M.T. is a 39-year-old female being seen by the PMHNP for a major depressive disorder. She is being managed with SNRI therapy in combination with cognitive behavioral therapy, but is having difficulty achieving remission. Her husband is becoming very frustrated. He wants to be supportive, but does not understand why she is so depressed. Two years ago she had an episode of depression when her sister died in an accident, but after 6 month of treatment she seemed to return to normal. Her husband says “she has nothing to be depressed about.” In trying to help M.T.’s husband understand the disease process, the PMHNP discusses with him that: 

A. The physiologic stress accompanying her first episode of depression may have produced changes in brain biology that makes her susceptible to subsequent episodes without an external trigger.

B. The pharmacotherapy required to achieve remission with her first episode resulted in neuroplastic changes that increased her likelihood of experiencing additional depressive episodes 

C. The scientific literature suggests that the loss of a sibling is the life event most closely associated with recurrent episodes of major depressive disorder throughout adulthood 

D. Response to pharmacotherapy often takes a minimum of 8 weeks and  M.T. is much more likely to achieve remission if her husband can continue to provide the necessary support throughout her remission period. 
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YouTube: https://www.youtube.com/watch?v=TWL9C9qKr84&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=12