| Course | NUR-7631 Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders Child and Adolescent Populations, Part A |
|---|---|
| Module | Module 2 |
| Paper type | Case analysis: adolescent depression |
| Length | About 1,038 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7631 Module 2
Seven in Ten With Both: Fluoxetine, CBT and an Honest Account of the Suicidality Warning for a 15-Year-Old With Major Depression
Student Name
M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner, Thomas Edison State University
NUR-7631: Advanced Assessment, Differential Diagnosis, and Management of Psychiatric Disorders: Child and Adolescent Populations, Part A
Mentor Name
Month Day, Year
Seven in Ten With Both: Fluoxetine, CBT and an Honest Account of the Suicidality Warning for a 15-Year-Old With Major Depression
Four Months of Withdrawal
Sofia, an invented patient, is 15 and a sophomore in Paterson. Over four months she has stopped answering friends' messages, quit the dance team and started sleeping through first period. She says she feels "nothing, like a gray wall," eats little and has lost five pounds. Her teachers have noticed her head on the desk. On bad nights she has thought sleep would be easier if it lasted, yet she has made no plan and has never hurt herself. Her score on the Children's Depression Rating Scale is 64, in the moderate to severe range. She has no history of mania, and her family history includes depression in her mother. She meets criteria for major depressive disorder.
Before settling on the diagnosis, the nurse practitioner checks what else could explain the picture. Thyroid tests and a blood count are normal, ruling out hypothyroidism and anemia as causes of her fatigue. She denies alcohol and drug use, and a confidential CRAFFT screen is negative. There is no recent trauma she wants to disclose, though the question will be asked again as trust grows. Her weight loss is modest and she has no binge eating or purging, so an eating disorder is unlikely. Her mother's history of depression raises her own risk and suggests that a family member may need support too.
What the Evidence Says
In the TADS trial, 439 depressed teenagers were assigned by chance to fluoxetine, CBT, the two together or a placebo for twelve weeks (Treatment for Adolescents With Depression Study Team, 2004). By week 12, seven in ten teens on both treatments had responded, against six in ten on the drug alone, four in ten in therapy alone and a third on placebo. The combination was superior to each treatment alone, and fluoxetine alone outperformed CBT alone at 12 weeks. More than a quarter of the teenagers entered the trial with serious suicidal thinking, and that thinking eased in every arm, most of all with combined treatment.
The Warning, in Numbers
In 2004 the FDA added a boxed warning to all antidepressants about increased suicidal thinking and behavior in children and adolescents. Hammad et al. (2006) analyzed 24 placebo-controlled pediatric trials with more than 4,500 patients submitted to the FDA. Antidepressants were associated with a modestly higher risk of suicidal thinking or behavior than placebo, roughly 4 percent compared with 2 percent; there were no completed suicides in the trials.
Bridge et al. (2007) pooled trials across depression, OCD and other anxiety disorders and set the risk against the benefit. For depression, the pooled increase in suicidal ideation or attempts was less than 1 percentage point, and the number needed to treat for one additional response was about 10, while the number needed to harm for one additional case of suicidal thinking or attempt was well over 100. In their judgment, the benefits of antidepressants appeared to outweigh the risks for young people with depression, with careful monitoring.
| Measure | Finding |
|---|---|
| Response with fluoxetine plus CBT | 71 percent (TADS) |
| Response with placebo | 35 percent (TADS) |
| Suicidal thinking or behavior, drug vs placebo | About 4 vs 2 percent (FDA trials) |
| Number needed to treat for depression response | About 10 (pooled) |
| Number needed to harm for suicidal ideation or attempt | Over 100 (pooled) |
Choosing With Sofia and Her Parents
Sofia's parents are frightened by the warning they read about online. The nurse practitioner explains the numbers above: in trials, a small number of young people had new suicidal thoughts on medication, there were no suicides, and untreated depression itself carries a much higher risk. Sofia wants to "feel something again" and is willing to start therapy. Given the severity of her depression and the trial evidence, the plan combines fluoxetine with CBT. Of the SSRIs, fluoxetine carries the most adolescent trial data and FDA approval for depression in this age group, so it is the first choice.
The Prescription and Monitoring
She starts fluoxetine at 10 milligrams each morning, moves to 20 milligrams after a week and may go to 40 milligrams at about week six if she has improved only partly. Weekly CBT begins at the same time, focused on behavioral activation, returning to one dance class and seeing one friend a week, and on challenging her belief that "nothing will change."
Suicidality is assessed at every contact, weekly for the first month, by direct questions about thoughts, plans and intent. A written safety plan lists her warning signs, coping strategies, people to call, the 988 crisis line and steps to make the home safer, including locking up medications and any firearms; her parents confirm that there are no guns in the home. Her parents are taught to watch for agitation, new self-harm or sudden changes and to call the clinic or 988 if they appear.
School and Family
With Sofia's permission, the school counselor is told that she is being treated for depression, without details, so that teachers can excuse missed work for a few weeks and the counselor can check in with her once a week. Her mother is encouraged to see her own clinician, since parental depression can slow a teenager's recovery and her mother described low mood of her own. These steps put the people who see Sofia every day inside the treatment plan rather than outside it.
Measuring Progress
Every second week Sofia completes the same rating scale. Response is a reduction of at least half; remission, a score near the normal range. If there is no meaningful improvement by week 8 at an adequate dose with good adherence, the plan is reviewed, including a switch to another SSRI, which helped in a later trial of treatment-resistant adolescents.
Conclusion
Sofia's major depression is moderate to severe and is affecting school, friendships and eating. Trial evidence shows that fluoxetine with CBT gives the best response, and pooled analyses show the suicidality risk is real but small compared with the benefit and the risks of untreated depression. Explaining the warning in absolute numbers, monitoring closely and building a specific safety plan let her family choose treatment with clear eyes.
References
Bridge, J. A., Iyengar, S., Salary, C. B., Barbe, R. P., Birmaher, B., Pincus, H. A., Ren, L., & Brent, D. A. (2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials. JAMA, 297(15), 1683-1696. https://doi.org/10.1001/jama.297.15.1683
Hammad, T. A., Laughren, T., & Racoosin, J. (2006). Suicidality in pediatric patients treated with antidepressant drugs. Archives of General Psychiatry, 63(3), 332-339. https://doi.org/10.1001/archpsyc.63.3.332
Treatment for Adolescents With Depression Study Team. (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA, 292(7), 807-820. https://doi.org/10.1001/jama.292.7.807
Reading the NUR 7631 Module 2 assignment instructions
Prescribing and diagnosis for young people sit at the center of NUR-7631's catalog wording, so this second module, laid out without a published syllabus, applies both to a depressed teenager. Expect a case analysis that establishes the diagnosis with a rating scale, weighs medication, therapy and their combination using pediatric trials, addresses the boxed warning with data, writes the prescription and builds a safety plan. Some classrooms set the case in a younger child or ask for a comparison of two SSRIs. Check what the prompt asks. Present the warning in absolute numbers, and make the safety plan specific to the young person's home. Include the school if the prompt allows. State the follow-up schedule for the first month of fluoxetine.
How this NUR 7631 Module 2 example is built
Sofia's four months of withdrawal, weight loss and passive thoughts of death open the case with her rating scale score. The TADS results for each arm are reported, including the fall in baseline suicidal thinking. Two pooled analyses quantify the warning, one from FDA trial data and one setting risk against benefit, summarized in a five-row table. A section shows how the numbers were explained to her parents. The prescription and CBT plan follow, with weekly suicidality checks and a written safety plan including means restriction. Measures and a plan for nonresponse lead to the conclusion. A short section brings her school counselor and her mother's own care into the plan.
Where the marks sit in the NUR 7631 Module 2 rubric
Adolescent depression cases are graded on diagnosis supported by a validated scale, a treatment choice based on adolescent trials, accurate presentation of the boxed warning with numbers, a correct prescription with titration and a specific safety plan. Mentors look for suicidality assessed at each contact, means restriction addressed and parents taught what to watch for. Measuring response and planning for nonresponse show clinical maturity. Group-authored trials should be cited correctly. Pediatric trials cited correctly in APA earn the final marks, and bringing the school and a parent's own health into the plan is often credited. Involving the school with consent shows how care reaches daily life. A dated plan for weekly contact in the first month earns credit.
Common NUR 7631 Module 2 mistakes, and how to avoid them
Students often mention the boxed warning without numbers, which leaves families with fear rather than information. Give the absolute risks and the benefits side by side. Another frequent error is citing adult antidepressant evidence for adolescents. Use pediatric trials. Write the starting dose and titration plan. Make the safety plan concrete, including locking up medications and asking about firearms. Plan what you will do if the first medication does not work, and say who at school will know. Send your NUR-7631 adolescent depression prompt and a first draft follows at no cost. Share with the school only the details Sofia has agreed to release, and say so in the paper.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More NUR 7631 and M.S. in Nursing, Psychiatric Mental Health Nurse Practitioner sample papers
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- NUR 7631 Module 3: Autism Case: Irritability, Parent Training, Risperidone and Aripiprazole
- NUR 7631 Module 4: Childhood Trauma Case: Trauma-Focused CBT After Witnessing Violence
- NUR 7631 Module 5: Eating Disorder Case: Medical Risk and Family-Based Treatment for Anorexia Nervosa
- NUR 7631 Module 6: Early-Onset Psychosis Case: Antipsychotic Choice and Metabolic Monitoring
- NUR 7600 Module 4: Lifespan and Controlled Substances Case: Methylphenidate for a 9-Year-Old
- NUR 7633 Module 5: Insomnia in Later Life Case: ISI Scoring, CBT for Insomnia and Sedative Risks
- NUR 7641 Module 2: Childhood Anxiety Case: SCARED Screening, CBT and Sertraline
- NUR 7620 Module 3: Child Therapy Case: CBT and Sertraline for a 10-Year-Old With Anxiety
NUR 7631 Module 2 questions, answered
Where can I find a free NUR 7631 Module 2 sample paper?
Sofia's full case, with the warning explained in numbers and her safety plan, is printed above.
What did the TADS trial show for adolescent depression?
After twelve weeks the combination helped about seven teens in ten, the drug alone six, therapy alone four and placebo roughly three and a half.
How big is the suicidality risk with antidepressants in adolescents?
In FDA trial data, about 4 percent on antidepressants versus 2 percent on placebo had suicidal thinking or behavior, with no completed suicides.
Do the benefits of antidepressants outweigh the risks for depressed teenagers?
A pooled analysis found about 10 adolescents needed treatment for one additional response, while over 100 needed treatment for one additional case of suicidal ideation or attempt.
What should a safety plan for a depressed adolescent include?
Warning signs, coping steps, people and crisis lines to contact, and making the home safer, including locking up medications and removing access to firearms.