Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Ana Tabet


Major depressive disorder (MDD) is a chief mental health illness that carries a profound economic burden. Many who suffer from MDD find little to no relief with traditional pharmacological interventions.The 2010 American Psychiatric Association Guidelines for Treatment of Patients with MDD recognized TMS as a second-line treatment choice. Several double-blind, randomized controlled trials illustrated the efficacy and safety of TMS as a viable treatment option for MDD. The purpose of this project was to implement standardized processes through the use of a treatment guideline to help provide comprehensive treatment options for patients suffering from moderate to severe major depressive disorder (MDD).Secondary aims involved staff training on the subjective and objective components of the patient health questionnaire (PHQ-9), along with the incorporation of collateral information in determining the severity rating of depression.The final project goal was centered on patient and staff education of transcranial magnetic stimulation (TMS) as a second-line treatment option for MDD. The Plan-Do-Study-Act cycle was used to improve clinical staff knowledge on the appropriate use of clinical observations combined with collateral inputs in the scoring of the PHQ-9 scores. The number of patients diagnosed with MDD totaled 185: only 90 (48.6%) qualified for TMS. A remarkable increase in patient interest in TMS was realized after patient education was conducted, as shown by a 32.2% increase from the pre-intervention number of 3 (3.3%).The outcomes suggest standardized treatment guidelines improved patient education on alternative treatment choices. The project illustrates the importance of using guidelines to help foster equitable care.