The PICOT Framework
This question had been formed taking the assistance of the PICOT format. This is undoubtedly one of the most effective and optimal format for evidence based practice in the health care scenario. The PICOT format stands for the five distinct yet interconnected elements of research in the context of evidence based practice (Saimbert, Pierce & Hargwood, 2016). The first element is the population which represents target group we have selected pertinent to the area of concern chosen for the study. In this case, I have chosen the target group of patients with depression or major depressive disorders. The second element in this case is the intervention that represents the element that is being tested or evaluated in the clinical research.
In this case, the intervention chosen is SSRI antidepressants which has recently been used in clinical research in treating negative thought process in depression patients with promising effects. The next element is the comparison, which is the antagonist of the intervention that is being tested. In this case, the comparison is standard treatment devoid of SSRI. The fourth element is the outcome, which is measurement parameter in any clinical evidence based practice. In this case, the outcome chosen is the improved symptoms in the patients (Abbade, Wang, Sriganesh, Mbuagbaw & Thabane, 2016). Lastly, the fifth element is the timeframe which is also optional, often omitted from the original framework. In this case, the time frame selected had been 6 to 12 months. Hence, as evidenced by the discussion above, the structured question for this research follows the PICOT format successfully.
Depression is one of the most common types of psychological disorders that prevails in the present day society. It has to be mentioned in this context that for the Australian health care scenario, approximately 3 million individuals are living with depression (Beyondblue.org.au, 2018). A very common trajectory for major depressive disorders is the gradual deterioration of the negative thought patterns in the patients leading to self-directed hatred to self-harm to ultimately suicidality. Although, there have been many treatment interventions and pathways that have been developed to address each of the phases of the above mentioned trajectory, the impact intensity had not been at par with the expectations. The selective serotonin reuptake inhibitors or SSRI are the class of drugs that has shown promising results in improving the symptoms of the patients suffering from major depression (Jakobsen et al., 2017). Elaborating in to the issue further, it has to be mentioned that this particular class of drug helps in enhancing the extracellular concentration of serotonin, a neurotransmitter that governs mood and emotions and limits its reabsorption by the presynaptic cells. As a result the concentration of serotonin in the synaptic cleft that is available to bind onto the postsynaptic receptor is enhanced, providing significant symptomatic management to the patients. As a result, this is a very important and effective antidepressants which has not as widely integrated in the health care context as expected. Hence it is my choice of topic area for this research paper.
Background
The research for this particular assignment has begun with the structured PICOT question that had been developed. There had been a preliminary research on the topic area taking the assistance of the Google scholar to gather starting insight on the topic of depression, major link to negative thought and suicidality, and the impact of SSRI antidepressants on the symptomatic management. The search phrases that had been used in the research had been ‘depression’, ‘standard treatment’, ‘intervention’, ‘SSRI’, ‘negative thoughts’, ‘suicadility’, and ‘symptomatic improvement’. Then the research phrases that has been developed based on the structured PICOT framework was research in different combinations using the Medline database. It has to be mentioned that Medline is an excellent resource for medical or clinical research studies as it provides the access to peer-reviewed and complete research articles along with the articles being authorative evidences, hence this database had been used in this paper (Dang & Dearholt, 2017).
First and foremost, the three non pre-set filter databases, Google scholar, Cochrane library and PubMed, to gather preliminary research evidence to start the paper on the topic area. After which the research question was crafted using the PICOT format (Echevarria & Walker, 2014). In the next stage, I had to use the preset filter database, Medline had been used for the final research for the assignment. In the first segment, the search resulted in 1524 articles. In the next stage, the search phrases were reshuffled and the Boolean operator AND had been used to reduce the number of results. To further narrow down the search results, the limiter of full text had been employed, which narrowed it down to 293 results. In the next two stages two more limiters namely abstract available and English language was applied, which narrowed the results down to 290. In the next phase, the research was further limited to only studies that had been published 2014 onwards which drastically reduced the number of results to 61. In the next few stages, the limiter of major headings were applied, and each reduced the results to 29 and 15 respectively. Lastly, the studies were further limited to the major heading of antidepressive agents which narrowed down the results to 6 which had been the desired result for this research study (Meyer, 2017).
Discussion:
Post the acquiring of the 6 articles that had been selected for the final discussion of the assignment, the next step of the assignment had been to arrive at a conclusion regarding the3 topic that had been selected for the evidence. As the search strategy and search results, the final results of research arrived at 6 articles. Although, it has to be mentioned that even though the research had been systematic and curated in an excellent planning, only there had been articles that were irrelevant in the study that had been rejected for the discussion part of the paper. Ultimately, only two papers, a primary evidence which had been an observation study and a secondary evidence which had been a systematic review had been chosen for this study to be two apt evidences for the research study.
Research Methodology
The first primary evidence is “Cognitive tolerability following successful long term treatment of major depression and anxiety disorders with SSRI antidepressants” by Popovic, Vieta, Fornaro and Perugi (2015). This had been an observation study involving 67 patients with major depressive disorders on which the intervention of SSRI had been used to arrive at a decision regarding the efficacy of treatment trajectory. The results indicate that the impact of the SSRI implementation on the patients might lead to symptomatic management, although there is considerable risk of side effects such as fatigue, inattentiveness, lack of concentration, memory impairment and apathy. The most notable strength of this article is the novel insight it is providing on the side effects of this treatment option, this is the first article to assess side effects of the SSRI along with judging its efficacy in treating symptoms, which is a very important aspect of biomedical research when considering the efficacy of a treatment option (Popovic, Vieta, Fornaro & Perugi, 2015). Hence, this article had been chosen as the best primary evidence obtained from the extensive research carried out.
The second article which had chosen as the secondary evidence is the “Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis” by Jakobsen et al. (2017). The fundamental aim of this article had been to explore the existing unclear evidence present regarding the efficacy of SSRI antidepressants on symptom management of depressive disorders. The results indicated that the efficacy of the antidepressant is questionable with respect to the high risk of adverse events or side effects mirroring the insight provided by the primary evidence. The most important strength of the article had been the inclusion of 131 studies with only randomized control trial design to reduce risk of bias and use of both meta-analysis and tri-sequential analysis, which enhanced the quality and reliability of the data.
There had been four other research studies that had been rejected from the final discussion due to a variety of reasons. The first article “Effects of selective serotonin and norepinephrine reuptake inhibitors on depressive? and impulsive?like behaviors and on monoamine transmission in experimental temporal lobe epilepsy” by Kumar et al. (2016) had been a case control study which had been rejected as the experiment had been done on rats which is completely irrelevant to the research. The second article had been “Treatment of Depression in CKD Patients with an SSRI: Why Things Don’t Always Turn Out as You Expect” by Cukor and Kimmel (2018) had been a narrative review which was excluded due to lack of clarity of the content and more focus on CKD symptom rather than effect of SSRI on depression. The third article had been “The effects of gestational stress and SSRI antidepressant treatment on structural plasticity in the postpartum brain – a translational model for postpartum depression” by Haim, Albin-Brooks, Sherer, Mills and Leuner (2016) had been an observational study, rejected due to more focus on structural plasticity of the brain rather than symptoms or effects of the SSRI as clinical manifestations. The fourth article had been “Antenatal depression, treatment with selective serotonin reuptake inhibitors, and neonatal brain structure: A propensity-matched cohort study” by Jha et al. (2016) had been a propensity matched cohort study which was also rejected as it had been more focussed on the brain plasticity of the patients rather than effect of the SSRI as a drug on the symptoms and onset of any clinically significant adverse events due to the drug.
Results
Conclusion:
On a concluding note, the research question asked had been to explore the efficiency and relevance of using the SSRI antidepressant as a treatment for patients with major depressive disorders and extreme negative thoughts. The above mentioned articles have not only addressed the research question asked, they have provided novel insight into the pros and cons of wide usage of the treatment option. Hence, it can be considered that research article is efficient in answering the question asked by this paper effectively and is the most credible sources.
References:
Abbade, L. P., Wang, M., Sriganesh, K., Mbuagbaw, L., & Thabane, L. (2016). Framing of research question using the PICOT format in randomised controlled trials of venous ulcer disease: a protocol for a systematic survey of the literature. BMJ open, 6(11), e013175. Doi: 10.1136/bmjopen-2016-013175
Beyondblue.org.au (2018). Statistics and references. Retrieved from https://www.beyondblue.org.au/about-us/research-projects/statistics-and-references [Accessed on 14th Nov]
Cukor, D., & Kimmel, P. L. (2018). Treatment of Depression in CKD Patients with an SSRI Why Things Don’t Always Turn Out as You Expect. Clinical Journal of the American Society of Nephrology, 13(6), 943-945. Doi: 10.2215/CJN.14421217
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=SZU6DwAAQBAJ&oi=fnd&pg=PP1&dq=evidence+based+practice+databases&ots=_gmLztSsCc&sig=YUufHezR_hN-Z5o6z2jltqOHitM#v=onepage&q=evidence%20based%20practice%20databases&f=false
Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT question. Nursing2018, 44(2), 18-19. Doi: 10.1097/01.NURSE.0000442594.00242.f9
Haim, A., Albin-Brooks, C., Sherer, M., Mills, E., & Leuner, B. (2016). The effects of gestational stress and SSRI antidepressant treatment on structural plasticity in the postpartum brain-A translational model for postpartum depression. Hormones and behavior, 77, 124. Doi: 10.1016/j.yhbeh.2015.05.005
Jakobsen, J. C., Katakam, K. K., Schou, A., Hellmuth, S. G., Stallknecht, S. E., Leth-Møller, K., … & Krogh, J. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC psychiatry, 17(1), 58. Doi: 10.1186/s12888-016-1173-2
Jha, S. C., Meltzer-Brody, S., Steiner, R. J., Cornea, E., Woolson, S., Ahn, M., … & Gilmore, J. H. (2016). Antenatal depression, treatment with selective serotonin reuptake inhibitors, and neonatal brain structure: a propensity-matched cohort study. Psychiatry Research: Neuroimaging, 253, 43-53. Doi: 10.1016/j.pscychresns.2016.05.004
Kumar, U., Medel?Matus, J. S., Redwine, H. M., Shin, D., Hensler, J. G., Sankar, R., & Mazarati, A. (2016). Effects of selective serotonin and norepinephrine reuptake inhibitors on depressive?and impulsive?like behaviors and on monoamine transmission in experimental temporal lobe epilepsy. Epilepsia, 57(3), 506-515. Doi: 10.1111/epi.13321
Meyer, M. N. (2017). Evidence-Based Practice: Success of Practice Change Depends on the Question. Evidence-Based Practice in Nursing: Foundations, Skills, and Roles. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=8RAzDwAAQBAJ&oi=fnd&pg=PA97&dq=PICOT+question+for+clinical+research&ots=lfdNLHaHlF&sig=lXBs20cRn0z39U1sVNcg_n8GP_s#v=onepage&q=PICOT%20question%20for%20clinical%20research&f=false
Popovic, D., Vieta, E., Fornaro, M., & Perugi, G. (2015). Cognitive tolerability following successful long term treatment of major depression and anxiety disorders with SSRi antidepressants. Journal of affective disorders, 173, 211-215. Doi: 10.1016/j.jad.2014.11.008
Saimbert, M., Pierce, J., & Hargwood, P. (2016). Developing Clinical Questions for Systematic Review. Comprehensive Systematic Review for Advanced Practice Nursing, 79. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=2SsODAAAQBAJ&oi=fnd&pg=PA79&dq=pico+framework+mcgowan&ots=IPmybxVYJJ&sig=LTbKkzO4-jFEfNxdndoqmr4JKvg#v=onepage&q&f=fals
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