Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Cathy Koetting - Department of Nursing


Cathy Koetting, PhD, DNP, APRN, CPNP-PC, PMHS, FNP-C

Sarah Jackson, DNP, APRN, FNP-C

Charles Tadros, MD


Visualizing Depressive Symptom Improvement: Implementing the 17-Item Hamilton Depression Rating Scale



Depression, a mental health diagnosis, has affected about 18.5% of adults (Villarroel & Terlizzi, 2020). Ketamine, a medication initially used as an anesthetic, has improved depressive symptoms in individuals struggling with treatment-resistant depression.


This quality improvement (QI) project used the 17-item Hamilton Depression Rating Scale questionnaire to assess depressive symptom changes in patients receiving intramuscular ketamine for treatment-resistant depression. The questionnaire was administered to patients pre-and post-intramuscular ketamine administration. The data was collected on injections one, three, and six on each participant’s set schedule of injections and participation period. The primary outcomes measured were the questionnaire scores before and after the administration of ketamine intramuscularly and the sum of the depressed mood questions (1-3), insomnia questions (4-6), physical symptoms questions (9-11, 16), anxiety questions (9-11, 15), and insight question (17). Paired-samples t-testing analyses were performed on the collected data.


The data showed that week one’s participants’ (n=14) scores significantly reduced the following categories: depressed mood and thought, anxiety, and physical symptoms. Week three’s (n=13) and week six’s (n=8) data showed a significant reduction in depressed mood and thought and anxiety categories.

Implications for Practice

This QI project provided encouraging data examining depression severity changes after the administration of intramuscular ketamine for patients with major depressive disorder or bipolar disorder. The results provide reassuring objective information for providers concerned about possible medication tolerance or misuse during treatment while ensuring providers that ketamine can be used to effectively improve depressive symptoms.