Treatment plans.
This is good. We just had a group meeting. I only need 2 treatment plans. One is for CBT and the other one is a long-term goal of social integration therapy. Also the treatment should be more narrative and not with the numbers. I also need a short reflection (1 paragraph) on my 2 treatments to add to our overall group reflection. This is an example of what my classmate wrote for the medication section and I need my CBT and long-term goal of social integration therapy to look similar to this in a narrative format. Can you also give me some legal and ethical risks?
To get started on his wellness journey, it is a good idea to investigate whether Conrad would benefit from psychopharmacology. Many MDD patients begin by taking selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants at the forefront of the treatment of depression, anxiety, eating disorders, and other psychiatric disorders (Darab et al., 2020; Edinoff et al., 2021). However, the use of SSRIs in adolescents is controversial. A Cochrane Review found that while methodological shortcomings made interpreting efficacy and safety difficult, most newer medications may result in only a small and unimportant reduction in symptoms (though some individuals might have a more significant response) (Hetrick et al., 2021). It is important to note that Conrad is almost 18, and the mean age of the participants in the children and adolescent studies evaluated by Hetrick et al. was 11.5 to 13.3 and 14.4 to 16, respectively. Ultimately, the authors conclude that if SSRIs are being prescribed, fluoxetine is the only drug they recommend as the first choice for initial treatment (Hetrick, 2021).
Finding a patient’s smallest effective drug dosage to treat their symptoms can require trial and error, as not all medications work for all patients (Darab et al., 2020). Additionally, there are several potential adverse effects of taking SSRIs that can lead to withdrawal from treatment. For fluoxetine, an abridged version of the most common side effects includes abnormal dreams, anxiety, dry mouth, flu-like symptoms, gastrointestinal issues, insomnia, lack of energy, nausea, rash, sexual dysfunction, somnolence, and tremor (Food and Drug Administration [FDA], 2023). More serious but less common side effects are allergic reaction, altered appetite and weight, increased risk of bleeding, and serotonin syndrome, a potentially fatal condition characterized by the excessive amassing of serotonin in the body (Edinoff et al., 2021; FDA, 2023; Shalivahan Reddy & Zilate, 2022).
The most worrying side effect for Conrad would be an increased risk of suicide, also called Treatment Emergent Suicidal Ideation (TESI). The fluoxetine label includes a black box warning that antidepressants increase the risk of suicidal thoughts and behavior in a younger cohort (FDA, 2023), but multiple meta-analyses of the data could not conclusively support a causal relationship (Edinoff et al., 2021; Li et al., 2024; Vinberg, 2020). However, this might be because the risk of self-harm or suicide is often exclusion criteria for medication studies (Hetrick et al., 2021). Regardless, given his history of a previous suicide attempt, we must be sure to monitor Conrad for any symptoms related to self-harm (Corcoran & Walsh, 2023, pp. 198-199).
Within the next two weeks, Conrad and his father will consult with a psychiatrist and discuss whether taking fluoxetine is appropriate at his time. If they agree to move forward, Conrad will begin with a 10 mg/day dose for a week and titrate up with the goal of reaching a therapeutic dose, typically 20 mg/day (FDA, 2023; Sohel et al., 2024). He will take the Beck Depression Inventory-II (BDI-II) prior to starting this pharmacotherapy to establish a baseline depression score, and he will repeat it once again every three months to monitor his progress. He will be given a complete list of possible side effects, with attention paid to more serious ones, especially the potential for suicidal ideation. Conrad must agree that if he gives any indication that he is having thoughts of self-harm, all interested parties will need to address the issue right away to ensure his safety.
To monitor his son’s progress, Cal will receive several copies of the DSM-5-TR Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure form to fill out biweekly. Cal will contact Conrad’s psychiatrist and therapist if any concerning patterns emerge. Conrad will be provided with a Patient Health Questionnaire (PHQ-9) to fill out weekly. He will also keep a daily mental health journal to keep track of his mood and any side effects he experiences. If the side effects are tolerable, Conrad will stick with treatment for at least four weeks—the time it takes for fluoxetine to take full effect in individuals with MDD (FDA, 2023). If he decides he wants to cease treatment or try a different medication, he will consult with his clinician to ensure he tapers off safely.
Answer preview to treatment plans.
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