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

Case Study, Part Two: Intervention With Karen

During an initial meeting, an advanced practice nurse who is knowledgeable about psychotherapy recognized the signs of depression in Karen's presentation for chronic back pain. The nurse scheduled a follow-up meeting in order to confirm the presence of MDD by proceeding through the diagnostic decision tree presented earlier. She confirmed the presence of the disorder and reported its presence to a mental health colleague to discuss possible interventions and course of treatment. After this consultation, she begins to intervene directly with Karen by developing and maintaining a strong and positive relationship.

The nurse spends 2 sessions gathering background information and exploring the various symptoms that Karen is experiencing. In the third session, she provides psychoeducation about MDD and answers any questions Karen has. In this session, Karen is asked to make a list of pleasurable activities. Karen chooses an activity to engage in over the next week. Over the next couple of sessions, the nurse explains the rationale for engaging in these activities, and she monitors Karen's engagement in these activities.

The nurse continuously monitors the patient's symptom severity by administering the BDI-2. Over the sessions, Karen begins painting again (an activity she lost interest in several months prior) and then slowly adds various other previously enjoyed activities. Further sessions involve maintaining her treatment gains and adherence. The nurse encourages Karen to proactively seek social interaction and monitor her activity involvement. With the support and behavioral interventions of the nurse, Karen begins to report a decrease in her symptom severity. She reports improved mood, sleep, and appetite, as well as a return of interest in a variety of activities that she previously enjoyed.


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