Role of a Nurse Practitioner Adult and Older Adult Essay

Week 2: Depressive Disorders
I have no one. My wife died suddenly 4 years ago and I know it was my fault. She had been complaining she was sick for a year, but the doctors kept saying it was nothing. When they finally found the cancer, it had spread throughout her body. I should have listened to her. She might have survived and I would not be alone. I seem to cry for no reason and my children don’t understand why I don’t want to go out of the house. This is where her memories are. Why would I want to leave?

Jose, age 75

The National Institutes of Mental Health acknowledges that depression is one of the most common mental disorders in the United States. It is associated with significant disability, fiscal impact, and considerable personal suffering. It may have significant impact on the individual, their family, and their social network. The PMHNP must be capable of providing comprehensive care for depressive disorders, including both psychotherapy and psychopharmacologic approaches.  Role of a Nurse Practitioner Adult and Older Adult Essay

This week, you will become “captain of the ship” as you take full responsibility for a client with a depressive disorder. You will recommend psychopharmacologic treatment and psychotherapy, identify medical management needs and community support, and recommend follow-up plans. You will also explore how to obtain a DEA license and the responsibilities for safe prescribing and prescription monitoring.

Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Chapter 8, “Mood Disorders” (pp. 347–386)
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

Chapter 12, “Psychotherapy of Mood Disorders”
Chapter 14, “Pharmacological and Somatic Treatments for Major Depressive Disorder”
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

\”Depressive Disorders\”
Major Depressive Disorder
Persistent Depressive Disorder (dysthymia)
Premenstrual Dysphoric Disorder
Substance/Medication-Induced Depressive Disorder
Depressive Disorder Due to Another Medical Condition
Other Specified Depressive Disorder
Unspecified Depressive Disorder
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. Role of a Nurse Practitioner Adult and Older Adult Essay

Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear.

To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.

As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role.

In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.

Learning Objectives
Students will:
Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with depression disorders
Recommend psychotherapy based on therapeutic endpoints for clients with depression disorders
Identify medical management needs for clients with depression disorders
Identify community support resources for clients with depression disorders
Recommend follow-up plans for clients with depression disorders
To prepare for this Assignment:

Select an adult or older adult client with a depressive disorder you have seen in your practicum.
In 3–4 pages, write a treatment plan for your client in which you do the following:

Describe the HPI and clinical impression for the client.
Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
Identify medical management needs, including primary care needs, specific to this client.
Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
Recommend a plan for follow-up intensity and frequency and collaboration with other providers.


Depression is a common psychiatric disorder that manifests as depressed mood, reduced energy, loss of interest, disturbed sleep, guilt feelings, lack of self-worth, lack of concentration, feeling of worthlessness and hopelessness, appetite changes and symptoms of anxiety. These symptoms can significantly impair the ability of a person to function and perform daily responsibilities (Stahl et al, 2015). In this assignment, a client diagnosed with major depressive disorder will be presented. The paper will discuss the HPI and the appropriate treatments for the client. In addition, the medical management needs, community support resources and follow-up plan for the client will be discussed.   Role of a Nurse Practitioner Adult and Older Adult Essay



HPI & Client’s Clinical Impression

The client is a 42-year-old female. She reported having started experiencing a sad mood two years ago after her grandmother, the only parent she knew died. According to the client, her life changed and she lost the desire to live.  A year ago, she sought medical help and she underwent group cognitive behavioral therapy but she claimed that it never helped her. Since then, she has never sought any other medical services. The client reported that she was currently feeling weak, tired all the time and had lost the will to live. Additional symptoms that were reported included disturbed sleep, lack of appetite, aggressive behavior, sadness throughout, weight loss, lack of interest in activities that she used to enjoy, and social withdrawal. The client reported that currently, she is not reporting to work as usual because she feels overwhelmed with life and does not see the need for working. In the light of DSM-5 diagnostic criteria, the client was diagnosed with major depression disorder (Stahl et al, 2015).

Psychopharmacologic Treatments

Citalopram 20 mg PO qDay: The recommended medication is citalopram. Citalopram is an SSRI that works by restoring the balance of serotonin within the brain and hence improves depression symptoms such as sadness, lack of energy, irritability, and feelings of wellbeing (Elliott, 2014). This medication was selected because its efficacy in improving depressive symptoms has been shown.  In addition, citalopram has a good safety profile, is well-tolerated and has minimal side effects (Stahl, 2014).

Psychotherapy Choices

Problem-solving therapy (PST): PST will be used to teach the client how to deal with life problems and events such as the loss of a loved one. In addition, PST trains people on how to make the best of their wellbeing by effectively addressing their problems. PST improves depressive symptoms and the quality of life by equipping people with problem-solving skills and improving their problem-solving skills (Renn & Arean, 2017). Therefore, it is expected that through PST, the client will gain problem-solving skills and also gain the ability to cope with life events such as the death of a loved one.

Medical Management Needs

There is a need for the client to begin the prescribed medication at a sub-therapeutic dose to assess if the client will tolerate the dose and respond to the minimally effective dose. It is also important to monitor the client’s adherence to the prescribed treatments. Moreover, there is a need to identify any stressors in the life of the client that may trigger depressive symptoms, as well as engage social support for her (Mark et al, 2017). Finally, the client should be assessed for any suicidal tendencies because individuals with severe depression have a high tendency of attempting suicide and suicidal ideation is common in major depressive disorder.  Role of a Nurse Practitioner Adult and Older Adult Essay

Community Support Resources

The most accessible local support group for people with depressive disorders and other mental health problems will be identified and have the client referred. This will give the client a chance to engage and interact with people with similar challenges and thus get peer support. Moreover, the client will be assigned a social worker who will monitor her progress and compliance with treatment while at home. Finally, she will be provided with reading materials covering major depression in order to help her get information on how to manage her condition (Turner & Lake, 2017).

Follow-Up Plan

The social worker will monitor the client’s progress and response to treatment while at home and also provide the required support. In addition, the client will be scheduled for review after two weeks. Healthcare providers who will be involved in the treatment of the client include a psychiatrist, PMHNP, and a social worker.

DEA License

Healthcare practitioners are required to have a DEA registration in order to administer, prescribe, and dispense controlled substances. It is possible to access a DEA license using their website


The diagnosis for the client is major depressive disorder according to the reported symptoms. The pharmacological treatment that was prescribed for this client is citalopram because the efficacy of citalopram in improving depressive symptoms has been demonstrated. On the other hand, the psychotherapy choice is problem-solving therapy to equip the client with problem-solving skills and coping skills. It is important to identify stressors in the client’s life and identify and engage the required social support. The client’s response and adherence to medication need to be monitored. The client will be provided with reading materials and referred to the appropriate local support groups.


Elliott R. (2014). Multi-modality: a new approach for the treatment of major depressive disorder, International Journal of Neuropsychopharmacology, 16(6), 1433–1442.

Mark C, Choon H & Ping Y. (2017). Managing depression in primary care. Singapore Med J, 58(8): 459–466.

Renn B & Arean P. (2017). Psychosocial Treatment Options for Major Depressive Disorder in Older Adults. Curr Treat Options Psychiatry, 4(1): 1–12.

Stahl M, Culpepper  L & Muskin P. (2015). Major Depressive Disorder: Understanding the Significance of Residual Symptoms and Balancing Efficacy with Tolerability. The American Journal of Medicine, (2015) 128, S1-S15.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Turner S & Lake J. (2017). Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. Perm J, 1(21), 17-024. Role of a Nurse Practitioner Adult and Older Adult Essay




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