Using a PICOT Framework and Evidence to Develop Care Practices

Using a PICOT Framework and Evidence to Develop Care Practices
PICOT research framework is significant in providing the most reliable evidence to
respond to critical clinical questions. It stands for Patient/Population, Intervention,
Comparison, Outcome, and Time (PICOT). This paper employs the PICOT framework in
determining the best treatment method for patients with depression and explains the critical
results from the sources of evidence that offer answers to the research question.
Employing the PICOT Approach in Depression Treatment
The practice issue that requires a solution is utilizing medication in treating
depression instead of relying on psychotherapy. The question this paper analyzes is: Is
medication more efficient than psychotherapy in the acute treatment of severe or moderate
depression? The two antidepressants this paper studies are Citalopram and fluoxetine,
medications that function by balancing these patients' brain chemicals known as
neurotransmitters that influence emotions and moods. The population this study focuses on is
patients with depression. However, it excludes trials involving patients who have gotten
treatment for not more than four weeks and those with psychotic depression. Moreover, it
does not include those with bipolar disorder and treatment-resistant depression.

Identifying Sources of Evidence

Fluoxetine
Fluoxetine is among the best antidepressants. It is a selective serotonin reuptake
inhibitor and functions by raising the brain's serotonin levels. Reducing serotonin, an innately
occurring neurotransmitter, in the brain leads to depression (Zhou et al., 2020). This chemical
messenger, serotonin, plays a significant function in brain areas that regulate thinking and
mood. Fluoxetine deals with this problem by raising serotonin levels. It achieves that by
ensuring that the discharged serotonin does not return to the nerve endings due to blocking.
Citalopram

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Citalopram is also one of the best antidepressants. It is effective for treating
depression because it ensures that no serotonin reuptake occurs in the presynaptic neurons.
This inhibition helps deal with depression by increasing serotonin levels in the brain (Cui et
al., 2018). When the nerve synapse has higher amounts of serotonin, one's moods improve.
However, other antidepressants are more effective than Citalopram, considering its activity
against neurotransmitters. Just like Fluoxetine, Citalopram also functions by blocking
serotonin reuptake. Therefore, it is also a selective serotonin reuptake inhibitor.

Findings from Articles

Even though psychotherapy, this case considers cognitive behavioral therapy, is very
effective in the acute treatment of severe or moderate depression, medication is more
efficient. CBT is effective in depression treatment because it helps understand concepts,
ideas, emotions, and behavior that lead to depression (Karyotaki et al., 2021). However,
Fluoxetine, Citalopram, and other antidepressants are more efficient in lowering the
disorder’s severity. Weighting the two options to identify the best approach is crucial
because, in some cases, psychotherapy can be a better option.
Citalopram and Fluoxetine are the best antidepressants; however, Fluoxetine is more
effective because its effect on the body lasts longer. This medication's prolonged half-life
makes it possible for it to stay in the bloodstream for longer; hence the patient feels its effect
for longer. The preliminary results of the study by Zhou et al. (2020) were acceptability and
efficacy. The research utilized all-cause cessation to gauge treatments’ acceptability since it
entails tolerability and accessibility. Suicidality was the secondary result. When the study
employed at least one standardized ranking scale to determine the severity of depressive
symptoms in the same experiment, it utilized a pre-set grading established on the consistency
of utilization and psychometric features across involved trials. The research documented the
results at 8 weeks for all assessments. However, in cases where there was no data at that

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point, it utilized information for 4-6 weeks. This study showed that Fluoxetine is more
effective in the acute treatment of severe or moderate depression than CBT.

Relevance of Findings

The study by Antoun Reyad et al. (2020) significantly contributed to this research
because it offers an all-inclusive description of how Fluoxetine functions to help in the acute
treatment of severe or moderate depression. The research observed that Fl