This document provides guidance for a student assignment to develop a treatment plan for a client with depressive disorder. As the "captain of the ship," the student will recommend psychopharmacological treatments, psychotherapy options, identify medical management needs, recommend community support resources, and develop a follow-up plan. The goal is for students to gain experience independently managing all aspects of care for a client with depression.

1. Depressive Disorders
The National Institutes of Mental Health acknowledges that
depression is one of the most common mental disorders in the
United States. It is associated with significant disability, fiscal
impact, and considerable personal suffering. It may have
significant impact on the individual, their family, and their
social network. The PMHNP must be capable of providing
comprehensive care for depressive disorders, including both
psychotherapy and psychopharmacologic approaches.
This week, you will become “captain of the ship” as you take
full responsibility for a client with a depressive disorder. You
will recommend psychopharmacologic treatment and
psychotherapy, identify medical management needs and
community support, and recommend follow-up plans. You will
also explore how to obtain a DEA license and the
responsibilities for safe prescribing and prescription
monitoring.
“Captain of the Ship” –
Depressive Disorder
As nurse practitioners strive to achieve full-autonomous
practice across the country, it should be noted that many states
grant this ability to practice independently to psychiatric mental
health nurse practitioners. To that end, you will be engaging in
projects this semester that assume that you are practicing in a
state that allows full-practice authority for NPs, meaning that
the PMHNP may be the “captain of the ship” concerning caring
for a patient population. The “captain of the ship” is the one

2. who makes referrals to specialists, coordinates care for their
patients/clients, and is responsible and accountable for
patient/client outcomes overall. This is a decided change from a
few decades ago when physicians were the “captain of the ship”
and NPs played a peripheral role.
In this Assignment, you will become the “captain of the ship” as
you provide treatment recommendations and identify medical
management, community support resources, and follow-up plans
for a client with a depression disorder.
Learning Objectives
Students will:
· Recommend psychopharmacologic treatments based on
therapeutic endpoints
for clients with depression disorders
· Recommend psychotherapy based on therapeutic endpoints for
clients with
depression disorders
· Identify medical management needs for clients with depression
disorders
· Identify community support resources for clients with
depression disorders
· Recommend follow-up plans for clients with depression
disorders

3. Assignment (Project)
To prepare for this Assignment:
Select an adult or older adult client with a depressive disorder
you have seen in your practicum.
In 3–4 pages, write a treatment plan for your client in which
you do the following:
Describe the HPI and clinical impression for the client.
Recommend psychopharmacologic treatments and describe
specific and therapeutic endpoints for your
psychopharmacologic agent. (This should relate to HPI and
clinical impression.)
Recommend psychotherapy choices (individual, family, and
group) and specific therapeutic endpoints for your choices.
Identify medical management needs, including primary care
needs, specific to this client.
Identify community support resources (housing, socioeconomic
needs, etc.) and community agencies that are available to assist
the client. Recommend a plan for follow-up intensity and
frequency and collaboration with other providers including PCP
or medical provider

4. Tip for the
Assignment
This week assignment, you will 'captain the ship'
you are the provider and writing the diagnostic work-up and
treatment plan
for a patient with
DEPRESSIVE DISORDER
. You will develop plans for a patient that you have worked with
in your practicum.
A few comments about the ‘Captain of the Ship’ assignment.
The spirit of the assignment is that you are directing the client’s
care, not simply writing a paper about depressive disorder.
When you are the team leader, it’s important to provide
authoritative direction for other providers. In your treatment
plan, it’s good to outline your collaboration with client’s other
providers. Later in the quarter, you will have another
opportunity to complete ‘Captain of the Ship’ project.
I have attached an excellent example of a different Captain of
the Ship project with this assignment and. Note that
this assignment is on depressive disorder, not on
Obsessive Compulsive
.
Learning Resources
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral

5. sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 8, “Mood Disorders” (pp. 347–386)
Gabbard, G. O. (2014).
Gabbard’s treatment of psychiatric disorders
(5th ed.). Washington, DC: American Psychiatric Publications.
Chapter 12, “Psychotherapy of Mood Disorders”
Chapter 14, “Pharmacological and Somatic Treatments for
Major Depressive Disorder”
American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
"Depressive Disorders"
o Major Depressive Disorder
o Persistent Depressive Disorder (dysthymia)
o Premenstrual Dysphoric Disorder
o Substance/Medication-Induced Depressive Disorder

6. o Depressive Disorder Due to Another Medical Condition
o Other Specified Depressive Disorder
o Unspecified Depressive Disorder
Stahl, S. M. (2014).
Prescriber’s Guide: Stahl’s Essential Psychopharmacology
(5th ed.). New York, NY: Cambridge University Press.
Grieve, S. M., Korgaonkar, M. S., Koslow, S. H., Gordon, E.,
Williams, L. M. (2013). Widespread reductions in gray matter
volume in depression.
NeuroImage: Clinical, 3
, 332-339. doi:10.1016/j.nicl.2013.08.016
Lach, H. W., Chang, Y-P., & Edwards, D. (2010). Can older
adults with dementia accurately report depression using brief
forms? Reliability and validity of the Geriatric Depression
Scale.
Journal of Gerontological Nursing, 36
(5), 30–37. doi:10.3928/00989134-20100303-01
Steffens, D. C., McQuoid, D. R., & Potter, G. G. (2014).
Amnestic mild cognitive impairment and incident dementia and
Alzheimer's disease in geriatric depression.
International Psychogeriatrics, 26
(12), 2029–2036. doi:10.1017/S1041610214001446
Drug Enforcement Administration. (n.d.).
Drug schedules

7. . Retrieved June 14, 2016, from
https://www.dea.gov/druginfo/ds.shtml
Required Media
Hagen, B. (Producer). (n.d.-b).
Managing depression
[Video file]. Mill Valley, CA: Psychotherapy.net.
Optional Resources
Gabbard, G. O. (2014).
Gabbard’s treatment of psychiatric disorders
(5th ed.). Washington, DC: American Psychiatric Publications.
Chapter 15, “Brain Stimulation Treatments for Mood
Disorders”
Ahern, E., & Semkovska, M. (2017). Cognitive functioning in
the first-episode of major depressive disorder: A systematic
review and meta-analysis.
Neuropsychology, 31
(1), 52–72. doi:10.1037/neu0000319
Anderson, N. D., Damianakis, T., Kröger, E., Wagner, L. M.,
Dawson, D. R., Binns, M. A., . . . Cook, S. L. (2014). The
benefits associated with volunteering among seniors: A critical
review and recommendations for future research.
Psychological Bulletin, 140
(6), 1505–1533. doi:10.1037/a0037610

8. Inoue, J., Hoshino, R., Nojima, H., Ishida, W., & Okamoto, N.
(2016). Additional donepezil treatment for patients with
geriatric depression who exhibit cognitive deficit during
treatment for depression.
Psychogeriatrics, 16
(1), 54–61. doi:10.1111/psyg.12121
Sachs-Ericsson, N., Corsentino, E., Moxley, J., Hames, J. L.,
Rushing, N. C., Sawyer, K., . . . Steffens, D. C. (2013). A
longitudinal study of differences in late- and early-onset
geriatric depression: Depressive symptoms and psychosocial,
cognitive, and neurological functioning.
Aging & Mental Health, 17
(1), 1–11. doi:10.1080/13607863.2012.717253
Shallcross, A. J., Gross, J. J., Visvanathan, P. D., Kumar, N.,
Palfrey, A., Ford, B. Q., . . . Mauss, I. B. (2015). Relapse
prevention in major depressive disorder: Mindfulness-based
cognitive therapy versus an active control condition.
Journal of Consulting and Clinical Psychology, 83
(5), 964–975. doi:10.1037/ccp0000050
Wanklyn, S. G., Pukay-Martin, N. D., Belus, J. M., St. Cyr, K.,
Girard, T. A., & Monson, C. M. (2016). Trauma types as
differential predictors of posttraumatic stress disorder (PTSD),
major depressive disorder (MDD), and their comorbidity.
Canadian Journal of Behavioural Science / Revue Canadienne
Des Sciences Du Comportement, 48
(4), 296–305. doi:10.1037/cbs0000056