Reply to these two classmate discussions in apa format and provide references to your answer

1-1Describe your assigned client's situation. Why are they presenting to the clinic? What medications are they currently taking?

Hassan Ayad is a 16-year-old male who presents to the clinic with his mother due to ongoing emotional and behavioral concerns. He reports persistent sadness, hopelessness, irritability, and a marked loss of interest in previously enjoyable activities, especially basketball, where he was once a key player. These symptoms began following the death of his father one year ago and have persisted despite ten months of cognitive behavioral therapy (CBT). His mother has grown increasingly worried, particularly after Hassan expressed a desire to quit the basketball teama significant change from his usual behavior. She is now requesting consideration of medication, as therapy alone has not led to improvement. Hassan has no significant medical history, does not use tobacco or alcohol, and is not currently on any medications. His physical exam and vital signs are within normal limits. He does have a documented peanut allergy, which must be considered when selecting pharmacologic treatment.Assess the applicable clinical practice guideline (CPG) for your assigned client. What treatment is recommended by the CPG for your client's situation?

According to the clinical practice guideline (CPG) of the American Academy of Child and Adolescent Psychiatry (AACAP) Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders, as well as the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) developed by the American Academy of Pediatrics (AAP). For a 16-year-old adolescent like Hassan Ayad presenting with moderate to severe major depressive disorder (MDD) that has not improved after an adequate trial of cognitive behavioral therapy (CBT), the first-line treatment for moderate to severe depression in adolescents who do not respond to psychotherapy alone is the combination of pharmacotherapy and continued psychotherapy (AACAP, 2018; Cheung et al., 2018). SSRIs (selective serotonin reuptake inhibitors) are the recommended pharmacologic agents, and among these, fluoxetine is the most strongly recommended due to its robust evidence for efficacy, safety, and FDA approval for use in children and adolescents aged 8 years and older. According to the GLAD-PC Part II guidelines, adolescents aged 12 to 18 with moderate to severe depression should be managed with a combination of an SSRIpreferably fluoxetineand evidence-based psychotherapy, such as cognitive behavioral therapy (CBT) or interpersonal therapy (IPT). If there is no improvement after 6 to 12 weeks of therapy alone, starting medication is considered appropriate. Although escitalopram is also approved for use in adolescents 12 and older, it is typically used when fluoxetine is not well tolerated. In Hassan's situation, his ongoing depressive symptoms over the past 10 months despite consistent CBT indicate that monotherapy has been insufficient. Therefore, based on current clinical practice guidelines, initiating fluoxetine alongside continued psychotherapy is strongly supported as the most effective and evidence-based course of treatment.

Discuss your personal professional assessment of the client's situation provided in the scenario. What pharmacological treatment is necessary and why?

Hassan Ayad is a 16-year-old experiencing moderate to severe depression, marked by persistent sadness, anger, hopelessness, and loss of interest in basketball following his father's death. Despite ten months of cognitive behavioral therapy (CBT), his symptoms have not improved, indicating the need for pharmacologic intervention. Based on current clinical guidelines (AACAP, 2018; Cheung et al., 2018), fluoxetine is the recommended first-line SSRI for adolescents due to its strong evidence of efficacy, FDA approval for use in youth, and favorable safety profile. Starting fluoxetine, alongside continued psychotherapy, offers the most effective and evidence-based approach for improving Hassan's mood and functioning while preventing further decline. Close monitoring for side effects and mood changes is essential during treatment initiation.

Reflect on additional questions you have about your assigned client that may influence treatment. What else do you want to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?

in order to ensure optimal treatment for Hassan Ayad, several additional questions and assessments are needed. First, it's important to screen for suicidal ideation or self-harm using tools like the PHQ-9 Modified for Adolescents or C-SSRS, as his worsening symptoms may increase risk. I would also assess sleep, appetite, academic performance, and social functioning to better understand the full impact of his depression. A family psychiatric history is crucial, especially to rule out bipolar disorder, as initiating an SSRI without doing so could trigger mania. Although fluoxetine doesn't require routine labs, a TSH, CBC, and metabolic panel may be useful to rule out other causes of depressive symptoms. Regular follow-up every 1-2 weeks is essential to monitor for side effects and suicidal thoughts. Lastly, a direct conversation with Hassan about his understanding of and comfort with treatment is important, along with involving his mother and possibly school staff for support.

References

American Academy of Child and Adolescent Psychiatry (AACAP). (2018). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 57(10), 687-696. https://doi.org/10.1016/j.jaac.2018.05.017Links to an external site.

Links to an external site.Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Ghalib, K., Laraque, D., & Stein, R. E. (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics, 141(3), e20174082. https://doi.org/10.1542/peds.2017-4082Links to an external site.

2-Describe your assigned client's situation. Why are they presenting to the clinic? What medications are they currently taking? Sixteen-year-old Hassan Ayad (DOB: 8/20/2008) arrives at the clinic with his mother, reporting persistent sadness, hopelessness, anger, and a loss of interest in his usual activities. Previously the star of his basketball team, he has experienced these symptoms since his father's passing last year. Despite undergoing cognitive behavioral therapy for the past ten months, he has found no relief. Recently, he expressed a desire to quit the basketball team, prompting his mother to seek medical intervention for depression. The provider's physical assessment reveals no abnormalities, leading them to consider appropriate medication options. Hassan's medical history includes depression, and he has a peanut allergy. His social history indicates that he has never smoked cigarettes or consumed alcohol. Physical exam shows a BMI of 23.6. His vital signs are stable. He is not currently taking any medications.

Assess the applicable clinical practice guideline (CPG) for your assigned client. What treatment is recommended by the CPG for your client's situation? According to American Psychological Association (2019), for theinitial treatment of adolescent patients with depressive disorders, the panel recommends that clinicians offer cognitive-behavioral therapy or interpersonal psychotherapy adapted for adolescents (IPT-A). The panel also recommends fluoxetine as a first-line medication compared to other medications for adolescent patients with major depressive disorder, specifically when considering medication options. Therefore, based on theclinical practice guideline (CPG) for Hassan, the appropriate prescription for Hassan is fluoxetine (Prozac) 10 mg as this client has no relief with cognitive behavioral therapy to manage his depression and is requesting medication. Studies also shows that "Fluoxetine was the most common choice, followed by Sertraline and Escitalopram"(Kaur et al.,2024).

Discuss your personal professional assessment of the client's situation provided in the scenario. What pharmacological treatment is necessary and why? Adolescent depression is emerging as a prevalent mental health concern globally, significantly impacting teenagers' emotional well-being, physical health, and social interactions. "Adolescents are currently in the phase of development and growth, and the 5-Hydroxytryptamine(5-TH) and norepinephrine neurotransmitter systems in the nervous system are not yet mature. The response to antidepressants is different from that of adults. At present, the commonly used antidepressants in clinical practice mainly include selective 5-HT reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic and tetracyclic antidepressants, etc." (Wu et al.,2025). The study also emphasis that "fluoxetine, an SSRIs, demonstrates efficacy and is generally well accepted among adolescents experiencing depression" (Wu et al.,2025).Based on thepersonal professional assessment of the client's situation provided in the scenario,Hassan has already engaged in CBT as recommended by clinical guidelines but has not experienced symptom relief. Since non-pharmacologic interventions have been ineffective, initiating medication is the next step.According to the recommendations for the Adolescent Population from the APA Guideline Development Panel for the Treatment of Depression,Fluoxetine is a first-line pharmacologic treatment for adolescents with depression.The recommended starting dose for adolescents is 10 mg. Also, the provider should clearly inform Hassan and his mother that the medication may require several weeks to take effect. It is crucial to monitor closely for any signs of worsening depression or suicidality, as these risks can emerge during the early stages of treatment. Regular follow-up appointments will be essential for evaluating effectiveness and identifying any potential side effects (APA, 2019; Rosenthal & Burchum, 2021).

Reflect on additional questions you have about your assigned client that may influence treatment. What else do you want to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes? As a Nurse practitioner, the additional questions and follow up would be the ongoing collaboration between Hassan, his mother, and healthcare providers which would help in optimizing outcomes and ensuring his mental well-being. Further assessments include screening for suicide risk to ensure Hassan's safety, exploring family and social dynamics to assess other contributing factors. Also, conducting laboratory tests on thyroid function, vitamin D levels can help to rule out physiological contributors to depression. Discussing with Hassan regarding his personal experiences and concerns about treatment also is important.

Reference

American Psychological Association. (2019).APA clinical practice guideline for the treatment of depression across three age cohorts.https://www.apa.org/depression-guidelineLinks to an external site.

Kaur, N., Doege, C., & Kostev, K. (2024). Prevalence of Antidepressant Prescription in Adolescents Newly Diagnosed with Depression in Germany.Children (Basel, Switzerland),11(10), 1246.https://doi.org/10.3390/children11101246Links to an external site.

Wu, T., Song, F., Cao, W., et al. (2025). Comparative efficacy of antidepressant medication for adolescent depression: A network meta-analysis and systematic review.BMC Psychiatry, 25(471).https://doi.org/10.1186/s12888-025-06941-xLinks to an external site.

Rosenthal, L., & Burchum, J. (2021).Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants(2nd ed.). Elsevier.