Running head: ADOLESCENT DEPRESSION AND ACUPUNCTURE 1
ADOLESCENT DEPRESSION AND ACUPUNCTURE 11
Adolescent Depression and Acupuncture
NUR4232: Integration of Evidence-Based Practice and Research in Nursing
August 7, 2020
Adolescent Depression and Acupuncture
Depression is a real disorder creating a global problem. The WHO identifies approximately 264 million people worldwide who suffer from this disorder (Depression 1, n.d.). Major depression, also known as major depressive disorder (MDD), is defined as a single episode or recurrent episodes of unipolar depression that results in a significant change in a client’s normal functioning (Halter, 2018). For a diagnosis of major depression to be made, five or more specific clinical findings must have been present during the same 2-week period (Halter, 2018). These clinical findings are a persistent feeling of sadness or a lack of interest or pleasure in external stimuli, accompanied by depressed mood, difficulties sleeping, or sleeping too much. They may experience conflicting feelings of failure and inadequacy, decreased ability to concentrate, indecisiveness, overtiredness, or suicidal ideation. Additionally, a change of more than 5% of body weight in a month or increase or decrease in motor activity can be another possible identifying symptom (Halter, 2018). For diagnosis, these symptoms must be experienced most of the day nearly every day, being the source of noteworthy and substantial deterioration in critical components of the patient’s life and be independent of any other ailments or substance abuse (Halter, 2018).
Research has shown that depression can be caused by more than just psychological factors. Depression is additionally affected by biological, genetic, and environmental factors (Armour et al., 2019). Etiologically, it is believed to be the result of changes in the reception of the neurotransmitters: serotonin, norepinephrine, and dopamine (Varcarolis & Varcarolis, 2015). These changes affect numerous parts of the brain, including the hippocampus, amygdala, and limbic systems (Varcarolis & Varcarolis, 2015). While these changes have been found to have some genetic association, much research, including biochemical markers and brain scans, are still underway (Varcarolis & Varcarolis, 2015)
Discussion of patient/population of interest: Adolescents experiencing symptoms of depression
In the US, the National Institute of Mental Health reports approximately An estimated 17.3 million or 7% of adults and 13.3% of adolescents who have had at least one major depressive episode with the prevalence leaning more towards females (Major Depression, n.d.). Among the adolescent population, as much as 70% of those who suffered the ordeal of a depressive episode experienced severe impairment associated with that episode (Major Depression, n.d.). It is scary to think that the youth of America are so affected by this disorder as suicide is a genuine concern for those who battle with depression. Adolescent depression is linked to substance abuse, early parenthood, higher medical expenses, and increased suicide risk (Lewandowski et al., 2013). Depression beginning before the age of 12 is further associated with increased risk for depressive episodes throughout their lifetime, reduced function, and psychiatric comorbidities (Lewandowski et al., 2013). Sadly, as of 2017, 60% of adolescents with this disorder did not receive treatment (Major Depression, n.d.). This, in part, maybe due to the dependence on pediatricians, almost singularly, to detect and diagnose adolescent depression. Pediatricians may be ill-prepared and or too pressed for time to collect and adequately interpret psychiatric findings, especially in the absence of clear guidelines for the treatment of adolescent depression (Major Depression, n.d.).
Intervention of Interest
Acupuncture is an ancient and traditional form of Chinese medicine that has gained popularity and respect in the medical community. The premise that acupuncture is built on is far removed from the views of modern western medicine. According to this approach, a steady flow of energy flows throughout the body called “qi.” This energy follows specific pathways or meridians that can become blocked, resulting in ailments. Acupuncture is the insertion of small needles in specific points along meridian lines. This technique is thought to stimulate these meridians to restore the free flow of energy, bringing the body back to a state of balance and wellness. Western medicine still struggles to explain the phenomenon as these points do not seemingly correspond to any anatomical structures.
One thought is that meridian lines are instead responsive liquid collagen crystals in connective tissue that support express cellular conduction (Dossey et al., 2016). Regardless of how it works, considerable research has been conducted regarding this form of complementary therapy that has shown it to be an effective modality for several ailments, including depression (Dossey et al., 2016). For children and adolescents, the use of antidepressants can cause significant adverse effects, most notably an increased risk of suicide. In comparison, the most common hazards related to acupuncture include itching, bleeding, or bruising at the site (Holland, 2018). The most significant risks, such as infection, are attributed to improper technique by unskilled technicians or practitioners (Holland, 2018).
Treating depression is very patient-specific and generally the result of trial and error. Depression is usually treated with psychotherapy and psychiatric medications (Depression 2, n.d.). In regard to adolescents, the American Academy of Pediatrics recommends simply active monitoring of mild depression. Concurrently, psychotherapy, and medication are recommended for moderate to severe depression in youth (Cheung et al., 2018). They also recommend close observation for side effects and ongoing monitoring of results. Collaboration between primary care providers and mental health specialists is recommended for the co-management of those with moderate to severe symptoms, especially if they appear resistant to treatment (Cheung et al., 2018).
2011–2014 Surveys reported that of those 12 years of age and older, 12.7% had taken an antidepressant in the last 30 days (Antidepressant Use Among, n.d.). Antidepressants are among the most commonly used drug classes in America (Antidepressant Use Among, n.d.). 19.6% of adolescents were singularly relying on counseling or psychotherapy care by a health professional (Major Depression, n.d.). There are many types of evidence-backed psychotherapy options such as cognitive-behavioral therapy and interpersonal therapy, shown to be effective in the treatment of depression (Depression 2, n.d.). 17.9% of patients, however, are being treated with a combination approach of medicinal and psychotherapy (Major Depression, n.d.). Only 2.4 % of adolescents rely simply on medication for the treatment of their depression (Major Depression, n.d.). Antidepressants, while shown to be effective, generally take 2-4 weeks to achieve a therapeutic level and can have harmful side effects related to sleep, concentration, appetite, and sexual function (Depression 2, n.d.). In children and adolescents with depression, there is an increased risk of suicide (Depression 2, n.d.). The FDA even requires manufacturers of antidepressants to include warning labels that alert of this increased risk, additionally providing the results of pediatric studies (Suicidality in Children, n.d.). Prozac is the only antidepressant approved for the treatment of depression in pediatric patients by the FDA (Suicidality in Children, n.d.).
Outcome of Interest
A meta-analysis of 29 studies between 1980 and 2018 found acupuncture to be positively correlated to a reduction in depression severity compared to mock acupuncture application, combination treatment, and a strictly medicinal approach consisting of SSRI/SNRIs (Armour et al., 2019). The studies that compared properly applied acupuncture and mock application showed a significant difference with real application besting the competition, implying that patient reactions to acupuncture are not merely a placebo effect (Armour et al., 2019). SSRI’s, when used in conjunction with acupuncture, consistently showed greater effectiveness at reducing depression symptoms than SSRI/SNRIs when used by themselves (Armour et al., 2019). Still, more studies need to be conducted. The reality remains that approximately 30% of those treated with psychotherapy and pharmacological options will remain unresponsive to treatment on some level (Armour et al., 2019). Alternative and complementary medicine provides another avenue to help patients.
Conclusion and PICO Question
Especially in a population where medication should be the last option such as adolescents, a complementary medicine modality such as acupuncture should be considered. The National Health Interview Survey conducted in 2007 reported 12 % of children 17 and younger had used some form of CAM within the last year (Dossey et al., 2016). CAM use is becoming more widely sought out; however, when polled, 67% admitted to not having discussed CAM with any of their providers. For those who did discuss the option, only 26% of the time was the subject broached by the providers (Dossey et al., 2016). Providers need to be actively researching CAMs such as acupuncture and offering it as an opportunity to augment already provided care. When it comes to adolescent depression, the question I crafted asks Does acupuncture reduce or eradicate signs and symptoms of depression in adolescents when added to psychotherapy?
Respect for Persons
All research involving human beings as participants must be conducted under the four ethical principles, including the respect of persons, justice, beneficence, and respect for the community. The principle of “respect for persons” is an essential element in any research that involves human subjects. It includes the recognition that human participants are autonomous, free, and unique individuals and demonstrating respect (Barrow & Khandhar, 2019). The principle also means that the researcher should recognize that each individual has a specific capacity and the rights to make their decision independently. Therefore, respecting people during the research ensures that the dignity of the participant is upheld. This is significant since one of my obligations as a nurse is to protect the clients while conducting research and ensure their dignity is upheld. The principle requires that individuals who can responsibly make individual decisions are accorded serious considerations (Ye et al. 2018). The same principle requires that people lacking autonomy, such as adults with advanced dementia or young children, are entitled to personal protection during the research. The principle of respect of a person is considered the source of the moral rule of confidentiality and informed consent. With this in mind, I will ensure that young adolescents, whether healthy or battling with depression or other mental challenges, are fully protected. I am generally obligated to obtain prior agreement from the participants, or their proxy decision maker to enroll them in the study.
For the agreement concerning the moral rule of informed consent to be considered valid, the participant or their proxy decision-makers must be in a cognitive capacity to make individual decisions and choose freely. The participant must also have adequate information and clearly understand what might be at stake when making specific decisions concerning the research. I will also take the necessary steps to protect the participant’s confidentiality by eliminating information that might personally identify them. There are various ways to keep the participant’s identity confidential (Barrow & Khandhar, 2019). Foremost, I will keep their record secure through the use of strong password protected files. I will also encrypt the files when sharing them. Additionally, making the data anonymous will guarantee that no one can know the contributing person.
The principle of beneficence is another ethical principle that I will focus on during this research. This principle can roughly be described as a situation where the researcher has the best interest of the participants in their mind. Therefore, this principle is behind the efforts that a researcher undertakes to minimize any risk that the participants may face. The principle also focuses on maximizing the benefits of the research to society (Ye et al. 2018). This is an important principle that is vital in my study since it involves adolescent participants who need to be protected. The principle means that I should implement measures during the research that generally benefit the participants. As a researcher, I have an obligation to appropriately care for the adolescent participants while promoting their mental health. The impairment of cognitive and emotional functions of the participants may result in abnormal behaviors, and I will have to address them effectively.
The primary aim of this principle is to act in a way that benefits others while promoting their safety and wellbeing (Ye et al. 2018). To ensure the effective implementation of this principle in my Evidence-based Practice (EBP) research, I will first analyze all the potential risks and benefits to the participants. Loss of privacy is one of the most common risks to the participants. Emotional distress, embracement, or physical discomforts are also the other risks to participants. Since I will have established techniques to deal with such risks, the study will be beneficial to the participants. Potential benefits to the society are the development of an effective intervention plan, access to more understanding of the overall topic of adolescent depression and acupuncture. Most importantly, the study will eventually bring satisfaction associated with helping others who may have similar conditions.
Concerning the principle of justice in any research involving human participants, the researcher should address the issue of distributing the burden and the benefit of the study. Therefore, it should not be a case where one group of society has to bear all the cost of the benefit while the other group realized the benefits (Ye et al. 2018). The issue of justice often arises during the selection of participants. This is a vital principle for me to conduct the (EBP) project successfully. It means that I will have to use justice when selecting the adolescent participants in the study. Therefore, there will be an ideal distribution of risk and benefits to society when recruiting the participants. The principle will help me implement the moral obligation to act based on fair adjudication between different competing claims in the study.
Ensuring justice in any research involving human begins in selecting the participants. Therefore, I will ensure I use adjudication to ensure an equal and fair distribution of risk and benefits to the participants and society in general. In this case, I will ensure that participant selection is primarily based on the research needs and convenience or availability (Ye et al. 2018). In order to achieve this aim, the inclusion or exclusion criteria will be explicit within the study protocols that should be strictly followed to ensure equal chances. Application of justice principle results in the appropriate selection of subjects.
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