11 Jun week 2 6670
Week 2: Depressive Disorders
I have no one. My wife died suddenly 4 years ago and I know it was my fault. She had been complaining she was sick for a year, but the doctors kept saying it was nothing. When they finally found the cancer, it had spread throughout her body. I should have listened to her. She might have survived and I would not be alone. I seem to cry for no reason and my children don’t understand why I don’t want to go out of the house. This is where her memories are. Why would I want to leave?
Jose, age 75
The National Institutes of Mental Health acknowledges that depression is one of the most common mental disorders in the United States. It is associated with significant disability, fiscal impact, and considerable personal suffering. It may have significant impact on the individual, their family, and their social network. The PMHNP must be capable of providing comprehensive care for depressive disorders, including both psychotherapy and psychopharmacologic approaches.
This week, you will become “captain of the ship” as you take full responsibility for a client with a depressive disorder. You will recommend psychopharmacologic treatment and psychotherapy, identify medical management needs and community support, and recommend follow-up plans.
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 8, “Mood Disorders” (pp. 347–386)
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
Chapter 12, “Psychotherapy of Mood Disorders”
Chapter 14, “Pharmacological and Somatic Treatments for Major Depressive Disorder”
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Depressive Disorders”
Major Depressive Disorder
Persistent Depressive Disorder (dysthymia)
Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive Disorder
Depressive Disorder Due to Another Medical Condition
Other Specified Depressive Disorder
Unspecified Depressive Disorder
Stahl, S. M. (2017). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (6th ed.). New York, NY: Cambridge University Press.
To access information on specific medications, click on The Prescriber’s Guide, 6th Ed. tab on the Stahl Online website and select the appropriate medication.
Depression Premenstrual dysphoric disorder Seasonal affective disorder (MDD with Seasonal Variation)
agomelatine
amisulpride
amitriptyline
amoxapine
amphetamine (d)
amphetamine (d,l)
aripiprazole (adjunct)
asenapine
atomoxetine
bupropion
buspirone (adjunct)
citalopram
clomipramine
cyamemazine
desipramine
desvenlafaxine
dothiepin
paroxetine
phenelzine
protriptyline
quetiapine (adjunct)
reboxetine
selegiline
sertindole
sertraline
sulpiride
tianeptine
tranylcypromine
triiodothyronine
trazodone
trimipramine
venlafaxine
vilazodone
vortioxetine
doxepin
duloxetine
escitalopram
fluoxetine
flupenthixol
fluvoxamine iloperidone
imipramine
isocarboxazid
ketamine
lisdexamfetamine
lithium (adjunct)
l-methylfolate (adjunct)
lofepramine
lurasidone
maprotiline
methylphenidate (d)
methylphenidate (d,l)
mianserin
milnacipran
mirtazapine
moclobemide
modafinil (adjunct)
nefazodone
nortriptyline
olanzapine citalopram
desvenlafaxine
escitalopram
fluoxetine
paroxetine
sertraline
venlafaxine bupropion
Grieve, S. M., Korgaonkar, M. S., Koslow, S. H., Gordon, E., Williams, L. M. (2013). Widespread reductions in gray matter volume in depression. NeuroImage: Clinical, 3, 332-339. doi:10.1016/j.nicl.2013.08.016
Lach, H. W., Chang, Y-P., & Edwards, D. (2010). Can older adults with dementia accurately report depression using brief forms? Reliability and validity of the Geriatric Depression Scale. Journal of Gerontological Nursing, 36(5), 30–37. doi:10.3928/00989134-20100303-01
Steffens, D. C., McQuoid, D. R., & Potter, G. G. (2014). Amnestic mild cognitive impairment and incident dementia and Alzheimer’s disease in geriatric depression. International Psychogeriatrics, 26(12), 2029–2036. doi:10.1017/S1041610214001446
Drug Enforcement Administration. (n.d.). Drug schedules. Retrieved June 14, 2016, from https://www.dea.gov/druginfo/ds.shtml
Required Media
Classroom Productions (Producer). (2015). Depressive Disorders [Video file]. San Luis Obispo, CA: Microtraining Associates.
Note: The approximate length of this media piece is 22 minutes.
Optional Resources
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
Chapter 15, “Brain Stimulation Treatments for Mood Disorders”
Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31(1), 52–72. doi:10.1037/neu0000319
Note: You will access this article from the Walden Library databases.
Anderson, N. D., Damianakis, T., Kröger, E., Wagner, L. M., Dawson, D. R., Binns, M. A., . . . Cook, S. L. (2014). The benefits associated with volunteering among seniors: A critical review and recommendations for future research. Psychological Bulletin, 140(6), 1505–1533. doi:10.1037/a0037610
Note: You will access this article from the Walden Library databases.
Inoue, J., Hoshino, R., Nojima, H., Ishida, W., & Okamoto, N. (2016). Additional donepezil treatment for patients with geriatric depression who exhibit cognitive deficit during treatment for depression. Psychogeriatrics, 16(1), 54–61. doi:10.1111/psyg.12121
Note: You will access this article from the Walden Library databases.
Sachs-Ericsson, N., Corsentino, E., Moxley, J., Hames, J. L., Rushing, N. C., Sawyer, K., . . . Steffens, D. C. (2013). A longitudinal study of differences in late- and early-onset geriatric depression: Depressive symptoms and psychosocial, cognitive, and neurological functioning. Aging & Mental Health, 17(1), 1–11. doi:10.1080/13607863.2012.717253
Note: You will access this article from the Walden Library databases.
Shallcross, A. J., Gross, J. J., Visvanathan, P. D., Kumar, N., Palfrey, A., Ford, B. Q., . . . Mauss, I. B. (2015). Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition. Journal of Consulting and Clinical Psychology, 83(5), 964–975. doi:10.1037/ccp0000050
Note: You will access this article from the Walden Library databases.
Wanklyn, S. G., Pukay-Martin, N. D., Belus, J. M., St. Cyr, K., Girard, T. A., & Monson, C. M. (2016). Trauma types as differential predictors of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and their comorbidity. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 48(4), 296–305. doi:10.1037/cbs0000056
Note: You will access this article from the Walden Library databases.
Assignment: “Captain of the Ship” Project – Depressive Disorder
As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role.
In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.
Learning Objectives
Students will:
Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with depression disorders
Recommend psychotherapy based on therapeutic endpoints for clients with depression disorders
Identify medical management needs for clients with depression disorders
Identify community support resources for clients with depression disorders
Recommend follow-up plans for clients with depression disorders
To prepare for this Assignment:
Select an adult or older adult client with a depressive disorder you have seen in your practicum.
In 3 pages, write a treatment plan for your client in which you do the following:
Describe the HPI and clinical impression for the client.
Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
Identify medical management needs, including primary care needs, specific to this client.
Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
