Major Depressive Disorder Assessment

Major Depressive Disorder Assessment

An 18 year old male presents with feelings of worthlessness. He admits to drinking alcohol daily. What are important assessments that a Nurse Practitioner should perform?  How will you decide the appropriate diagnoses and evidence based interventions? Are screening tools available? What tool is quick used in the outpatient setting and provides valid depression assessment? What screening tool allows a focused psychotherapeutic intervention? 

Discussion 7: Major Depressive Disorder Assessment 

One of the common psychosocial symptoms experienced in primary-care settings is depression. The term depression is used to describe an extensive range of negative emotional experiences, scoping from sadness to disregard to pleasurable activities to self-hate. Besides, the hallmarks of major depression include sadness and apathy that is distinguished from ordinary mood changes. The common clinical patient presentation of depression is moderate to severe sadness and apathy feelings that one can attribute to depression (Dunphy et al., 2019). The clinical presentation comprises complaints of unexplained fatigue, and hyperactivity, anger, irritability, and anxiety. The assessment of the patient’s major depression need not be excessively complicated, but the emphasis of the assessment should take account of more than the absence or presence of substantial sadness or apathy.

The U.S. Preventive Services Task Force B recommendations advocate for implementation for adequate screening systems for depression among general adults to guarantee accurate diagnosis, an effective treatment plan, as well as a suitable follow-up (USPSTF, 2016). The USPSTF recommends two quick questions for the preliminary screening for depression. First, the 18-year-old patient should be asked if he has felt down or hopeless in the last month. The second question is whether the patient has been experiencing minimal interest in doing things in the last month. If the patient offers a positive response to either one of the two questions in the preliminary screening indicates the possibility of major depression; however, the test has a higher false-positive rate. Therefore, the nurse practitioner should conduct a confirmatory test using the validated screening instruments or clinical interview.

Furthermore, an effective supplementation to the USPSTF two-question screening is the Patient Health Questionnaire‚Äď9 that constitutes a checklist of 9 symptoms by asking the patient to state the frequency of occurrence of symptoms in the previous two weeks. The PHQ-9 instrument is filled out quickly by the patient in the exam room before the primary-care visit and is scored based on the frequency of symptoms. A similar metric of the severity of symptoms is the self-rated Quick Inventory Depressive Symptomatology that is used for screening depression and additional benefits of including the severity of symptoms which in turn provided a sensitive change metric with treatment.

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After the self-assessment of the depression symptoms, the nurse practitioner could determine the intensity, duration, and impact on the functioning of symptom to consider the treatment priorities. If the patient is experiencing difficulty listing the symptoms, the assessment will be substituted using screening tools like the Zung Self-Rating Depression Scale, Beck Depression Inventory, checklists, direct observations, or yes-or-no questions. Besides, the practitioner should indicate that the purposes of asking the yes or no questions are to gain a full understanding the depression rather than qualifying or disqualifying for treatment (Bickley et al., 2017).  Besides, the patient should be prudently evaluated for fundamental medical conditions since neurological and medical disorders, as well as pharmacological substances, may produce depression symptoms. Thus, a physical examination and medical history should be conducted, including urinalysis, neurological examination, and routine blood work. The medical history includes the personal and family history of depression and suicide.

A medication assessment will include OTC drugs, herbal agents, as well as alcohol and substance use. The DSM-5 symptoms criteria for the diagnosing major depression necessitate that five or more symptoms have been manifested in the same two-week period and signify a change from earlier functioning. The symptoms are depressed mood, anhedonia, feelings of hopelessness, apathy, appetite change, hypersomnia or insomnia, retardation, energy loss, guilt or worthlessness, loss of concentration, and recurrent death or suicidal thoughts.

The goal of the patient’s therapy is the remission of the depressive symptoms as the standard for a successful depression treatment plan, which is the absence of symptoms or below 5 PHQ-9 scoring. Alternatively, the response could be defined as a 25% to 50% decrease on the PHQ-9 score (Halpern & Vermeulen, 2017). The attainment of remission is significant since incomplete relief of depressive symptoms might increase the risks of relapse and impairment. The bases of treatment are the use of suitable antidepressants and/or psychotherapy. If the patient has either mild to moderate depression, the recommendation is either drugs or psychotherapy, in case more severe depression, the evidence-based guidelines advocate for simultaneous drugs or psychotherapy (Michigan Quality Improvement Consortium, 2012). However, if the patient has expressed suicidal intent or the history consists of suicidal attempts, it is important to consult a psychiatrist or behavioural specialist. The effective medications in the front-line treatment are selective serotonin reuptake inhibitors, norepinephrine reuptake inhibitors, tricyclic antidepressants, dopamine agonists, and serotonin-norepinephrine reuptake inhibitors (Kaiser Permanente Care Management Institute, 2012). Besides, the prescription of antidepressant medications commences with patient education, including the potential benefits, specific medication, expected effects, adverse effects, management, and handling an emergency.

Also, cognitive-behavioral and interpersonal therapy have been proven to be effective for depression treatment. A combination of both psychotherapy and pharmacotherapy is effective for patients with major depression for patients with untreated depression. Finally, follow-up during the treatment necessary to make sure that the patient has adhered to therapy by monitoring to ensure that the patient filled the prescription and took the medication. The treatment outcomes are assessed using diagnostic assessment tools regularly to appraise the effectiveness of prescription in the early phases of treatment till remission of full symptoms has been obtained.


Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Bickley, L. S. (2017).¬†Bates’ pocket guide to physical examination and history taking. Philadelphia: Wolters Kluwer.

Dunphy, L. M. H., In Winland-Brown, J. E., In Porter, B. O., & In Thomas, D. J. (2019). Primary care: The art and science of advanced practice nursing. Philadelphia, PA: F.A. Davis Company.

Halpern, J., & Vermeulen, K. (2017). Disaster Mental Health Interventions: Core Principles and Practices. Florence Taylor and Francis.

Kaiser Permanente Care Management Institute (2012). Adult depression: Clinical practice guidelines. Kaiser Permanente Care Management Institute, Oakland, CA. Retrieved from http://www.providers.kaiserpermanente.org/info_assets/cpp_cod/cod_depression_guideline_0712.pdf

Michigan Quality Improvement Consortium. Medical management of adults with hypertension. Revised August 2011. Retrieved from https://www.ahrq.gov/gam/index.html

U.S. Preventive Services Task Force (January 26, 2016). Screening for Depression in Adults US Preventive Services Task Force Recommendation Statement. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/depression-in-adults-screening

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