Depression is a mental state in which the brain chemically changes affecting an individual's feelings and reaction to situations. Major depressive disorder (MDD) is a complex mood alteration characterized by deep feelings and sorrow, and often occurs in a day, week, and year (van Krugten et al., 2017). The rise in the spread of MDD has raised concerns among experts in the medical field. Therefore, an assessment on the type of studies conducted in MDD is significant in identifying the way out of the crisis by mitigating risks through anticipation of future issues and questions regarding the mental health state.
Indicators of Patients with Major Depressive Disorder in Need of Highly Specialized Care: A Systematic Review
The unmanageable MDD cases require early identification for the medical practitioners to recommend a highly specialized type of care for the patient. As a result, the procedure involved during treatment of an unmanageable MDD patient will be minimized resulting in its effectiveness. In this regard, the study by van Krugten et al. (2017) reviews indicators among MDD patients that guide the therapist on individuals who require specialized care.
The study entailed a review of previous works which retrieved 7,360 articles. Among these articles, 1,388 were excluded due to duplication. Additionally, 5,917 articles were excluded due to the difference in the research design or the subject matter under discussion in these papers. Among the remaining fifty-five papers, sixteen met the eligibility criteria. The sixteen papers were reviewed in the study by van Krugten et al. (2017), since MDD was their primary diagnosis, the research design adopted, and the content of the papers was relevant.
A structured qualitative analysis was conducted in the form of a literature review. The studies under review were retrieved from PubMed and PsycINFO databases. Eligibility criteria were used by two reviewers to determine the studies to be used. After the identification and selection of quality studies, three reviewers conducted a further analysis of the studies through the use of a pre-piloted form that meets set standards.
Strength and limitation of the study
The study by van Krugten et al. (2017) is reliable and valid since literature searches on legit databases ensure authentic works were reviewed. Additionally, the literature searches conducted made sure that the current study is well structured, and information drawn from the sixteen selected papers was used to make evidence-based findings. However, one of the significant limitations is that the study does not give any contributions regarding medication efficacy. Additionally, there is no precedence on the effect of the use of highly specialized care on MDD patients. The criteria for providing highly specialized care may not be well defined, but the development of a valid tool would play a significant role in the identification of indicators among patients.
In summary, the study yielded results since the indicators of MDD patients who require specialized treatment were uncovered. The study comprehensively covers the signs of an MDD patient who needs specialized treatment. Some of the signs deduced include the patient's treatment response history and whether remission was achieved or not. However, the study faced limitations such as the omission of essential indicators through the exclusion of studies that would have provided valuable information.
Major Depressive Disorder: Understanding the Significance of Residual Symptoms and Balancing Efficacy with Tolerability
Culpepper, Muskin and Stahl (2015) conducted a study aimed at reducing the cost of MDD to the economy by assessing the significance of residual symptoms of the medical state, and how to strike a balance between efficacy and tolerability to achieve remission.
Patients diagnosed with MDD are assessed to determine the effectiveness of medication on their health. The study focuses on the remission perspective of the patients by investigating the patient's predisposal to factors such as recurrence and chronicity. As a result, patients with and without residual symptoms were assessed. An analysis of the intake of antidepressants used or the type and duration of therapy initiated on the patients was aimed at identifying the level of the improved outcome on the patients.
The qualitative research methodology was adopted in the review of the literature on MDD. The specific literature analyzed includes insights into the relevance of residual symptoms in finding appropriate measures to reduce the signs. The exploratory methodology uses a semi-structured design to uncover trends in remission among patients diagnosed with MDD.
Strength and limitations of the study
The study majorly focused on a literature review of previously conducted studies in a quest to find improved outcomes in the use of anti-depressants. The research methodology adopted is useful in the analysis of personal characteristics and behaviors among patients with MDD. As a result, the study used the information to formulate appropriate strategies that will fit the needs of resistant MDD patients. To further elaborate, the research achieved its goal through the incorporation of an individually optimized treatment among resistant patients. The major limitation of the study was that the qualitative descriptions do not give a magnitude of MDD patients' resistance which can be illustrated in detail through the use of numbers.
The complexity of MDD among patients is as a result of the difference in symptom diagnosis. As a result, patients respond differently to medication; there are those who achieve remission with an initial therapy while others require individualized optimized treatment to reach remission. Therapists use neurobiological principles to accord treatment of patients who fail to achieve remission with the first medication.
Combination of Antidepressant Medications from Treatment Initiation for Major Depressive Disorder: A Double-Blind Randomized Study
In his study, Blier (2010) found that to increase the efficiency of medical treatments on MDD patients; combined antidepressant drugs should be administered. Moreover, an increase in the number of drugs combined results in an increase in remission rates.
The study was conducted on 105 patients located in three different sites. The first research was conducted on 65 patients located in the University of Florida. The rest of the patients were located in the University of Ottawa, Institute of Mental Health Research and a clinic in Canada. Two guidelines were used in the selection of patients the diagnostic and statistical manual and the Hamilton Depression Rating Scale. The patients had to meet the requirements as set by DSM-IV and a rating of at least 18 on the HAM-D scale.
The study adopted a double-blind approach where the study experimenters and the patients did not know the experimental groups allocated. The patients were randomly assigned to four groups of medication and the results observed on the HAM-D scale.
Strength and limitation of the study
The major strength of the study was the specification of the antidepressant drugs used and the use of the double-trial approach which ensured the validity and reliability of the results was guaranteed. The study added new insights into the literature of mental health; however, factors such as financial cost or intolerable side effects would limit its application in social work practice. The major limitation is in the recruitment of the study population which would result in inappropriate interpretations.
The study by Blier et al. (2010) found that the combination of anti-depressant drugs result in superior medical effectiveness in the intervention of an MDD patient. A double-blinded approach was adopted in the study with the aim of assessing the effects of combined antidepressant use. The findings on the study suggested that the combination of anti-depressant drugs would double the remission rates. Additionally, the combination of the anti-depressant drugs is well tolerable as the fluoxetine monotherapy according to the HAM-D score.
Conclusively, a therapist diagnoses a person of major depressive disorder upon an assessment of patient symptoms. These signs include weight loss, agitation feelings, insomnia, concentration troubles, tiresomeness, and withdrawal of interest from what was once an exciting activity. Studies have shown that an increase in remission rates are attributed to the use of combined antidepressant drugs.
Blier, P., Ward, H., Tremblay, P., Laberge, L., Hebert, C., & Bergeron, R. (2010). Combination of antidepressant medications from treatment initiation for major depressive disorder: A double-blind randomized study. The American Journal of Psychiatry, 167(3), 281-8.
Culpepper, L., Muskin, P., & Stahl, S. (2015). Major depressive disorder: Understanding the significance of residual symptoms and balancing efficacy with tolerability. The American Journal of Medicine, 128(9), 1-15.
van Krugten, F., Kaddouri, M., Goorden, M., van Balkom, A., Bockting, C., Peeters, F., & Hakkaart-van Roijen, L. (2017). Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review. PLOS One Journal, 12(2), e0171659.
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