Identify your refined clinical question. My clinical question is; Regarding patients who have been diagnosed with major depressive disorder, how does electroconvulsive therapy compare with pharmacological therapy in terms of decreasing depressive symptoms over the course of a six-month period?
Evidence-Based Clinical Question Search
There are various treatments for major depressive disorder (MDD) available today. However, various factors, such as treatment resistance and high comorbidity with other chronic health problems, make treating and managing MDD challenging. MDD has been shown to have increased resistance and irritability in response to most pharmacological therapies available (Perugi et al., 2019). This has pushed clinical researchers to explore other treatment methods for treatment-resistant MDD to determine the efficacy, effectiveness, and safety of alternative methods as compared to pharmacological methods, as electroconvulsive therapy (ECT) is viewed as the most effective method for MDD (Ren et al., 2018). This paper compares the efficiency and safety of electroconvulsive therapy (ECT) in reducing depressive symptoms over the course of six months as compared to pharmacological therapy. The paper also reviews evidence on methods to improve ECT efficiency and safety that can be integrated into nursing practice for the management of depressive disorders.
Refined PICOT Question
Refining the PICOT question requires answering various questions specific to the elements of the question. For instance, the PICOT question answers questions that provide details on the characteristics of the patient population or the problems researched, such as the demographics of the population or the nature of the health problem. In this case, the health problem and population are the patient populations that have been diagnosed with major depressive disorder. The next step is to define the intervention, which includes identifying a specific treatment method. In this case, the specific intervention is electroconvulsive therapy. The next step in refining the PICOT question is identifying a specific alternative treatment that compares with the selected intervention for the same population or health problem. In this case, pharmacological therapy is selected as the alternative to compare electroconvulsive therapy. The next step is determining the specific outcomes of the intervention selection that also act as the basis for comparing the intervention and the treatment method. The specific outcome of my PICOT question is decreasing depressive symptoms. I have included a timeframe in the PICOT question to determine the intervention’s outcomes after a specific time. The timeframe for the PICOT question is a course of six months.
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Therefore, my refined clinical question is: Regarding patients who have been diagnosed with major depressive disorder, how does electroconvulsive therapy compare with pharmacological therapy in terms of decreasing depressive symptoms over the course of a six-month period?
Database Summary
A database search for literature related to the PICOT question was conducted using PubMed, Wiley Online Library, and SpringerLink databases. Search terms such as “electroconvulsive therapy,” “pharmacological therapy,” “ECT for depression,” “ECT effectiveness and safety,” and “ECT versus Pharmacological therapy for major depressive disorder” and Boolean operators such as “AND” and “OR” were used. Multiple search results were obtained across the databases. Filters such as text availability, article type, and the year of publication were used to obtain more specific results. The search selected full-text articles for clinical trials and randomized controlled trials. The search for the literature was also limited to papers published in the last five years, that is, between 2018 and 2022.
Evidence-Based Quantitative Randomized Controlled Trial Article
Gamble, J. J., Bi, H., Bowen, R., Weisgerber, G., Sanjanwala, R., Prasad, R., & Balbuena, L. (2018). Ketamine-based anesthesia improves electroconvulsive therapy outcomes: a randomized-controlled study. Canadian Journal of Anesthesia, 65(6), 636–646. https://doi.org/10.1007/S12630-018-1088-0/TABLES/4
The authors of the article ‘Ketamine-based anesthesia improves electroconvulsive therapy outcomes: a randomized-controlled study’ aimed to determine if ketamine-based anesthesia improved the depression outcomes of electroconvulsive therapy. Previous studies have equivocally agreed on the benefits of the use of ketamine in improving depressive symptoms in ECT treatment. For instance, Carspecken et al. (2018) argued that although compared to methohexital as a single dose, ketamine did not induce any significant improvements in depression as an induction agent for ECT, the use of ketamine in ECT was potentially beneficial for some p