Symptom Reduction and Deprescribing in a Patient With Treatment-Resistant Depression Using Sublingual Ketamine Troches: A Case Report

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2025-07-05

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10.7759/cureus.87343

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Francis, Elizabeth (2025). Symptom Reduction and Deprescribing in a Patient With Treatment-Resistant Depression Using Sublingual Ketamine Troches: A Case Report. Cureus. 10.7759/cureus.87343 Retrieved from https://hdl.handle.net/10161/32995.

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Francis

Elizabeth Francis

Consulting Associate in the School of Nursing

Integrity-driven, doctorally prepared psychiatric nurse practitioner with a strong clinical background in emergency medicine and mental health, providing exceptional care to patients across the lifespan with varying acuity levels. Dynamic history of leadership with a significant record of contributions to quality improvement.

I graduated Cum Laude with a Bachelor of Science in Nursing. I was elected by my peers to serve as the President of my nursing class for the 2.5 year duration of my undergraduate program at Cox College. I was also selected by my nursing professors to be a student ambassador to represent the college, coordinate with alumni, and help recruit new students. I worked my first 4 years after graduation as an ER nurse full-time and in various inpatient and outpatient mental health settings per diem, caring for patients across the lifespan.

I graduated with both my Masters (Psychiatric Nurse Practitioner specialty) and Doctorate degrees in nursing from Duke University. Duke has been ranked the #1 PMHNP program in the nation for 5 consecutive years. 

I am a psychiatric-mental health nurse practitioner currently practicing at an outpatient private psychiatric practice in Kansas. In addition to my clinical work, I provide contract-based telepsychiatry services for two organizations during evenings and weekends. I also serve as adjunct faculty in Duke University and Rockhurst University's psychiatric-mental health graduate nursing programs, and actively precept PMHNP students at my private practice. I am a board member of the Kansas chapter of the American Psychiatric Nurses Association (APNA), have presented posters at national conferences, and have published in multiple peer-reviewed nursing and medical journals. 



I currently work as a board certified psychiatric mental health nurse practitioner assessing, diagnosing, prescribing medicine, and incorporating psychotherapy into (almost) all appointments. I see patients across the lifespan ages 5-75, and specialize in depression, anxiety, OCD, eating disorders, trauma, bipolar spectrum, ADHD, and substance misuse. I also operate a small private practice where I see a limited number of patients on a pro-bono basis that are not insured and cannot afford the out of pocket cash pay rates for mental health services. My private practice serves as an accessible option for underserved communities, where mental health providers are scarce and community mental health programs are often burdened with extended waitlists.

I’m passionate about integrating psychotherapy into medication management appointments, policy improvement in healthcare, nursing education, and implementing innovative metabolic and nutritional interventions for mental health conditions

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