Date of Award

2024

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Dr. Benjamin White

Readers

Patrick Murphy

Abstract

A large proportion of individuals with major depressive disorder (MDD) do not receive adequate therapy benefits from conventional monoaminergic antidepressant drugs, leading to treatment-resistant depression (TRD) (Di Vincenzo et al., 2021). Treating MDD with two failed antidepressant trials can lead to TRD, a condition wherein patients are twice as likely to be hospitalized in comparison to depressed patients who are not treatment-resistant (Gaynes et al., 2020). MDD and dysthymia are jointly responsible for 46.9 million disability-adjusted life years (DALYs) globally, with each DALY equivalent to a healthy year of life lost to the disability caused by depressive disorders (Vos et al., 2020). In fact, MDD is the single largest contributor to the loss of healthy life, and this contribution has further increased during the COVID-19 pandemic (WHO, 2017). When benchmarked against a total of 369 diseases and injuries, depressive disorders were the 13th leading cause of overall burden and the seventh leading cause of nonfatal burden, globally (Voss et al., 2020). According to the U.S. Food and Drug Administration (FDA) and the European Medicines Agency, TRD is a failure to respond to two or more antidepressant regimens despite adequate dose, duration, and adherence to treatment (U.S. Food and Drug Administration, 2018). It is estimated that TRD affects a range of 6-55% of people receiving antidepressant treatment (Liu et al., 2021). Compared to MDD, TRD is associated with higher rates of chronic medical comorbidities, more frequent and longer hospitalization visits, and impaired functioning in daily activities (Touloumis, 2021; Dibernardo et al., 2018). Additionally, patients with TRD often struggle with substance use disorders, anxiety, and insomnia among other psychiatric concerns, and have a heightened risk of mortality by suicide compared to patients with MDD alone (Cepeda et al., 2018; Kern et al. 2023). Evidently, the prevalence and burden of both MDD and TRD indicates an imperative need to implement therapies beyond conventional antidepressant medication.

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