Management of Treatment-Resistant Depression Discussion Paper

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Management of Treatment-Resistant Depression Discussion Paper

Part 1

How long should the next regimen last?

From the part 1 scenario provided, her next antidepressant prescription should preferably last at least 6 to 12 months to achieve long-term remission given her history of relapse after a failed tape.

If remission is not achieved within 2 to 3 months of restarting therapy, what should occur?

If she does not achieve remission within 2 to 3 months of restarting therapy, her treatment plan should be reevaluated. The doctor should think about adjusting the dosage, switching medications, or combining therapies like psychotherapy (Włodarczyk et al., 2021). During this period, close monitoring is essential. If there is still no change after careful adjustment and around 12 weeks of treatment, a more complete appraisal is required to explore alternative strategies and probable underlying problems. Patience and collaborative decision-making between the patient and her healthcare practitioner are critical in determining the best appropriate treatment for her specific disease (Voineskos et al., 2020). Management of Treatment-Resistant Depression Discussion Paper

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References

Voineskos, D., Daskalakis, Z. J., & Blumberger, D. M. (2020). Management of treatment-resistant depression: challenges and strategies. Neuropsychiatric disease and treatment, 221-234.

Włodarczyk, A., Cubała, W. J., & Stawicki, M. (2021). Ketogenic diet for depression: A potential dietary regimen to maintain euthymia?. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 109, 110257.

Part 2

The initial plan of care

The 32-year-old nurse’s initial treatment plan includes educating the patient on proper hand hygiene practices, prescribing a mild topical corticosteroid cream for two weeks, advising the use of mild soap and lukewarm water, recommending frequent application of fragrance-free moisturizers, identifying and avoiding irritants, suggesting barrier creams for protection, and scheduling a follow-up appointment to assess progress and adjust treatment if necessary (Ramos Campos et al., 2020). Management of Treatment-Resistant Depression Discussion Paper

Education to prevent further hand dermatitis

The patient would be instructed on many critical actions to prevent further hand dermatitis. To begin, they should use lukewarm water and moderate, fragrance-free soap while washing their hands. After washing, it is critical to dry hands gently and apply moisturizer immediately. To protect the skin, gloves should be used when handling irritants or during work shifts (Kersh et al., 2021). Barrier creams should be administered prior to exposure to possible irritants.

Furthermore, the patient should recognize and avoid triggers such as strong chemicals. Because stress can aggravate skin issues, stress management measures may be recommended. Education on the proper use of topical corticosteroid cream is critical, emphasizing the significance of adhering to the application parameters (Ramos Campos et al., 2020). Finally, the importance of regular follow-up sessions to assess progress and make modifications based on reaction should be emphasized.

References

Kersh, A. E., Johansen, M., Ojeaga, A., & de la Feld, S. (2021). Hand dermatitis in the time of COVID-19: a review of occupational irritant contact dermatitis. Dermatitis, 32(2), 86-93.

Ramos Campos, E. V., Proença, P. L. D. F., Doretto-Silva, L., Andrade-Oliveira, V., Fraceto, L. F., & de Araujo, D. R. (2020). Trends in nanoformulations for atopic dermatitis treatment. Expert Opinion on Drug Delivery, 17(11), 1615-1630. Management of Treatment-Resistant Depression Discussion Paper

Part 1

According to the scenario in part 1, the patient’s following treatment regimen should ideally last until he or she achieves remission. Suppose remission is not completed within 2 to 3 months of restarting the medication. In that case, the treatment plan may need to be reassessed, taking into account factors such as dosage adjustments, alternative medications, or additional interventions to address the patient’s specific needs and her history of depression (Voineskos et al., 2020). Regular contact with a healthcare professional is essential for monitoring progress and making educated decisions about the regimen’s length and changes (Włodarczyk et al., 2021).

References

Voineskos, D., Daskalakis, Z. J., & Blumberger, D. M. (2020). Management of treatment-resistant depression: challenges and strategies. Neuropsychiatric disease and treatment, 221-234.

Part 2

The initial plan of care

Education to prevent further hand dermatitis

Part 1
A female patient is a diagnosed depression patient who needs to restart on medications. Her major symptoms are lack of interest in her usual activities and some anxiety associated with her workplace stress, but she denies issues of sleep disturbance and overeating. These were issues when she was diagnosed as depressed 2 years ago. She received a selective serotonin reuptake inhibitor (SSRI) medication, Paxil, at that time. She is reluctant to take them again because she had an onset syndrome that she had not been warned about. She admits she did not do very well on it because the MD took a slow and watchful approach to altering her medications. She also had a “rough time” when she decided to stop taking it after 2 years. She read an article that said timelines for depression medication therapy have changed and she has some questions about this. Management of Treatment-Resistant Depression Discussion Paper

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Her first question is whether she will have “onset” syndrome for her new SSRI prescription of citalopram and, if so, how long would it last?
She needs clarification on what the term self-limiting means.
The patient then asks about the internet article about the newer approach behind aggressively moving dosage levels higher at a rapid pace (unlike the slow and cautious approach she had previously).
She wants to know how long she is expected to stay on the higher dose prior to thinking about tapering them off.
She, however, is a patient who has a return to a depressive state after one failed taper. How long should the next regimen last? If remission is not achieved within 2 to 3 months of restarting therapy, what should occur? Management of Treatment-Resistant Depression Discussion Paper

part 2
Case Study

Complaint: Itchy red hands

A 32-year-old nurse presents to clinic with a 2 week history of worsening redness, dryness, and rash on her hands. They recently graduated from nursing school and has started working on a medical-surgical unit. The patient washes hands multiple times a day and has noticed the dryness and redness has worsened during the winter months.

Assessment: The skin on the patient’s hands is red, dry, scaly, and excoriated, consistent with hand dermatitis.

What would be the initial plan of care for this patient with hand dermatitis?
What education would be provided to prevent further hand dermatitis? Management of Treatment-Resistant Depression Discussion Paper