Psy-Q: Why are Advance Practice Nurses (APNs) particularly well-positioned to address treatment-resistant depression? Brayden N. Kameg, DNP, PMHNP‐BC, CARN, CNE, answers.


Brayden N. Kameg, DNP

Answer: “Advanced practice nurses leverage nursing theory to develop a holistic, comprehensive, and patient-centered plan of care that makes them particularly effective in developing therapeutic relationships with patients experiencing a variety of mental health problems. This allows them to work closely with these patients over time to enhance care continuity and improve patient outcomes,” explains Brayden N. Kameg DNP, PMHNP‐BC, CARN, CNE, who co-authored a review in Perspectives in Psychiatry Care looking at alternative TRD approaches led by APNs.

Kameg explains that since APNs are usually certified in a specific specialty, other behavioral health professionals might benefit from partnering with APNs to provide and deliver integrated behavioral health care within the primary care setting. “This approach is well-established as an intervention that can not only improve health outcomes but also increase engagement in treatment,” she says. “Furthermore, psychiatric mental health nurse practitioners can work effectively in interprofessional settings with physicians, social workers, psychologists, and counselors, to deliver high-quality care and to improve patient compliance and outcomes.”

(See more on the role of mental health professionals in primary care.)

APNs caring for patients with TRD can be most effective by considering the following steps, as suggested by Kameg:

  • Make sure you have a complete, comprehensive psychiatric history to guide treatment planning and medical decision-making.
  • Take a patient-centered approach to treatment, with patient goals and preferences informing the treatment plan.
  • Consider both pharmacological and non-pharmacological strategies to get the best results.

Clinicians treating patients with TRD must also stay on top of the latest treatment options, which include “novel and emerging interventions such as transcranial magnetic stimulation and ketamine or esketamine,” says Kameg.

She stresses that it’s crucial to understand that hopelessness can be a key feature of depression. “Therefore, clinicians should be certain to offer and promote hope for future remission and improvement in quality of life,” says Kameg.

Kameg also recommends that clinicians follow SAMHSA’s Serious Mental Illness Advisor (#SMIAdvisor).  See more perspectives on this topic.

Last Updated: Jun 3, 2021