Literature Review for a DNP Project

Introduction

The current chapter is intended to give the reader a state of the art review of the literature precise for the therapy of those individuals who are suffering from depression and comorbidity of anxiety. A well-researched analysis of existing peer-reviewed studies and data will create a strong ground for the DNP project implementation. This analysis should be thorough. Through integrative review, salient lessons, issues, and research avenues deserving more scrutiny are brought to the limelight by multiple authors.

Performing a comprehensive review of the literature before designing and applying evidence-based practices is a very significant step in the implementation of projects that are meant to deal with comorbid anxiety and depression. Such a tool guarantees the fact that the planned interventions which are SSRIs and CBT (selective serotonin reuptake inhibitors and cognitive behavioral therapy) are developed in line with the newest scientific research results and best available empirical evidence. Another fundamental issue is rich analysis which would illuminate any obstacles, facilitators, and strategies of choosing the suitable modalities for the treatment delivery.

This section critically reviews and simplifies the current state-of-the-art research which establishes the theoretical underpinnings and offers evidence for comparing psychotropic or pharmacological agents (SSRIs) with non-pharmacological strategies (CBT) that manage anxiety and depression. The reviewed literature will be used to bolster evidence in designing an efficient, applicable, and evidence-based DNP project, in the sense of reducing the disastrous impact of these comorbid conditions on individuals.

Clinical Question

Amongst those suffering from anxiety and depression in the medicated state, how does the clinical treatment with serotonin selective reuptake inhibitors (SSRIs) respond to the alternative psychological roots assessment (CBT) in diminishing dual anxiety and depression symptoms in three months of therapy?

Literature Review

Simultaneous mental health issues (co-morbid depression and anxiety) are among the major public health challenges, but they significantly suppress the quality of life and function of psychosocial and the whole welfare of the people. Bipolar disorder and depression’s co-occurrence is a rather common phenomenon, there are large-scale epidemiological studies that indicated that 45- 60% of those who are diagnosed with one disorder also meet the the criteria for the other (Gabriel et al., 2020). Thus this comorbidity, it is known to cause more severe symptoms, to further aggravate the health problem, to interfere with the person’s daily life and to reduce response to the treatments as compared to either to the disorder of anxiety or the disorder of depression when they are considered as single. Early interventions must therefore be given special attention as dealing with the co-morbidity of mental health and substance abuse with its individual and societal consequences is imperative.

Among numerous pharmacological treatments, SSRIs is the first-line option and remain the leading approach in the management of both anxiety- and depressive disorders. SSRIs work by blocking serotonin reuptake which is a major neurotransmitter that correlates with mood regulation, emotional processing, and anxiety reaction. In this way, they have reduced the core symptoms such as psychological and physical problems related to the diseases (Gabriel et al., 2020). In respect of multiple randomized control trials (RCTs) and meta-analytic reviews, it has been clearly established that selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, sertraline, paroxetine, and escitalopram are more efficacious in alleviating anxiety or depressive symptoms than the placebo in all the subtypes of different disorders

The evolving treatment for these psychiatric disorders has resulted in cognitive behavioral therapy (CBT) as a non-pharmacological psychotherapeutic approach that has come to dominate the sphere of anxiety and mood problems. CBT is a directed approach to the problem, – it is short-term and structured. It focuses on maladaptive thinking, behaviors, and cognitive distortions that maintain the subjective discomfort (Dubinsky et al., 2021). With the help of reappraisal as well as actions based upon exposure, CBT debilitates people with the skill of coping and tools needed to control anxiety, depression and functional impediments. Information from several RCTs and meta-analyses attests to the effectiveness of CBT in the healing of diverse anxiety disorders including generalized anxiety disorder, social anxiety disorder, panic disorder, and depression with the efficacy indices similar or surpassing those of pharmacotherapy.

SSRIs and CBT have proven to be highly effective in the management of unipolar disorders and well-established evidence base as treatments manage symptoms in individuals experiencing comorbid, condition. However, this has not stopped a continuous investigative and debate of how these two therapies compare to each other in managing the opposite conditions. studies inform that the combined treatment technique containing medication with therapy will achieve better results in comparison to those where only pharmacotherapy or psychotherapy is used. While an example was the recent meta-analysis ((Saha et al., 2021) which found that management of mood disorders, the combined treatment of antidepressant medication and CBT was more effective than antidepressants alone in reducing depressive symptoms among patients with comorbid anxiety and depression.

While others find that both SSRIs and CBT are comparable in the short term, some studies suggest that CBT can be more beneficial in the long term for particular populations, general symptoms or healthcare cost. The large nonsuperiority trial conducted by (Kalin, 2020) proved that CBT was non-inferior to antidepressants and on reducing symptoms of comorbid anxiety and depression for 16 weeks while CBT had supersior outcomes lasting for a period of 12 months as continue after follow up. For example, a review study by (Wilson et al., 2020) also revealed that psychotherapy was on par while antidepressants in treating anxiety disorders hoping that there are far less cases of psychotherapy relapse than antidepressants.

Whether CBT or SSRI will be appropriate is likely to be influenced by condition specificity, symptom severity, attitudes towards respective therapy, individual characteristics and all others factors (Saha et al., 2021; (Dubinsky et al., 2021). Such as, it has emerged that CBT is the most feasible method of treating generalized anxiety disorder and panic disorder but SSRIs provide great help in social anxiety disorder. Moreover, the practical challenges involved in cost and accessibility, treatment adherence and side effects could affect which treatments are chosen and end up succeeding.

In conclusion, both pharmacological approach (SSRIs) and non-pharmacological approach (CBT) have been observed to possess efficacy in dealing with comorbid anxiety and depression; however, the best treatment plan for these conditions remains as a research and contested area. Presented studies point out the need to match treatment toward the patient’s characteristics, symptom profiles, choice and practical considerations. It becomes imperative to carry out more high-quality independent studies that primarily focus on comparative analytics between these interventions as well as to further explore the possibility of combined or sequenced modalities to get improved outcomes in this highly prevalent and limiting comorbidity.

Literature Review Matrix

References

Dubinsky, M. C., Dotan, I., Rubin, D. T., Bernauer, M., Patel, D., Cheung, R., … & Keefer, L. (2021). Burden of comorbid anxiety and depression in patients with inflammatory bowel disease: a systematic literature review. Expert review of gastroenterology & hepatology, 15(9), 985-997. https://doi.org/10.1080/17474124.2021.1911644

Gabriel, F. C., de Melo, D. O., Fráguas, R., Leite-Santos, N. C., Mantovani da Silva, R. A., & Ribeiro, E. (2020). Pharmacological treatment of depression: A systematic review comparing clinical practice guideline recommendations. PLoS one, 15(4), e0231700. https://doi.org/10.1371/journal.pone.0231700

Gill, A. (2021). DNP FINAL REPORT: ENHANCING NURSES’ KNOWLEDGE ON OPIOIDS TO PROMOTE SAFE OPIOID USE IN POST-OPERATIVE PATIENTS: AN EVIDENCE-BASED PRACTICE PROJECT. DNP Final Reports. https://scholarworks.uttyler.edu/nursingdnp/22/

Kalin, N. H. (2020). The critical relationship between anxiety and depression. American Journal of Psychiatry, 177(5), 365-367.https://doi.org/10.1176/appi.ajp.2020.20030305

Khawagi, W. Y., Steinke, D. T., Nguyen, J., & Keers, R. N. (2019). Identifying potential prescribing safety indicators related to mental health disorders and medications: A systematic review. PLOS ONE, 14(5), e0217406. https://doi.org/10.1371/journal.pone.0217406

Lebel, S., Mutsaers, B., Tomei, C., Leclair, C. S., Jones, G., Petricone-Westwood, D., … & Dinkel, A. (2020). Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates. Plos one, 15(7), e0234124. https://doi.org/10.1371/journal.pone.0234124

Rios, P., Cardoso, R., Morra, D., Nincic, V., Goodarzi, Z., Farah, B., … & Tricco, A. C. (2019). Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews. Systematic reviews, 8(1), 1-16. https://doi.org/10.1186/s13643-019-1163-9

Saha, S., Lim, C. C., Cannon, D. L., Burton, L., Bremner, M., Cosgrove, P., … & J McGrath, J. (2021). Co‐morbidity between mood and anxiety disorders: A systematic review and meta‐analysis. Depression and anxiety, 38(3), 286-306.https://doi.org/10.1002/da.23113R

Ter Meulen, W. G., Draisma, S., van Hemert, A. M., Schoevers, R. A., Kupka, R. W., Beekman, A. T., & Penninx, B. W. (2021). Depressive and anxiety disorders in concert–A synthesis of findings on comorbidity in the NESDA study. Journal of affective disorders, 284, 85-97. https://doi.org/10.1016/j.jad.2021.02.004

Wilson, R. S., Yung, A. R., & Morrison, A. P. (2020). Comorbidity rates of depression and anxiety in first episode psychosis: A systematic review and meta-analysis. Schizophrenia research, 216, 322-329. https://doi.org/10.1016/j.schres.2019.11.035