week 12 journal 2023
We have experienced a case of depression relapse with a pregnant patient for seven months. When she first came to the clinic, we recommended Zoloft 50mg daily, a selective serotonin reuptake inhibitor (SSRI), as it is safe during pregnancy and hoped it would relieve her depression. However, the situation worsens over time, as she cannot stop imagining losing her unborn child as she had lost three other pregnancies, so she fears the same would happen. Therefore, all efforts are futile, especially with changing hormones; she continues experiencing depression relapses.
As psychiatric mental health nurse practitioners, we have significantly helped patients cope with depression relapses. Though they keep occurring, the worst has not yet happened, and there is hope she will carry her baby to full-term. Kumar et al. (2020) elaborates that a PMHNP must build a therapeutic relationship, including educating patients, providing psychotherapy, and administering suitable medication for individualized mental health cases. Since our patients always come to us for help with emotional and behavioral issues, we are uniquely positioned to handle their mental health requirements. We have established a therapeutic relationship with the patient by managing her symptoms and medication to keep her healthy as well as the baby. Lately, she has been going for two weeks without a relapse, unlike before when we could have the same problem many weekly.
The primary goal, in this case, is to prevent relapse. Gotter (2017) elaborates that preventing relapse includes identifying triggers, introducing lifestyle changes, and managing stress. Stress management has been paramount in this case, and we strive to help the patient avoid it. Previously, she could not pass the first trimester without losing her pregnancy, but she has gone up to seven months with the current one. We encouraged her to practice meditation and mindfulness without concentrating on the bad things that could happen to her.
The second goal is to help the patient get back into a state where she feels entirely optimistic and self-confident even after giving birth so she can return to her normal level of functioning. Battle et al. (2016) explains that sometimes, medication and therapy work faster for some patients, while others take longer to return to their everyday lives. The patient’s case could take longer or worsen after giving birth, as taking care of a newborn is very demanding. We will continue with the sessions and medications as we will continue to monitor her condition until she returns to normalcy.
References
Battle, C. L., Uebelacker, L., Friedman, M. A., Cardemil, E. V., Beevers, C. G., & Miller, I. W. (2016). Treatment goals of depressed outpatients: a qualitative investigation of goals identified by participants in a depression treatment trial. Journal of Psychiatric Practice®, 16(6), 425-430. 10.1097/01.pra.0000390763.57946.93
Gotter, A. (2017, August 3). How to avoid depression: Prevent relapse and avoid triggers. Healthline. https://www.healthline.com/health/how-to-avoid-depression#5.-Reduce-stress-
Kumar, A., Kearney, A., Hoskins, K., & Iyengar, A. (2020). The role of psychiatric mental health nurse practitioners in improving mental and behavioral health care delivery for children and adolescents in multiple settings. Archives of psychiatric nursing, 34(5), 275-280. 10.1016/j.apnu.2020.07.022
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