This article written by Shelton and Papakostas deals with the health problem of treatment-resistant depression (2008). This refers to a situation where at least one trial of an antidepressant has failed. More specifically, the study investigates the effectiveness of atypical antipsychotics in treatment-resistant depression. This subject was chosen due to the report by the recent "National Institute of Mental Health Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study," which shows a very small percentage of people who actually recovered as a result of their first antidepressant treatment (Shelton & Papakostas, 2008).
The subject of this study is very important for Health People 2010, as it deals with the issue of effectiveness of antidepressants. The authors noted that there are several new antidepressants available in the market, and yet, the data showing responses of patients as a result of these antidepressants are dismal. For example, there are significant functional impairments found among patients who already had at least 50% improvement on the depression scale. Moreover, despite the relatively high mean dose of antidepressants, the fact remains that only few people actually recover from depression (Shelton & Papakostas, 2008).
This condition deserves adequate attention because it comprises about ten to twenty percent of people who have major depressive disorders. Thus, about 10-20% of depressed people fail to respond to traditional antidepressant treatments (Greenberg, et al., 2004). Existing data, however, do not segregate the affected population based on demographical indicators such as age and gender. The factors affecting this condition are not addressed by extant literature, but some research suggests ways of addressing the condition. Thus, in this article, it is suggested that atypical antipsychotics be used instead of traditional antidepressants.
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Atypical antipsychotics include drugs such as aripiprazole, risperidone, olanzapine, and ziprasidone. In order to determine how these drugs are relevant to treatment-resistant depression, the authors conducted a study consisting mainly of a study and review of clinical literature dealing with the use of such drugs to depressed patients (Shelton & Papakostas, 2008).
From their review of clinical literature, the authors found two atypical antipsychotics that seemed promising based on controlled clinical trials. These drugs are quetiapine and olanzapine. The effectiveness of other atypical antipsychotics were either not supported by data or contradicted by a later study. Thus, the authors were not able to conclude that all atypical antipsychotics are effective for treatment-resistant depression, because existing clinical literature on the matter is decidedly mixed and unclear (Shelton & Papakostas, 2008).
Nurses would play a significant role in the treatment of treatment-resistant depression, especially since the study showed how a lot of antidepressant medications do not work on the patients. It is noted that nursing is a profession that plays a very important role in the provision of health care. Since nurses spend a significant amount of time with patients, especially when they conduct rounds and take direct care of the patients, nurses often become more familiar to the patients than the doctors.
The nurses’ role in the recuperation or treatment of a patient is not limited to routine procedures and mechanical acts. More importantly, nurses could play a very important role in helping a patient recover psychologically from an illness. Nurses could help depressed patients by establishing a good, healthy, and strong relationship with the patient. More specifically, nurses should attempt to make patients comfortable so that they would be allowed by patients to treat them effectively.
Depression and stress are natural consequences of an illness. These emotional facets of the healthcare profession require nurses to know how to attend to these emotional needs. Emotional sensitivity and proper communication with patients would allow nurses to inspire patients with treatment-resistant depression to recover, despite the difficulty and the lack of effectiveness of various antidepressants in the market today.
Nurses interested in getting better on giving emotional support to patients could join nurses' associations, such as the NSW Nurses' Association. Details could be found at their website, http://www.nswnma.asn.au/nswnmamembers/benefits/. Organizations such as these provide support and assistance to nurses and give valuable information relating to the profession.
Chambers, M. (1998). Interpersonal mental health nursing: research issues and challenges. Journal of Psychiatric and Mental Health Nursing 5, 203-211.
Shelton, R. C. & Papakostas, G. I. (2008). Augmentation of antidepressants with atypical antipsychotics for treatment-resistant major depressive disorder. Acta Psychiatrica Scandinavica 117, 253-259.
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