April 02, 2024

Major Depressive Disorder: Assessing Response to Therapy and Helping Patients Reach Remission

Posted By: Denise Vanacore, PhD, FNP-BC, PMHNP-BC

Best Practice for Assessing Response to MDD Therapy and Helping Patients Reach Remission
As a healthcare professional (HCP), it's important that part of our process is to evaluate the patient’s response to therapy. When patients say, “Hey, you know, I'm really feeling better. My mood is better, but I still don't feel like myself,” it's important for us to not just focus on the fact that their mood is better. We should not wave the remission banner too soon and continue to assess and treat as we see the patient in follow-up. We need to look for things like resistance to treatment. Sometimes the patient still has leftover symptoms of depression indicating an inadequate response, while other times those thoughts are adverse effects of the medication.

While patients can have some improvement in mood, sometimes we see a disconnect, with cognitive dysfunction occurring or even emotional blunting. When you start asking questions about the things that they can do, and the things that they still feel that they are unable to do often, this is where you see issues. They may mention not being able to complete daily tasks. They may report not being able to organize their calendar, or get to appointments on time, or meet deadlines at work or for home, like taking children to school, etc. So those cognitive issues really need to be discussed with the patient and then evaluated and obviously, as HCPs, we want to further treat those so that the patient can get to full remission.

One of the things I always tell HCPs is to make sure you know colleagues you can call for assistance when you need help with a case. When you're looking at that patient who you're not sure is completely in remission and you're not sure which direction to go, you want to have some assessment strategies to figure out what might be going on. Is there emotional blunting? Is there cognitive dysfunction? Are there other adverse effects that the patient is concerned about? Has the patient suddenly developed some suicidality that wasn't there before?

Like anything else in primary care, we want to get patients to full remission, we don't treat hypertension or diabetes to just good enough. We try to treat to our goal numbers and in mental healthcare, we want to be doing that as well. If we’re monitoring a PHQ-9, a BDI, or an anxiety inventory, we want to try to get to the patient being actually in remission.

Optimizing Communication With Patients and Employing Motivational Interviewing
As a provider, I find it helpful to talk to the patient about the importance of good communication and I always ask them to reach out to me and let me know when things might be changing because they might be experiencing changes in cognitive function or changes with an adverse effect. I don't want them to assume that some changes are a normal part of depression or depression treatment. While it's important for the patient to be able to reach out, it's also important for the HCP to employ motivational interviewing techniques with a lot of open-ended questions that will allow the patient to further verbalize what they are feeling and what is going on. This way, you will have additional assessment information to make decisions.

Strategies to Facilitate Ready and Affordable Patient Access to Optimal MDD Therapy
As we look at how we treat patients, a lot of times we follow guidelines that recommend to always start a particular medication first and then if that fails, try something else. Thereafter, we get to a place where we need to start a medication that is going to require a prior authorization or a peer review to provide rationale for why we are considering something different. This is important because we want to make sure that we are using the best medication to treat our patients. So often I like to put a lot of good clinical decision-making in my notes explaining what I've tried, what hasn't worked, what follow-up I have done, and sometimes even genetic testing can help guide what medications would work better. If you are submitting a prior authorization to an insurance company, you’ll want to include lab work that has been done, your note, and a letter from you explaining your treatment process before requesting the authorization.

Although genetic testing is still in its infancy and we're still looking closely at the data as they come out, it can sometimes be a helpful tool to determine what a patient might better respond to than what you’ve been trying. I know that patients sometimes get nervous about this. It is a simple cheek swab, so I try to reassure patients about the procedure. The key is looking at how you can write a prior authorization or a peer-to-peer letter so that you can make sure that your patient is able to access this form of diagnostic testing. I think it is something for us as HCPs to continue to assess and look at as it evolves as again a strategy that we can use to assist patients.

Filed under: Psychiatry , NPs & PAs

February 27, 2024

Guidance on Opioid Tapering

Posted By: Heather J. Jackson, PhD, FNP-BC, NEA-BC, FAANP

Within the United States, pain is the most common reason for adults to seek medical care within both ...

Filed under: Neurology, Psychiatry, Public Health, Substance Abuse, NPs & PAs

February 20, 2024

Patient Education: Safe Use of Opioid Analgesics a ...

Posted By: Amanda Zimmerman, PA-C

When providing patients with prescriptions of any type, it is best practice to also provide them wit ...

Filed under: Neurology, Psychiatry, Public Health, Substance Abuse, NPs & PAs

December 05, 2023

Navigating Nonpharmacologic Approaches to Chronic ...

Posted By: Theresa Mallick-Searle, MS, PMGT-BC, ANP-BC

The concept of multimodal treatment in chronic pain management goes back to some of the early establ ...

Filed under: Psychiatry, Preventive Medicine, Public Health, Substance Abuse, NPs & PAs

February 26, 2021

Diet and Depression: Is There a Link?

Posted By: Mary Knudtson, DNSc, NP, FAAN

Depression and anxiety are the most common mental health conditions worldwide and a leading cause of ...

Filed under: Psychiatry

November 10, 2020

Bringing Awareness to Body Dysmorphic Disorder (BD ...

Posted By: Lakshi M. Aldredge, MSN, ANP-BC, DCNP

Social media has revolutionized the way that humans see themselves. Thanks to filters and Photoshop, ...

Filed under: Miscellaneous, Psychiatry

October 30, 2020

Anxiety and Depression Amid COVID

Posted By: Mary Knudtson, DNSc, NP, FAAN

Lately, we've been hearing a lot about increases in anxiety and depression in the United States due ...

Filed under: Health Policy and Trends, Psychiatry

Clinical Education Alliance Terms and Conditions

These Terms of Use ("Terms") apply to your use of the websites, mobile applications and other resources provided by Clinical Education Alliance LLC (“CEA”) and its affiliates (referred to collectively as "CEA," "us," "we" and "our") that are intended for use by healthcare professionals, which we refer to as the "CEA Network," including the personalized information and services that meet the needs and interests of users of the CEA Network such as medical news, reference content, clinical tools, applications, sponsored programs, advertising, email communications, continuing medical education, market research opportunities and discussion forums (collectively, the "Services"). You will always be able to view the most current version of these Terms by clicking on the Terms of Use link at the bottom of any page of a CEA Network property. Note that these Terms do not apply to our properties and services that display a link to different terms of use. In the event that we expand the CEA Network through our acquisition of another company and/or its properties, that company may operate its properties subject to its own terms of use accessible via a link on such properties until we integrate its practices with ours, at which point a link to these Terms will be displayed on its properties. By using the Services, you agree to these Terms, whether or not you are a registered member of the CEA Network. These Terms govern your use of the Services and create a binding legal agreement that we may enforce against you in the event of a violation. If you do not agree to all of these Terms of Use, do not use the Services!

We reserve the right to change these terms from time to time. The most current version may be viewed by clicking on the “Terms of Use” link at the bottom of designated pages on the Clinical Education Alliance Sites. Use of the Clinical Education Alliance Sites after the effective date constitutes acceptance of the amended Terms of Use. When you leave a CEA Web site and go to another Web site, different terms apply and CEA has no responsibility or liability for any content on those sites.

Clinical Education Alliance Content

The Clinical Education Alliance Sites incorporate information, including modules, capsules, journal articles, medical news, references, interactive case studies, other continuing education material, downloadable software applications, advertising, and other healthcare information, which is intended for adults who are licensed healthcare professionals. This information is not intended to serve as a substitute for the healthcare professional’s clinical judgment. If you are a consumer who chooses to read this professional-level information on Clinical Education Alliance Sites, you should not use or rely on that information as professional medical advice or use it to replace any relationship with your physician or other qualified healthcare professional or any information they may have provided to you. For medical issues or concerns, including decisions about medications and other treatments, consumers should always consult their physician or, in serious cases, seek immediate assistance from emergency personnel.

The Content on the Clinical Education Alliance Sites is developed or selected in accordance with our published Editorial Policies. However, users access and use this material at their own risk. It is the reader’s job to evaluate the accuracy of any information and results from interactive programs found on the Clinical Education Alliance Site. If you are a healthcare professional, you should rely on your professional judgment in evaluating any and all information and confirm the information contained on the Clinical Education Alliance Sites with other sources and reliable third parties before basing any treatment or advice on it. If you are a consumer, you should evaluate the information together with your physician or another qualified healthcare professional.

DISCLAIMERS AND LIMITATIONS OF LIABILITY

THE CONTENT, APPLICATIONS, SOFTWARE, AND ALL OTHER MATERIAL ON THE CLINICAL EDUCATION ALLIANCE SITES ARE PROVIDED “AS IS” AND WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NONINFRINGEMENT. ALL WARRANTIES, EXPRESS OR IMPLIED, ARE HEREBY DISCLAIMED. CLINICAL EDUCATION ALLIANCE SHALL NOT BE LIABLE FOR ANY SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, INCLUDING, WITHOUT LIMITATION, PHYSICAL HARM OR INJURIES, LOST REVENUES, OR LOST PROFITS, RESULTING FROM THE USE OR MISUSE OF THE CLINICAL EDUCATION ALLIANCE SITES, OR ANY INFORMATION, APPLICATIONS, MATERIALS, OR SOFTWARE THEREON, EVEN IF CLINICAL EDUCATION ALLIANCE HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, OR FOR ANY CLAIM BY ANOTHER PARTY. CLINICAL EDUCATION ALLIANCE DOES NOT WARRANT THAT THIS SITE OR ANY APPLICATIONS OR SOFTWARE WILL BE FREE OF BUGS, INACCURACIES, OR ERRORS, NOR DOES CLINICAL EDUCATION ALLIANCE WARRANT THAT ANY SITE, SOFTWARE, OR APPLICATION IS FREE OF VIRUSES OR OTHER HARMFUL ELEMENTS.

A user’s use of the Clinical Education Alliance Sites, and any reliance on any materials, information, software, or applications, is at the user’s own risk. You agree that you hereby release Clinical Education Alliance and its affiliates, owners, respective directors, officers, employees, advertisers, authors, and contributors from any and all liability or obligations arising from the use of the Clinical Education Alliance Sites. A user’s sole remedy for any problem or concern is to exit the Web site or application. You agree that you will indemnify and hold Clinical Education Alliance harmless for any loss, damages, or liability suffered by Clinical Education Alliance as a result of your use of any Clinical Education Alliance Site or material, application, information, or software thereon or your submission of any material to Clinical Education Alliance. Clinical Education Alliance reserves the right to restrict or limit access to this Web site.

CEA Programs, Tools, and Databases

The Clinical Education Alliance Sites include interactive programs, clinical tools, and databases intended for the use of healthcare professionals. These materials are not intended as professional advice or recommendations of particular products. Physicians and other healthcare professionals who use our interactive programs, tools, or databases should exercise their own clinical judgment as to the results. Consumers who use the tools or databases do so at their own risk.

Individuals with any type of medical condition are specifically cautioned to seek professional medical advice before beginning any sort of health treatment. For medical concerns or issues, including decisions about medications and other treatments, users should always consult their physician or other qualified healthcare professional.

Ownership of Clinical Education Alliance Sites—Copyright and Trademarks

The entire contents and design of the Clinical Education Alliance Sites, including the software applications, tools, and databases, are protected under US and international copyright laws. These materials are owned by CEA or its affiliates or are used with permission of their owners or as otherwise authorized by law. All rights are reserved, worldwide. You may look at the Clinical Education Alliance Sites, download individual articles or applications to your personal computer or handheld device, and print a reasonable number of pages for your own personal reference. You must not remove any copyright notices from our materials. We reserve all our other rights. This means you may not sell, rewrite, or modify any content or other material found on any Clinical Education Alliance Site, redistribute it, put it on your own Web site, or use it for any commercial purpose without our prior written authorization.

The names of the CEA products and services are protected by trademark laws in the United States. Any use of our trademarks or service marks requires prior written approval from CEA.

You may link to a CEA Web site if your Web site offers products, services, or information of interest to the professional healthcare community. You are not allowed to link to the Clinical Education Alliance Sites if you post illegal, obscene, or offensive content or if the link is likely to have a negative impact on CEA’s reputation. Any other use, such as framing any part of a CEA Web site or incorporating any CEA content into another Web site, product, or application, requires advance written permission from Clinical Education Alliance. Clinical Education Alliance assumes no responsibility for any Web sites or materials that are linked to Clinical Education Alliance Sites or materials.

Software Products and Applications

Clinical Education Alliance makes some software and accompanying documentation available for downloading from our Web sites and/or from iTunes. These materials are protected by copyrights under US and international law and are owned by Clinical Education Alliance or companies that have licensed the software to us. We do not transfer any ownership rights in software or documentation to you when you download it from our Web site and/or directly from iTunes. You may use the software and accompanying documentation for their intended purpose. You are not authorized to further copy or distribute the software and accompanying documentation, nor may you attempt to recreate or reverse engineer our software or applications. In addition, some software available for downloading from our Web sites and/or from iTunes is subject to US export controls. By downloading or using such software, you are representing to us that your download of such software complies with these controls.

US Government End Users

If you are affiliated with the US government, please note that the software and documentation available on our Web sites and/or directly from iTunes are “commercial items,” as that term is defined in 48 C.F.R. 2.101 (October 1995), consisting of “commercial computer software” and “commercial computer software documentation,” as such terms are used in 48 C.F.R. 12.212 (September 1995). Consistent with 48 C.F.R. 12.212 and 48 C.F.R. 227.7202-1 through 227.7202-4 (June 1995), all US government end users acquire the software and documentation with only those rights set forth herein.

Social Media, Message Boards, and Forums

Clinical Education Alliance offers users the opportunity to engage in social media interactions with both experts and other users of the sites. As with other online social media, users must exercise sound judgment in both the information that they post and in how they assess the postings of other users. As such, users are expected to adhere to the social media recommendations made by the American Medical Association when utilizing the social media capabilities of CEA sites. In particular, users must be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments and must not post identifiable patient information on CEA sites. In social media interactions, users must maintain appropriate boundaries of the patient–physician/care provider relationship in accordance with professional ethical guidelines just as they would in any other context. Users acknowledge that privacy settings are not absolute and that once on the Internet, content posted by them may be copied by third parties and republished out of the control of Clinical Education Alliance. Thus, users should routinely monitor their own Internet presence to ensure that the personal information and content that they post and, to the extent possible, that is posted about them by others is accurate and appropriate.

Users are expected to refrain from submitting comments or messages that are defamatory, hateful, or obscene or that harass others. Users may not impersonate any other person or violate any other person’s or entity’s legal rights or submit falsified credentials or experiences. Users agree that they will not submit any materials that violate or infringe any copyrights, trademarks, patents, trade secret, or other intellectual property rights of any third party. Clinical Education Alliance retains all copyrights in the content posted by users to its sites. Clinical Education Alliance may adopt additional rules to govern use of social media, message boards or forums, to which users will be subject.

Copyright and Other Legal Violations

If you believe that any material on this Web site infringes your copyright, please notify us as follows, under the Digital Millennium Copyright Act (“DMCA”). To notify us, the DMCA requires that you: 1. Send an email notice to Clinical Education Alliance at customersupport@clinicaloptions.com. 2. Include the following information in your email: a. Identify the copyrighted work(s) you claim is infringed; b. Identify the material you claim is infringing the copyright(s) and give enough information for Clinical Education Alliance to locate that material; c. Include a physical or electronic signature of the copyright owner or a person authorized to act on the copyright owner’s behalf (the “Claimant”); d. Include the Claimant’s name, address, and telephone number(s); e. Include a statement that the Claimant has a good faith belief that use of the disputed material is not authorized by the copyright owner or his agent; and f. Include a statement, under penalty of perjury, that the information in the notification of copyright infringement is accurate and that the Claimant is the copyright owner or is authorized to act on behalf of the copyright owner.

If you believe any content or material on the Clinical Education Alliance Sites violates any laws, please notify customersupport@clinicaloptions.com. Please include details about your concerns and an email address for contacting you.

Governing Law

Clinical Education Alliance controls the Clinical Education Alliance Sites from its offices in the state of Virginia in the United States of America. The Clinical Education Alliance Sites can be accessed from any of the United States and from other countries worldwide. Since the laws of each state or country may differ, both you and Clinical Education Alliance agree that the laws of Virginia, without regard to conflicts of laws principles, will apply to all matters relating to use of the Clinical Education Alliance Sites and materials, including software and applications.

Clinical Education Alliance makes no representation that materials on these sites are appropriate or available for use in countries aside from the United States. Accessing the Clinical Education Alliance Sites from territories where their contents are illegal is prohibited. Those who choose to access these sites from other locations do so at their own risk and are responsible for compliance with any and all applicable local laws or regulations.

Acceptance Procedure

By downloading or accessing materials on the Clinical Education Alliance Sites and/or directly from iTunes or registering with us, you agree to all the terms and conditions in this agreement, including the Terms of Use and Privacy Policy. If you disagree with any of these Terms of Use or Privacy Policy, please refrain from using the Clinical Education Alliance Sites or materials.

Privacy Policy

Because we provide education for healthcare professionals, we pay special attention to privacy issues. The purpose of our Privacy Policy is to identify the information we may collect about you, describe the uses we may make of your information and the security measures we take to protect it, and discuss your options for controlling your information. You can review our Privacy Policy by clicking on the “Privacy Policy” link at the bottom of designated pages on the Clinical Education Alliance Sites.

Disputes

If you fail to comply with these terms, we have the right to suspend or eliminate your account and remove any information you have placed on our site, including your registration information. We may also take any legal action we think is appropriate. If there is any dispute between us concerning this agreement or your use of any Clinical Education Alliance Site or materials or applications, we both agree to submit the dispute to nonbinding mediation, followed by binding arbitration. Both the mediation and the arbitration will be governed under the rules of the American Arbitration Association, and the venue for the arbitration will be Virginia.

Questions or Concerns About Our Terms of Use

For questions or concerns about these Terms of Use, please send an email to customersupport@clinicaloptions.com

These terms of use were last updated in July 2021.