone (Baum et al., 2018). In this integrated approach, the patient is not just subjected
to clinical care management alone but also home care and behavioral healthcare (Baum et al.,
2018).
Evidence-based treatment should start some time after initial diagnosis
Once a diagnosis has been made, treatment should not start immediately unless the
patient is suffering from severe depression. For mild depression, there should be a six week
period of active support as well as monitoring of the patient’s condition and symptoms before
treatment, if needed, begins (Boyd et al., 2018). Studies have found that many patients suffering
from mild depression can positively respond to supportive therapy that is non-directional and
which is combined with regular monitoring of the patient’s symptoms (Cheung et al., 2018). This
approach is especially useful when parents of the patient are not ready and willing to accept
standard depression treatments (Cheung et al., 2018).
A mental health specialist should be consulted if the patient, in addition to depression, is
an abuser of substances which complicate their condition (Cheung et al., 2018). If the depression

GUIDELINES FOR ADOLESCENT DEPRESSION TREATMENT 5
is mild, the consultation can be made in the primary care setting. However, if it is severe then the
patient should be referred to the mental health specialist (Cheung et al., 2018). When making this
decision it is important to consider barriers to access to such care such as cost. In general,
referral to the mental health specialist should only be done when the depression is very severe
(Cheung et al., 2018).
Co-management of treatment should be made in case of referrals
Once a referral has been made, there is need to have a plan for co-management of the
patient. This plan should provide each of the professionals involved in the care of the patient
with responsibilities and roles (Cheung et al., 2018). For instance, there should be clarity on the
professional tasked with roles such as case coordination and making follow-ups. Management of
the patient’s condition should also involve the patient himself as well as his family (Cheung et
al., 2018). When assigning roles for the patient’s management, the patient and the family should
also be provided with responsibilities because they are team members in the management of the
condition (Cheung et al., 2018).
Treatments recommended should be scientifically tested and proven
After diagnosis of depression, the patient and their family should be provided with
appropriate education and other support measures to help in the management of the condition
(Boyd et al., 2018). Thereafter, they should be provided with multiple treatment options that can
not only allow the patient to improve their functions but also resolve their symptoms. The
treatment options recommended should be proven scientifically to be effective and without
serious side effects (Cheung et al., 2018).
There are generally two main treatments methods of depression. These are psychotherapy
and use of antidepressants (Cheung et al., 2018). Psychotherapy includes treatment methods such

GUIDELINES FOR ADOLESCENT DEPRESSION TREATMENT 6
as cognitive behavior therapy (CBT). It has been found to be relatively effective in depression
treatment either on its own or in conjunction with other treatment methods (Boyd et al., 2018).
Apart from psychotherapy, antidepressants can also be used for depression treatment. The
most effective antidepressants have been found to be selective serotonin reuptake inhibitor
(SSRIs) (Cheung et al., 2018). It is recommended that they mostly be used when the depression
is severe (Cheung et al., 2018). Due to possibility of adverse effects such as transition to mania,
and increased risk of suicide and self-harm, antidepressants should first be administered in small
doses (Cheung et al., 2018). The level of the patient’s toleration to the dosages should then be
monitored. If there are no adverse effects on the patient, higher dosage levels can then be
administered. While both psychotherapy and antidepressants can be effective on their own,
studies have found that the most positive results are found when the two interventions are
combined (Baum et al., 2018).
For antidepressant treatment, patient should be monitored for emergence of adverse events
A patient may not react well to antidepressant drugs. Instead of reducing symptoms some
antidepressant drugs may make the condition worse (Cheung et al., 2018). These adverse effects
include behavioral activation such as suicide attempts, headaches, and nausea (Cheung et al.,
2018). There is, therefore, need for healthcare providers to routinely monitor the condition of the
patient after giving them antidepressant drugs. This monitoring can be done through face-to-face
interviews. Alternatively, it can be done using telephone interviews. Either of the methods had
been found to be effective in providing the required information (Cheung et al., 2018). During
monitoring, it is important that the input of not just the patient but also their families is
considered. Some of the aspects of the patient to be monitored include their functioning both at

GUIDELINES FOR ADOLESCENT DEPRESSION TREATMENT 7
home and in school settings, risky behaviors, and severity of their depressive symptoms (Cheung
et al., 2018).
Tracking of goals and treatment outcomes
Whether the patient is being treated using psychotherapy, antidepressants or both, it is
important that the outcomes from the treatment as well as goals be tracked and preformed in a
systematic way. This tracking includes assessing functioning of the patient in various important
domains (Cheung et al., 2018). These domains include peer setting, school, and home setting. It
also includes an assessment of the patient’s depressive symptoms. Some of the symptoms to be
assessed include adverse effects resulting from use of antidepressant drugs, risk of suicide, and
nausea (Cheung et al., 2018). The assessment will also look at whether the patient is adhering to
their treatment as well as an examination of any new environmental stressor that may worsen
their condition. An evaluation of these treatment outcomes will help the healthcare providers
managing the condition of the patient to determine whether their interventions are meeting their
goals or not (Cheung et al., 2018). In general, the goal of any treatment intervention is to reduce
the symptoms of the depression and to improve the functioning of the patient. When treatment
outcomes are not positive then the intervention measures need to be reconsidered. However, it is
important to note that the functioning of the patient may not necessarily improve at the pace of
the treatment (Boyd et al., 2018). It may take some time before the patient starts showing signs
of improvement in functioning. Due to this fact, just because a treatment intervention is not
producing quick results does not mean that it should be discontinued.
Reassessment of initial treatment
Within 6-8 weeks, the treatment intervention measures employed should lead to an
improvement in the condition of the patient (Cheung et al., 2018). If this is not the case, there

GUIDELINES FOR ADOLESCENT DEPRESSION TREATMENT 8
should be a reassessment of not just the treatment but also of the diagnosis of the patient. It could
be that the patient has a different condition from the one that they are being treated for. It could
also be that the treatment interventions employed are not effective. Whatever the case, a
reassessment of the diagnosis as well as treatment will lead to adoption of more effective
measures to bring the patient to health. At this stage, it is advisable that the patient be referred to
a mental health specialist (Cheung et al., 2018).

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References

Baum, R. A., Manda, D., Brown, C. M., Anzeljc, S. A., King, M. A., & Duby, J. (2018). A
Learning Collaborative Approach to Improve Mental Health Service Delivery in Pediatric
Primary Care. Pediatric Quality & Safety, 3(6), e119.
Boyd, R. C., Lewis, J., Borreggine, K., & Benton, T. D. (2018). Adolescent Depression:
Identification and Treatment. Current Treatment Options in Pediatrics, 4(3), 350-362.
Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Laraque, D., Stein, R. E., & GLAD-PC
STEERING GROUP. (2018). Guidelines for adolescent depression in primary care
(GLAD-PC): Part II. Treatment and ongoing management. Pediatrics, 141(3),
e20174082.