Evidence-Based Treatments for Depression: CBT and Paroxetine

This report focuses on the application of professional knowledge and values in mental health nursing, specifically addressing the treatment of depression. It begins by exploring the chosen topic of depression, its impact, and the cognitive behavioral therapy (CBT) intervention. The report delves into what CBT entails, its strengths, limitations, and the role of nurses in its implementation. Furthermore, it examines the medication management aspect, concentrating on the antidepressant paroxetine, including its dosage, side effects, and the nurse's role in its administration. The report provides a comprehensive overview of evidence-based treatments and interventions in the context of nursing care for depression, with a focus on CBT and paroxetine.

Developing professional knowledge and values
in mental health nursing

CONTENTS
INTRODUCTION......................................................................................................................1
CHOSEN TOPIC – DEPRESSION...........................................................................................1
CHOSEN INTERVENTION – CBT (COGNITIVE BEHAVIOUR THERAPY)....................1
CBT – What is it?...................................................................................................................1
Barriers of CBT......................................................................................................................2
Strength of CBT.....................................................................................................................2
Limitation of CBT..................................................................................................................3
Psycho-education of CBT.......................................................................................................3
Role of a nurse in CBT...........................................................................................................4
MEDICATION MANAGEMENT OF DEPRESSION.............................................................4
CHOSEN MEDICATION – PAROXETINE............................................................................4
Paroxetine – what is it?...........................................................................................................4
Dosage....................................................................................................................................5
Side effects.............................................................................................................................5
Systematic review of paroxetine............................................................................................6
Medication supply..................................................................................................................6
Role of a nurse in paroxetine administration..........................................................................7
CONCLUSION..........................................................................................................................7
REFERENCES...........................................................................................................................8

INTRODUCTION
It is quite important to have professional knowledge and values in relation with the
mental health nursing. This is due to the fact that through having this knowledge nurses and
other caregiver staff will be in a position to offer specialized care to the patients suffering
from mental illness and disorder. Considering this, the main aim of the present research
report is to analyse the evidence-based treatments along with the interventions in the context
of nursing care. The report will be going to select one topic and will significantly determine
interventions and possible treatments inclusive of medication management. For this, purpose,
the selected topic for the current research work is depression. Further, the evidence based or
intervention which is related with the selected topic depression is cognitive behavioural
therapy (CBT). The later part of the research report will also be going to throw some light on
medication management and for depression there is one medication which has been selected
and that is paroxetine.
CHOSEN TOPIC – DEPRESSION
Depression the most common and mental illness that negatively effects on the human
thinking ability or capability. It also analysed that how they act, behave. In this report, it will
focus on the depression and identify that how it will impact on the human being during covid-
19 pandemic. At the time of lockdowns, many people have faced a mental illness because of
isolation. Based on the national statistics, it has been calculated or estimated that 21% of
adults or young people experience some kind of depression. In some cases, women and
young adults are likely to experience the depression approximately 43% aged between 16 to
29. Initially, it has been measured the signs or symptoms, compared with 20-25% of men of
same age group (Joint Commissioning Project on Mental Health, 2014). Based on the NICE
2020, it has been chosen cognitive behavioural therapy and consider the best intervention in
the treatment for depression.
CHOSEN INTERVENTION – CBT (COGNITIVE BEHAVIOUR
THERAPY)
CBT – What is it?
Talking in relation with the acronym CBT which stands for cognitive behavioural
therapy, it is a type of a talking therapy which is being utilized for treating the people who are
suffering from assortment of issues related to the mental health. According to McLeod
(2019), cognitive behavioural therapy is grounded on the nation that the manner each and
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every individual think that is cognition and the manner in which they feel that is emotion and
the manner in which they perform actions that is behaviour all communicate with each other.
Particularly, the thought process of each and every individual helps in identifying the feelings
as well as behaviour. As stated by Chand and et.al, (2018), there are different investigations
which have proved that cognitive behavioural therapy can be considered as one of the most
beneficial and useful treatment for major depressive disorder irrespective of the harshness of
the indications or signs. Nevertheless, the author has further demonstrated that for the
purpose of having effective treatment of the patient being suffering from the issues of severe
depression than combination treatment which includes CBT along with pharmacology such
as antidepressants should be offered to the patients rather than giving only treatment.
Antidepressants such as paroxetine will be elaborated in the medication management section
later in this report which is being regarded as one of the most crucial accountabilities in
nursing practices.
Barriers of CBT
Like many other contemporary psychotherapies, the cognitive behavioural therapy is
also reinforced and supported by the EAV (European American values) and this has resulted
in to manifest culture as one of the effective barriers in retrieving cognitive behavioural
therapy. The culture barrier further helps in originating different other blockades as well like
racism, stigma, level of awareness of therapists, religious belief and amount of religiosity.
Nevertheless, it has been represented in the evaluation by Benuto and O’Donohue (2015) that
very small amount of proof has been found out that cultural variations lead in dependably
enhanced effect size and does not reflect predictable equality in terms of cultural tailoring. In
spite of this, it has been recommended that all the techniques in the cognitive behavioural
therapy needs to be adapted as per the culture for further promotion of flexibility of
treatment, inclusive efficiency and observance. In addition to this, it can also be
recommended that the accountabilities of nursing practices are to bridge gap amid these
barriers as per the Nursing and Midwifery Council code, nurses are required to give priority
to people and must give effective treatment to them as individual and are also liable to uphold
their self-respect (Beck and Hindman, 2017). They are also required to evade making
suppositions and must determine their diversity and choices and admire the human right of
each and every people.
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Strength of CBT
One of the most important strengths of cognitive behavioural therapy as defined by
Guatam and et.al., (2020) is that there is no single side effect or allergies being related with
this therapy. Nonetheless, patients who are suffering from acute depression with suicidality
might consider the management of CBT alone as a very difficult task and they might require
some medications along with the other treatments prior taking into account cognitive
behavioural therapy. Thus, it can be suggested from this that risk as well as presentations of
the individuals might influence on or identify their level of involvement with the therapy.
It has been further displayed by the authors that cognitive behavioural therapy is
utilized for modifying the fundamental plans or principles that helps in maintaining
depression and thus, decreases the probabilities of occurring this again which is quite evident
from its usefulness, dissimilar to pharmacology wherein the indication has given away more
prospects of deterioration because of the dependency or enduing utilization of medicine.
Therefore, from this it can be proposed that cognitive behavioural therapy helps in promotion
of independence which is bigheartedness and non-maleficence (Beck, 2016).
Limitation of CBT
Speaking in relation with the limitation of the cognitive behavioural therapy, it has
been stated by McLeod (2019) that the detailed and accurate role being performed by the
processes related to cognition is not yet identified. Furthermore, till date is has not be
clarified about whether faulty thoughts and reasonings are result of the psychological
medicine or implication of it due to the fact that proof in this regard recommends that
negative as well as despondent thoughtfulness might leads into depression instead of
becoming one of its reasons. As per Fennell (2018), depression is defined as a multifaceted
situation and its reasons are not comprehended completely. There are variety of factors which
plays a crucial role in depression such as psychology, environment, biology and genetics and
thus, it can be recommended that even though the cognitive behavioural therapy is very
useful, the scope of this therapy is quite narrow and is not being regarded as the all-inclusive
treatment as thought process is being regarded as only one garment of the whole functioning
of human beings.
Psycho-education of CBT
Attributing in relation with the cognitive behavioural therapy, it is being defined as
one of the leading approaches related to psychotherapy because of the strong research help
along with the fast timeline of the treatment. At times when the customers are aware in
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regards with the CBT, they generally consider that this therapy can be applied to their own
lives without any difficulties. Thus, for the purpose of the patient to make use of this therapy
successfully, it is crucial that they must have a robust comprehension of the cognitive model
primarily. Further, in the first and second session, psychoeducation with generally initiate and
will endure across the treatment. Additionally, psychoeducation is being regarded as one of
the most part in CBT (Tambuyzer, Pietersand Van Audenhove, 2014). It encompasses
educating the patient in regards with the depression, disorder and anxiety they might have
and also supports them in comprehending the facts and to have evidence-based treatment.
Moreover, psychoeducation in CBT explains the things that takes place in the brain which
leads to the occurrence of symptoms to helps them. Seeking help from this, clients can easily
understand about their disorder and helps them in adopting the strategies that can support
them in building new circuits in the brain.
Role of a nurse in CBT
There are many types of roles being defined by the Nursing and Midwifery Council
code. The very first is nurses are required to identify as well as perform their job inside the
boundaries of their capability. In other words, this signifies that their roles and
accountabilities in the cognitive behavioural therapy is quite restricted but each and every
nurse can still keep their professional standards along with the behaviour through helping and
assisting patients by comforting them (NICE guidelines, 2021). Secondly, it is also crucial on
the part of the nurses to make sure that each and every patient are well informed in relation
with the procedure related to cognitive behavioural therapy comprising all the advantages and
the probable negative impacts, increased knowledgeable consent and making sensible
modifications for patients at times when it is needed. Thirdly, it also important on the part of
the nurses to make sure about the safety of the patients by assessing the risk and mental
evaluation and monitoring the medication if needed and related credentials.
MEDICATION MANAGEMENT OF DEPRESSION
CHOSEN MEDICATION – PAROXETINE
Paroxetine – what is it?
Speaking in relation with paroxetine, it is an antidepressant which falls in the category
of drugs known as selective serotonin reuptake inhibitors (SSRIs). Paroxetine disturbs the
chemicals in the brain that might be unbalanced in some of the individuals due to disorders,
anxiety and depression. This medicine is being utilized for treating the patients suffering from
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depression comprising key depressive disorder. In addition to this, it is also being utilized for
treating patients with panic disorder, post-traumatic stress disorder, obsessive-compulsive
disorder, premenstrual dysphoric disorder and anxiety disorders (Spencer, 2019).
Furthermore, for the purpose of treating the hot flashes concerning to menopause, Brisdelle
brand is being utilized. It is not for treating any other conditions except this. Other than this,
paroxetine also offers supports different people to come out depression and this medicine also
have some lesser number of unwanted affects as compared to the other earlier
antidepressants. This medicine for depression is accessible only if it is prescribed by the
doctor and it comes as tablets along in the liquid bottle which can be swallowed. Moving
further, paroxetine oral tablets are known as prescription drugs and thus, it is present in
immediate release as well as enduring release forms. Besides, these forms are present in the
market as the brand name drugs like Pexeva. Paxil and Paxil CR, each having different
treatment for different conditions. They are also available as a generic drug which generally
costs lesser as compared to the brand name versions (Germann, Ma, Han and Tikhomirova,
2019).
Dosage
The medicine for depression that is paroxetine is present in the market as 10mg, 20mg
and 40mg tablets and is also accessible as a liquid. The 10 ml of liquid paroxetine is similar
to 20 mg of tablet. Most of the people will initiate with the dose of either 10 or 20 mg. three
might be augmentation in this dosage to 40 mg till the doctor agrees that the patient have
searched out the dose that suites them. In addition to this, the maximum recommended dose
for this medicine is 50mg or 60mg a day based on the reasons of taking this medicine. As per
the British National Formulary (BNF) (2021), does for the use in case of depression is 20-
50mg daily. It has been suggested that one should start by 10 mg everyday in case of panic
disorder for minimizing aggravation of symptoms (Paroxetine Hcl - Uses, Side Effects, and
More, 2022). It has also been suggested that this should medicine should be taken in morning
for preventing sleep disorders. Moreover, for the people who are older that is more than 65
years of age, the maximum amount suggested for the dose in 40 mg every day. If patients
have issues related to kidneys and liver than the dosage might be decreased as compared to
the general one.
Side effects
Similar to all other medicines, there are some side affects of paroxetine as well in
some of people. However, for many of them it has no side effects or only minor ones.
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Paroxetine oral tablet might result into drowsiness and might also impact the capability of an
individual to take decisions, react fast and think clearly. It is suggested that people who are
on this medication must not drive and utilized heavy machinery and must not perform actions
which involves attention until they understand the manner this drug influence them. There are
some other side affects of this medicine of depression being defined by the British National
Formulary (BNF) (2021). Some of the common side affects of this medicine involves
dizziness, sleepiness, impotence, weakness, nausea, anxiousness, sweating and reduction in
the appetite of the patients. However, there are some serious side effects of this medicine
such as alteration in the behaviour and mood like panic attacks, agitation, sleeplessness and
thoughts related to dying, there might be serotonin syndrome or neuroleptic malignant
syndrome such as reactions and symptoms might encompass agitation of muscles, high and
low pressure of blood, fever, sweating and muscle rigidity. Besides, the most alarming is the
augmentation in the thought related to suicide. This type of risk is quite high during the initial
few months of treatment.
Systematic review of paroxetine
In the review being done by Purgato, P. and et.al. (2014), emphasis has been given on
the impact of antidepressant drug paroxetine for shedding light in regards with the areas of
drug treatment for depression. Different studies were being searched out and this drug was
being compared with the other antidepressant in treating people with depression. There were
large studies involved in this review and were being grouped as per the kind of drugs they are
and comparison was made against them. The fundamental result of the study stated that
paroxetine was more useful and beneficial as compared to the other drugs such as reboxetine.
However, paroxetine was found to be less effective than mirtazapine as well as citalopram. In
addition to this, there were some evidences were also shown in this study that paroxetine is
less well tolerated as compared to the agomelatine and St John's. this is due to the fact that
more patients which have been allocated paroxetine have experienced some or the other side
effects of this anti depression pill (Beck and Naz, 2019). Thus, it can be concluded that there
is definitely some clinical and meaningful differences exists amid paroxetine and other
antidepressants but in case of acute cases paroxetine is less affective.
Medication supply
Speaking in volume in relation with the medication supply of Paroxetine, it is being
referred as the means by which this medicine of depression is products and is being delivered
to the patients. Nevertheless, the supply of medicine is a complex process which needs
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different number of phases to be considered for making sure that the medications are
accessible and present to each and every patient. In relation with the supply of paroxetine,
there are variety of stakeholders being involved in the pharmaceutical supply chain
encompassing producers, wholesaler, distributors along with the pharmacy benefit managers
(PBM). In such type of multifaceted processes, the stakes are quite high for the companies
which sales the medicine. There are different brands and companies present in the market like
Pexeva. Paxil and Paxil CR, which are selling the medicine of depression and other mental
disorder in the market. Each of these brands are not suitable for all conditions as they are
having different treatment for different conditions (Bennett and Babbage, 2014). Paroxetine
is also available as a generic drug which generally costs lesser as compared to the brand name
versions. There are many stores and companies which are distributing these drugs incorrectly
and this hampers the name of the company and satisfaction level of the customers. The
ineffective supply chain in this field might also disrupt the healing procedure of the
individuals who are suffering from these diseases and generate negative impact on their
health.
Role of a nurse in paroxetine administration
The nurses play a crucial role at time of providing medicines to the patient and the
users. This is necessary for the reason that in case proper medication will not be provided to
the patient then this can affect the health of the person to a great extent. the medicine
paroxetine is being used in order to treat depression, panic attack, anxiety, post- traumatic
stress, obsessive compulsive disorder (OCD) and others (Brunet and et.al., 2021). This
medicine is very important for the nurses to provide to the patient so that they can recover
from the disease in better and effective manner. The crucial role which nurse plays at time of
treating patient with depression is to inform the patient of the risk being associated with the
increase in fractures with paroxetine.
Also, it is the responsibility of the nurse that they must advise the patient and their
family members that they must take care of the suicidality because in case dose change or the
early therapy the tendency of suicide increases within the patient (Paroxetine, low dose,
2022). Along with this it is the responsibility of the nurse that they must also advice the
patient that in case of any sign or symptoms then they must communicate it to the health care
professional.
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CONCLUSION
Thus, from the above analysis it can be concluded that the above report has
successfully determined and explored different knowledge pertaining to the evidence-based
treatment for the topic depression. Further, the report has significantly outlined about the
important intervention for depression that is cognitive behavioural therapy which can be used
along with the medication such as paroxetine for the purpose of having effective treatment of
the patients being suffering from depression and any other form of metal disorder. The final
section of the report has thrown light on medicine management for depression has effectively
explored about the dosage, relative side effects of using this medicine and the crucial role
being played by nurse in administration of paroxetine.
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REFERENCES
Books and journals
Beck, A. and Naz, S., 2019. The need for service change and community outreach work to
support trans-cultural cognitive behaviour therapy with black and minority ethnic
communities. The cognitive behaviour therapists, 12.
Beck, A., 2016. Transcultural CBT for anxiety and depression. Routledge: London
Beck, J. and Hindman, R., 2017. Cognitive therapy. New Delhi: Wolter Kluwer India Pvt
Ltd.
Bennett, S.T. and Babbage, D.R., 2014. Cultural adaptation of CBT for Aboriginal
Australians. Australian Psychologist, 49, pp.19–21.
Benuto, L.T. and O'Donohue, W., 2015. Is culturally sensitive cognitive behavioural therapy
an empirically supported treatment? The case for Hispanics. International Journal of
Psychology & Psychological Therapy, 15(3), pp.405–421.
Brunet, A. and et.al., 2021. Tackling the global problem of traumatic stress in low-income
countries: a pilot clinical trial comparing reconsolidation therapy to paroxetine in
Nepal. BMC psychiatry, 21(1), pp.1-9.
Chand, S.P and et.al, 2018. Cognitive Behavioural Therapy for Maladaptive Perfectionism in
Medical Students: A Preliminary Investigation. Academic Psychiatry. 42. pp.58–61.
Fennell, M., 2018. Cognitive behaviour therapy for depressive disorders. New York: Oxford
University Press.
Germann, D., Ma, G., Han, F. and Tikhomirova, A., 2019. Brittain HG (ed.). Paroxetine
hydrochloride. Profiles of Drug Substances, Excipients, and Related Methodology.
Analytical Profiles of Drug Substances and Excipients. 38. pp.367–406.
Guatam and et.al., 2020. Cognitive Behavioural Therapy for Depression. Indian Journal of
Psychiatry. 62(8). p.223.
Joint Commissioning Project on Mental Health. 2014. Guidance for commissioners of mental
health services for black and minority ethnic service users. London: Joint
Commissioning Project on Mental Health.
Purgato, P. and et.al., 2014. Paroxetine versus other anti‐depressive agents for depression.
Cochrane Database of Systematic Reviews.
Spencer, E.D., 2019. CBT for Anxiety: A Step-By-Step Training Manual for the Treatment of
Fear, Panic, Worry and OCD. PESI Publishing & Media.
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Tambuyzer, E., Pieters, G. and Van Audenhove, C., 2014. Patient involvement in mental
health care: one size does not fit all. Health Expectations 17, pp.138–150.
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