Optimizing Treatment for Depression: Integrating TMS and Ketamine Through Provider and Clinical Staff Education

Abstract

This Doctor of Nursing Practice (DNP) project aimed to evaluate the impact of an educational intervention created to improve mental health care providers, nurses, and other clinical staff's knowledge of the combined use of Transcranial Magnetic Stimulation (TMS) and ketamine for treating treatment-resistant depression (TRD). TRD affects a significant number of individuals who have Major Depressive Disorder (MDD) and often do not respond to traditional antidepressant therapies, thus leading to a need for other modalities. Novice treatments for TRD include ketamine, an NMDA receptor antagonist, and TMS, a non-invasive brain stimulation technique, both of which have demonstrated effectiveness. However, many of those who are involved in the care of those receiving ketamine, TMS, or both remain unaware of the synergistic benefits of combining the two treatments. This project utilized a quality improvement (QI) framework, specifically the Plan-Do-Study-Act (PDSA) model, to design and implement an educational intervention for mental health providers managing ketamine treatment in outpatient settings. Participants took a 10-question pre-quiz, then engaged in a 10-minute PowerPoint voice-over education session, followed by the same 10-question post-quiz to assess their knowledge of the mechanisms and clinical data supporting the combined use of ketamine and TMS. Data analysis involved comparing pre- and post-quiz results to evaluate a change in knowledge. This project aimed to enhance the clinical teams' knowledge, improve treatment outcomes for patients with TRD receiving ketamine and TMS, and contribute to the growing knowledge of integrating advanced treatment modalities in mental health care. This project aimed to address critical provider education and improve patient care in managing treatment-resistant depression.