Evaluating Effective Management of Depression

Evaluating Effective Management of Depression
Depression is predicted to be among the leading diseases and global burden by 2030, especially in the high-income countries. In the United Kingdom, antidepressants are considered first-line treatment. According to Arroll, Moir, and Kendrick (2017), the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describe three categories of depression, including severe, moderate, and mild. It is therefore imperative to understand how the symptoms manifest in the different categories and the effective management approaches, including pharmacological and non-pharmacotherapy. This paper, therefore, examines depression as among the main mental health conditions, the diverse treatment options, and the current state of the topic. Also included is the relationship between this topic and my goals.
Topic Description
The topic involves understanding the different management strategies for depression. The National Institute of Health and Care Excellence (NICE) note some of the inventories that can be used to assess depression. Two of the tools include the hospital anxiety and depression scale (HADS) and patient health questionnaire 9 (PHQ-9). The main use of these tools is to evaluate the severity of the condition and monitoring the patients’ progress (Hopkins, Crosland, Elliott, & Bewley, 2015). Some of the statistical data showing the importance of understanding the prevalence and management strategies of depression are provided by the World Health Organization (WHO). In 2017 only, the condition was identified as the main cause of disability and ill health (WHO, 2018). WHO states that at least 300 million individuals live with depression. From 2005-2015, there was an 18% increase in the number of people with the condition. Some of the symptoms related to the condition include constant fatigue, appetite change, anxiety, restlessness, worthlessness feeling, and suicidal ideation.
Despite the availability of PHQ-9 and HADS tools in diagnosing depression, effective management of the condition remains under evaluated. This is centered on changing patient symptoms and different management strategies such as collaborative care. Bjorkelund et al. (2018) contend that organizational intervention strategies and collaborative care approaches should be centered on effective leadership, supportive decision making, and integration of community and specialist resources. In addition, comprehensive training to healthcare providers is imperative to enhance their knowledge in evaluating patients and developing effective management strategies. On the other hand, research demonstrates that individual interventions are not effective in managing depression in primary care. With the introduction of different drugs and non-pharmacological management strategies, understanding the combination of these interventions can significantly reduce depression while enhancing the quality of life and patient satisfaction. Notably, managing depression through drugs, lifestyle modification, and profound follow-up reduces the length of stay at the hospital and promotes the individual’s quality of life.
Significance of the Topic
The significance of understanding the different management strategies for depression is vital in developing holistic and evidence-based practices for the condition. According to Bjorkelund et al. (2018), increased time in the waiting room for screening, developing clinical guidelines, and separate individuals cannot be compared to the regular primary care based on the effectiveness. Khusid and Vythilingam (2016) argue that complex interventions and collaborative care are essential in primary care as well as educating healthcare professionals. In the treatment and prevention of depression, strengthening the nurses’ roles as care managers in carrying out counseling through telephone and providing treatment advice demonstrates the integration of specialized and primary care. In effective care management, it entails an increased collaboration between primary caregivers and patients to ensure continuity in care. An essential element in collaborative care management is ensuring adequacy in the antidepressants and the adherence in the medication plan. This reduces the symptoms’ burden.
The use of selective serotonin reuptake inhibitors (SSRIs) as first-line treatment for depression has increased significantly. Jakobsen et al. (2017) posit that various meta-analysis and reviews show that SSRIs have significant effects on depressive symptoms. Understanding how SSRIs work is essential in determining the prescription of the drug alongside other interventions in care management. Haim, Albin-Brooks, Sherer, Mills, and Leuner (2016) note that SSRIs affect the neurotransmitters’ concentration in one’s brain, which suppresses the depressive symptoms. However, there are questions regarding the clinical and beneficial aspects of these SSRIs. The impacts of depression include meeting the activities of daily living and increased suicidal ideation. Haim et al. (2016), in a literature review, shows that SSRIs are important in addressing these symptoms, thus promoting the individual’s quality of life. In the US, these drugs have become the most popular, especially Fluoxetine, which was introduced in 1986. The mode of action is through inhibiting the reuptake of presynaptic serotonin. Understanding the role of SSRIs in managing depression aids in its prescription as first-line drugs.
Application, Integration, and the Current State of Affairs
The core application of knowledge in depression management and in particular, the use of SSRIs aids in formulating care management interventions that are holistic. These include using drugs, initiating cognitive based therapy, and lifestyle modification. The use of antidepressants in managing the condition is centered on their mode of action. However, the patient should be educated on the effects of these drugs. In effective healthcare, patient education is vital in promoting adherence to medication despite the severity of the side effects. Some of the side effects of the SSRIs include nausea, insomnia, diarrhea, and gastrointestinal challenges. According to Miller and Hen (2015), the metabolism of SSRIs is through the cytochrome P450 system. It is also essential to educate the patient on drug interactions such as antipsychotics, benzodiazepines, and phenytoin. Understanding this topic aids in conducting effective education for the patient on the side effects and drug interactions and how the associated challenges can be averted.
The implications of understanding the different management strategies of depression are centered on identifying the diverse diagnosis approaches and developing management strategies that are tailored towards addressing the patient symptoms and needs. Some of the key insights from conducting this study are the symptoms that should be present among depressed patients to establish effective interventions. Herron and Mitchell (2018) argue that at least three conditions should be present to conclude that a patient has depression. These include depressed mood, increased fatigue or reduced energy, and loss of interest and pleasure. Other symptoms that should be present to aid in making conclusions regarding the condition include insomnia, reduced appetite, suicidal ideation, and feelings of unworthiness and hopelessness. Notably, these symptoms should be present for more than two weeks. It is vital for healthcare providers to demonstrate competence in identifying these symptoms and make an effective judgment.
The current state of depression topic is based on establishing the prevalence of the condition and clinical management. One of the main aspects being evaluated presently is the prevalence of depression among the aged, which Herron and Mitchell (2018) note that it affects approximately 1-4% of the population. For the clinical depressive symptoms, the rates are more than 35% for the aged. Another current state of depression topic is the effective treatment strategies and the main challenge of missing the diagnosis procedure. The prevalence of depression among the aged is higher than other populations as a result of other conditions, loneliness, and isolation. Further, depression is related to increased mortality and morbidity rates. Other challenges related to the condition which need to be evaluated and mitigated include the increased alcohol and substance abuse among depressed individuals. In psychotic management of this condition, the current state of this topic entails underdiagnosis, which results in under treatment.
Relate to Course
The topic of depression management through the integration of different strategies such as SSRIs, cognitive based therapy, and conducting effective follow-up for the patient aligns with previous courses and my professional development goals in both short- and long-term. In my previous courses, I have learned about comprehensive care management for patients with different conditions from chronic to minor illnesses. A healthcare model that stands out in my learning in other courses and this program is person-centered care, which entails treating the patient as a whole. In this model, it involves factoring in the physical, psychological, and social aspects of the patient. In depression management, the person-centered care significantly applies and in particular, addressing all the patient’s needs (Arroll et al., 2017). Another essential aspect of person-centered care is enhancing the patient’s awareness regarding a condition and its management. This element is also included in depression care management, which involves educating the patient about SSRIs, their mode of action, and side effects.
In my professional development plan (PDP), both the short- and long-term objectives involve developing skills and competencies in various aspects and enhancing my medical knowledge. Depression remains a major healthcare burden, as discussed above in the current state of affairs. The relationship between my goals and the topic of depression management is centered on the different skills that healthcare providers are required to demonstrate in their practice. These include interpersonal and communication, which are essential in promoting the interaction between the patient and the healthcare provider to establish the patient needs and educate the individual on the different management strategies (Haim et al., 2016). Through this topic, I have understood the importance of continuous learning regarding the current healthcare interventions on health challenges which aid in developing evidence-based practices. Notably, these practices are applicable in my current program and diverse fields of healthcare practice. For instance, care coordination is applicable to depression and other acute conditions.
In summary, depression remains a major health burden and is estimated to be the leading cause of high mortality and morbidity rates by 2030. This trend is despite the development of effective diagnosis approaches such as PHQ-9 and HADS. It is therefore essential to understand the different management strategies and the current trends from research. These include the use of SSRIs and collaborative care plan. Evaluating this topic further is vital in formulating evidence-based practices for the condition to promote the patient’s quality of life and reduce the length of stay at the hospital.

References
Arroll, B., Moir, F., & Kendrick, T. (2017). Effective management of depression in primary care: a review of the literature. Br J Gen Pract Open, 1(2), bjgpopen17X101025.
Bjorkelund, C., Svenningsson, I., Hnage, D., Udo, C., Peterson, E. L., Ariai, N., … & Wallin, L (2018). Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial. BMC family practice, 19(1), 28.
Haim, A., Albin-Brooks, C., Sherer, M., Mills, E., & Leuner, B. (2016). The effects of gestational stress and SSRI antidepressant treatment on structural plasticity in the postpartum brain-A translational model for postpartum depression. Hormones and behavior, 77, 124.
Herron, J. W., & Mitchell, A. (2018). Depression and antidepressant prescribing in the elderly. Prescriber, 29(3), 12-17.
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Jakobsen, J. C., Katakam, K. K., Schou, A., Hellmuth, S. G., Stallknecht, S. E., Leth-Moller, K., … & Krogh, J. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry, 17(1), 58.
Khusid, M. A., & Vythilingam, M. (2016). The emerging role of mindfulness meditation as an effective self-management strategy, part 1: clinical implications for depression, post-traumatic stress disorder, and anxiety. Military medicine, 181(9), 961-968.
Miller, B. R., & Hen, R. (2015). The current state of the neurogenic theory of depression and anxiety. Current opinion in neurobiology, 30, 51-58.
WHO (2018). Depression. Let’s talk. Retrieved June 21, 2019, from https://www.who.int/mental_health/management/depression/en/