DNP Project -Depression Assignment
Depression is a major cause of disability whose prevalence continues to increase across the globe. Wang et al (2017) highlight that, among women and men, its prevalence ranges between 20%-25% and 7%-12% respectively. It remains the fourth largest contributor to the global disease burden and by the year 2030, depression will become the second cause of disability globally. It is an essential determinant of the QoL, accounting for an estimated 50% of psychiatric visits and 19% of hospital admissions, which is attributable to its recurrent nature and its significant impact on morbidity and mortality rates, and economic cost (Wang et al., 2017). Its economic impact relates to workplace presenteeism and absenteeism and among working-age adults, it generates direct and indirect healthcare-related costs through income loss, retiring early, and loss of working hours. Kamenov et al (2017) further emphasize that the most significant impact of depression on the economy is lost productivity and this presents essential costs to employers. Therefore, healthcare providers must determine the most effective therapeutic strategies to utilize that produce the most significant short term and long-term outcomes in the management of depression.
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Unmet Gaps
There is adequate evidence to support the short-term pharmacological and psychotherapeutic interventions of depression. Besides, most studies reveal that post-therapy, the outcomes of pharmacotherapy and psychotherapy in managing mild depression are similar. Nevertheless, the intervention with the best outcomes is combining psychotherapy with pharmacotherapy in comparison to psychotherapy or pharmacotherapy alone. The study by Furukawa et al. (2018) revealed that overall, combining medications and psychotherapy was superior compared to monotherapy in regards to acceptance and efficacy in the short term. The researchers further concluded that, for specific patient subgroups, providers should use either psychotherapy or pharmacotherapy alone since it is less costly, match personal preferences, and has fewer adverse effects. However, the findings of the study did not explain the long-term effectiveness of pharmacotherapy compared to the combination of pharmacotherapy and psychotherapy is not well known.DNP Project -Depression Assignment
How the Project Will Address Unmet Issues
This project purposes to establish the long-term effects of drug therapy alone compared to combining drug therapy and psychotherapy. Therefore, the project will incorporate adult patients diagnosed with mild depression. The author will assign the participants to either a control group (drug therapy) or intervention group (drug therapy and psychotherapy) and assessed at various points to determine the effectiveness of treatment. The author will determine the effectiveness of the interventions based on participants’ QoL, and the presence and severity of symptoms identified using a depression scale. The study by Karyotaki et al (2016) reveals that combined therapy gives a superior and enduring effect, in comparison to using drug therapy alone. The researchers further recommend psychotherapy as an alternative for combined therapy in the acute phase. It has long-term benefits; it has no side effects, and empowers patients’ mechanisms to cope and a set of skills that they can use to improve their lives after the treatment phase. However, combining drugs with psychotherapy has long-term outcomes
Research Question: Is drug therapy alone as effective as a combination of psychotherapy and drug therapy in lessening the symptoms of depression in patients with mild depression
References
Furukawa, T. A., Efthimiou, O., Weitz, E. S., Cipriani, A., Keller, M. B., Kocsis, J. H., & Schramm, E. (2018). The cognitive-behavioral analysis system of psychotherapy, drug, or their combination for persistent depressive disorder: personalizing the treatment choice using individual participant data-network metaregression. Psychotherapy and psychosomatics, 87(3), 140-153.
Kamenov, K., Twomey, C., Cabello, M., Prina, A. M., & Ayuso-Mateos, J. L. (2017). The efficacy of psychotherapy, pharmacotherapy, and their combination on functioning and quality of life in depression: a meta-analysis. Psychological medicine, 47(3), 414–425. https://doi.org/10.1017/S0033291716002774
Karyotaki, E., Smit, Y., Henningsen, K. H., Huibers, M. J. H., Robays, J., De Beurs, D., & Cuijpers, P. (2016). Combining pharmacotherapy and psychotherapy or monotherapy for major depression. A meta-analysis on the long-term effects. Journal of Affective Disorders, 194, 144-152.
Wang, J., Wu, X., Lai, W., Long, E., Zhang, X., Li, W., & Wang, D. (2017). Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open, 7(8), e017173.DNP Project -Depression Assignment
Doctor of Nursing Practice Project: Drug Therapy Versus Psychotherapy Combined with
Drug Therapy for Mild Depression
The prevalence of depression continues to surge globally, affecting more than 264 million individuals of all ages (Wang et al., 2017). Depression differs from normal mood fluctuations and short-term emotional reactions to daily life stressors. Depression is a significant cause of disability and suicide, especially among teenagers (Kroning & Kroning, 2016). According to Wang et al. (2017), depression ranges from 20 to 25 % and 7 to 12 % among women and men, respectively. When long-lasting and with severe intensity, depression can become a severe mental health condition. It is the largest contributor to the global disease burden, and it is predicted that depression will become a leading cause of disability worldwide by the year 2030 (Kamenov, 2017).
Depression is a significant determinant of quality of life (QOL), accounting for a projected 50% of psychiatric visits and 19% of hospital admissions (Guthrie et al., 2016). This is attributed to the recurring nature and its vital impact of morbidity, mortality, and economic costs. Among the economic effects of depression are workplace absenteeism among working adults, loss of income, early retirement, and loss of working hours (Kamenov et al., 2017). These authors further assert that the highest economic cost of depression is a loss of productivity and its consequential costs. The approximated financial cost of depression is $1. 7 trillion (Trautmann et al., 2016). Other impacts of depression are feelings of emptiness and worthlessness, trouble with memory and thinking, increased rates of suicide, risk of heart attacks, clinginess, fatigue, and weight fluctuations (Wang et al., 2017). Therefore, determining the most effective therapeutic strategies for patients with mild depression is a crucial role for healthcare personnel. Healthcare providers must identify approaches with the most significant short and long-term outcomes for these patients to improve their quality of life.
Drug Therapy versus Psychotherapy Combined with Pharmacotherapy for Mild Depression
There is adequate evidence that supports the short-term benefits of drug therapy to treat mild depression (Furukawa et al., 2018). Most studies reveal that the results of drug therapy and psychotherapy are similar in managing depression symptoms post-therapy (Kamenov et al., 2017). However, new evidence suggests that combining drug therapy with psychotherapy is the most effective intervention for treating mild depression compared to the use of each approach alone. A study conducted by Furukawa et al. (2018) revealed that combining drugs and psychotherapy was a superior approach for treating mild depression with more long term benefits. The researchers, however, noted that using either strategy alone is acceptable for specific patient subgroups as the approach is inexpensive and matches the individual preferences of the patient. Notably, the long-term impact of drug therapy compared to the combination of drug therapy and psychotherapy has not been well investigated.
How the Project Intends to Fill the Existing Gap
This project intends to explore the long-term effects of drug therapy alone compared to a combination of drug therapy and psychotherapy. This project’s patients will be adults diagnosed with mild depression. Health professionals will initiate drug therapy in some and combination therapy to the other group. The patients will then be evaluated at different points to determine and compare the effectiveness of the treatments. The efficiency of the interventions will be based on the patient’s quality of life, presence, and severity of depression symptoms.
PICO Question
Is drug therapy alone as effective as a combination of psychotherapy and drug therapy in lessening the symptoms of depression in patients with mild depression?DNP Project -Depression Assignment
Background/Significance
Wang et al. (2017) assert that depression among adults is highly prevalent globally as 1 out of 4 individuals is diagnosed with depression. Drug therapy or combination therapy are both effective in treating the condition. Determining the long-term effectiveness of these approaches is crucial. In light of this, this project is highly significant as it addresses the effectiveness of drug therapy alone compared to a combination of drug therapy and psychotherapy to treat the symptoms of depression. Effective treatments are available for mild depression, including antidepressants and psychotherapy.
Although psychotherapy and antidepressants are equally effective for most depressive disorders and anxiety, evidence suggests that combined treatment is superior to each of the therapy alone (Karyotaki et al., 2016. Evaluating the effect of such an approach on the patient’s quality of life and severity of symptoms is incredibly crucial as it assists healthcare providers to treat patients based on evidence-practice guidelines. This project aims to investigate the long-term impact of drug therapy alone compared to a combination therapy consisting of pharmacotherapy and psychotherapy in treating mild depression. Based on existing evidence, the likely outcomes for this project will be that combination therapy has more superior benefits compared to drug therapy alone. Pharmacotherapy in depression treatment is more effective short-term as it reduces the severity of the symptoms.
However, the recurrent nature of depressive episodes prioritizes combination therapy in improving the quality of life among patients diagnosed with depression. This project will have a significant impact. It will reduce the costs of treating depression, and improve the quality of life for patients with depression. Combined therapy enhances the quality of life by reducing depressive symptoms (Karyotaki et al., 2016). According to Furukawa et al. (2018), combined therapy is also cost-effective.
Identification of the Problem/Gap
While combination therapy has been proven effective in treating mild depression, the long-term effects of drug therapy and combination therapy have not been well investigated. Few short-term studies have evaluated the impact of combination therapy to treat depression in the ‘real world’ (Karyotaki et al., 2016). Most studies have focused on the effectiveness of drug therapy, which has shown numerous short-term benefits in depression treatment. Depression is a crucial indicator of the quality of life (Wang et al., 2017). Therefore, examining the effect of the disorder on the patient’s quality of life is a vital aspect in gauging the effectiveness of each approach. Although drug therapy is effective in reducing the extent and severity of symptoms, it is not as effective in determining the patient’s quality of life. Notably, psychotherapy generally centres on the reduction of symptoms and functioning impairments, including cognitive, social, and interpersonal functioning (Cook, 2017). Enhancing the general positive quality of life is the implicit and explicit goal of pharmacotherapy. Both treatment approaches have been proven to have similar impacts on the short-term. However, combination therapy has a higher potential of reducing depression symptoms and improving the quality of life among patients. Assessing the long-term effectiveness of combination therapy is thus warranted.
Description of the Problem/Gap
The adult population is mostly affected by depression. In the US, 18.3 million adults were diagnosed with depression in the year 2017, equating to approximately 18 % of the entire United States adult population (Lim et al., 2018). The incidence of depression is higher in women compared to men. At the global level, over 300 million individuals are diagnosed with depression, which is equivalent to 4.4 % of the entire global population (Wang et al., 2017). Significant causes of depression among adults are family history, early childhood trauma, drug use, and existing medical conditions (Hellman, 2018). Other risk factors for depression are low self-esteem, personal account of mental disorders, certain medications, and stressful events such as the loss of a loved one.DNP Project -Depression Assignment
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Currently, the treatment plan for mild depression is dependent on the type and severity of depression. Antidepressants are used to treat the symptoms of depression for some, while others focus on psychotherapy. As of today, the administration of antidepressants is the most common approach used to treat depression. While these drugs relieve the symptoms for most patients, research suggests that there is no one-size-fits-all approach is depression treatment. Individually tailored treatments, either combining drugs with psychotherapy or using each intervention independently, may be used depending on critical patient factors such as the severity of the symptoms and type of depression. It is incredibly crucial to highlight that antidepressants do not work for all patients. For patients with mild depression, antidepressants have a limited effect. However, antidepressants are highly effective for patients with more severe forms of depression. Although antidepressants are not as effective for mild depression, it does not mean that they are unnecessary. Patients with some extreme forms of depression tend to rely on psychotherapy to reduce the severity of symptoms and improve the quality of life.
Nonetheless, we know that this does not mean that all patients presenting with mild depression should be offered combination therapy. This would be the approach in an ideal world with unlimited resources. However, mental health professionals must consider the cost/benefit ratio while providing combination therapy. While the treatment has been proven effective compared to single treatment modalities, the effect sizes are mostly unassertive. There is an added strain in mental health brought about by combining psychotherapy with medications which must be incorporated into the patient’s treatment plan.
Both therapies are equally effective, but combined treatment with drugs and psychotherapy has been proven to be superior compared to either therapy alone (Furukawa et al., 2018). According to these authors, there are numerous empirically validated benefits of combined therapy for the treatment of diabetes. It improves short-term recovery rates, faster response rates, and enhances long-term recovery rates. Combined therapy medication adherence leads to greater patient satisfaction, and decreases long-term costs and social services use.
Combining drug therapy with psychotherapy has significant implications on cost, population, policy, education, and healthcare systems. According to Kappelmann et al. (2020), combined therapy is cost-effective from the healthcare system viewpoint. It is also the dominant treatment approach from a social standpoint. Cost-effectiveness of combination therapy is assessed by determining the incremental cost-effectiveness ratio (ICER) for each successfully treated patient and by the ICER per quality-adjusted life years. Combined therapy increases the rate of successfully treated patients.
Additionally, combination therapy for treating mild depression significantly impacts the patient population. Patients using combined therapy have higher short-term and long-term recovery rates, low risks of relapse, enhanced long-term social functioning, improved compliance to drugs, greater patient satisfaction, and reduced long-term health costs. Patients with inadequate responses to single treatment modalities also significantly benefit from combined treatment. Not only does combined treatment produce faster short-term benefits, but it also has numerous lasting advantages. Patients receiving antidepressants together with psychotherapy usually have lower relapse rates compared to patients relying on antidepressants only to treat mild depression. They also have better long-term social adjustments compared to patients on depression drugs alone. For patients over the age of 60, research has shown that combining medications with psychotherapy decreases the likelihood of depressive relapse (Grover & Avasthi, 2019). Compared to drug therapy alone, combined therapy is effective for reducing relapse after discontinuation of treatment.
Combination therapy also impacts health policy. Enhancing the quality of care for depression is required to raise the value of care and improve the benefit of treatment dollars. Decreasing a functional limitation through care improvement could increase a patient’s annual income. From the patient’s viewpoint, quality improvement contributes to better functioning, an aspect which significantly improves patient satisfaction. This could be meaningful to plans competing for patient enrollment. The policy implications of cost-effective combination therapy are twofold. First, it will establish standard care measures in the public domain, which will, in turn, allow health plans and employers to identify providers offering the best care. Second, it will drive the incentives for higher quality mental care.
The impact of combination therapy for treating depression on the education centre on the incorporation of combination therapy as an evidence-based treatment for mild depression in the nursing curricula. According to Borglin et al. (2019), depression training should focus on how nurses can identify and monitor depression, manage the condition, and utilize practical approaches based on patient-specific factors such as depression type and severity of symptoms. DNP Project -Depression Assignment
Further, a treatment modality combining pharmacotherapy and psychotherapy impacts the entire healthcare system (Furukawa et al., 2018). Effective management of mental health disorders is a priority for all health organizations. Depression can be dependably diagnosed and treated in primary care. According to the World Health Organization, a preferable treatment guide should consist of pharmacotherapy combined with psychotherapy. Given the surge of evidence asserting that combination therapy in treating mild depression, health systems should implement the approach to improve patient outcomes, decrease depression-related costs, and enhance patient satisfaction and quality of life. Although medications alone are effective in producing short-term benefits, there is a need to use drug therapy together with psychotherapy to achieve more lasting outcomes. These include a reduced likelihood of relapse, improved social functioning, and enhanced quality of life among patients diagnosed with mild depression.
References
Borglin, G., Räthel, K., Paulsson, H., & Sjögren Forss, K. (2019). Registered nurses experiences of managing depressive symptoms at care centres for older people: a qualitative descriptive study. BMC Nursing, 18(1). https://doi.org/10.1186/s12912-019-0368-5
Cook, S. C., Schwartz, A. C., & Kaslow, N. J. (2017). Evidence-based psychotherapy: Advantages and challenges. Neurotherapeutics, 14(3), 537-545. https://doi.org/10.1007/s13311-017-0549-4
Furukawa, T., Efthimiou, O., Weitz, E., Cipriani, A., Keller, M., & Kocsis, J. et al. (2018). Cognitive-Behavioral Analysis System of Psychotherapy, Drug, or Their Combination for Persistent Depressive Disorder: Personalizing the Treatment Choice Using Individual Participant Data Network Metaregression. Psychotherapy And Psychosomatics, 87(3), 140-153. https://doi.org/10.1159/000489227
Guthrie, E. A., Dickens, C., Blakemore, A., Watson, J., Chew-Graham, C., Lovell, K., Afzal, C., Kapur, N., & Tomenson, B. (2016). Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness. Journal of Psychosomatic Research, 82, 54-61. https://doi.org/10.1016/j.jpsychores.2014.10.002
Grover, S., & Avasthi, A. (2019). Clinical practice guidelines for the management of depression in children and adolescents. Indian Journal Of Psychiatry, 61(8), 226. https://doi.org/10.4103/psychiatry.indianjpsychiatry_563_18
Hellman, M. (2018). Social causes of depression, anxiety and stress. Nordic Studies on Alcohol and Drugs, 35(3), 149-151. https://doi.org/10.1177/1455072518773613
DNP Project -Depression Assignment