Brief Treatment Strategies for Major Depressive Disorder: Advice for the Primary Care Clinician

Ivan Valdivia, PhD Candidate; Nadine Rossy, BAC, PhD Candidate


Topics in Advanced Practice Nursing eJournal. 2004;4(1) 

In This Article


Major depressive disorder (MDD) is a common chronic and debilitating, but highly treatable, affective disorder. In the current climate of managed care, which limits the number of sessions and the type of treatment that can be provided, it has become important for clinicians to identify how they can best fulfill this mandate. There are many evidence-based treatments available to clinicians, including pharmacotherapy and psychotherapy, but patient preference, clinician availability, and time limitations often dictate the treatment approach. This article describes several behavioral techniques that can be easily adapted by primary care advanced practice nurses and other clinicians in order to provide brief but effective treatment to depressed patients. These techniques include: behavioral activation, guided self-management, and treatment adherence monitoring. The application of appropriate, evidence-based treatments by primary care clinicians will maximize the number of people effectively treated for MDD and relieve some of the strain on the healthcare system.

Karen, 32 years of age, presents to her primary care provider with complaint of chronic pain related to a previous back injury. She appears quiet and shy. In addition to the constant low backache, she reports feeling sad most days and has lost considerable interest in many of the activities that she once enjoyed, such as skiing and painting. She describes having difficulty concentrating at work and feeling guilty about many things that she does and has not done. In addition, she is complaining of having a poor appetite and having problems staying asleep. She reports that these symptoms are reduced on days she has less pain, but over the past 2 weeks, her symptoms have remained constant.


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