Depressive Disorders

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

- SSRIs typically tolerated better

substance-induced depressive disorder

Person does not experience depressive symptoms in the absence of drug or alcohol use or withdrawal

Assessment of Depression

- Affect - Thought processes - Mood - Feelings - Physical behavior - Communication - Religious beliefs and spirituality

Depressive disorder associated with another medical condition

- Can be caused by kidney failure, Parkinson's disease, and Alzheimer's disease - Symptoms that result from medical diagnoses or certain medications are not considered major depressive disorder

Other treatments for depression

- Electroconvulsive therapy (ECT) - Transcranial magnetic stimulation - Vagus nerve stimulation - Deep brain stimulation - Light therapy - St. John's wort - Exercise

Nursing Interventions

- Empathic and trusting - Unobtrusive observation and routine suicide screening - Reframing of negative thoughts - Medication education and treatment reinforcement

light therapy

- First-line treatment for seasonal affective disorder (SAD) - Efficacy due to influence of light on melatonin - Effective as medication for SAD - Negative effects: headache and jitteriness

Major Depressive Disorder (MDD)

- Five (or more) of the following in 2-week period: Weight loss and appetite changes, Sleep disturbances, Fatigue, Worthlessness or guilt, Loss of ability to concentrate, Recurrent thoughts of death - PLUS—at least one symptom is also either: Depressed mood or Loss of interest or pleasure - Persistent for minimum 2 weeks to 6 months - Chronic: Lasting more than 2 years - Recurrent episodes common - Symptoms cause distress or impaired function - Episode not attributed to physiological effects - Absence of a manic or hypomanic episode - Anhedonia: Lack of interest - Anergia: abnormal lack of energy

St. John's Wort

- Flower processed into tea or tablets - Thought to increase serotonin, norepinephrine, and dopamine in the brain - Useful in mild to moderate depression

recovery model

- Focus on patient's strengths - Treatment goals mutually developed - Based on patient's personal needs and values

persistent depressive disorder

- Formerly known as dysthymia - Low-level depressive feelings through most of each day, for the majority of days - At least 2 years in adults - At least 1 year in children and adolescents - Must have two or more of the following: Decreased appetite or overeating, insomnia or hypersomnia, low energy, poor self-esteem, difficulty thinking, and hopelessness

Disruptive Mood Dysregulation Disorder

- Introduced in 2013 due to the alarming rate of children and adolescents diagnosed with bipolar. - Constant and severe irritability and anger in children 6-18 years old. - Onset before 10 years of age - To be diagnosed must exhibit irritability, anger, and temper tantrums in at least two settings: home, school, or with peers.

Epidemiology of Depression

- Leading cause of disability in the United States - First episode often occurs at a younger age - Lifetime risk peaks at middle age - Older adults are the least likely to develop major depression or any psychiatric disorder - Non-Latino Whites have the highest 12-month prevalence rate - African-Americans experience a more persistent depression with greater functional impairment - Women have the highest lifetime risk; men report greater problems with substance abuse

Depressive Disorders

- Major Depressive Disorder - Disruptive mood dysregulation disorder - Persistent depressive disorder (previously dysthymia) - Premenstrual dysphoric disorder - Substance/medication-induced depressive disorder - Depressive disorder due to another medical condition

transcranial magnetic stimulation (TMS)

- Noninvasive - Uses MRI-strength magnetic pulses to stimulate focal areas of the cerebral cortex - Presence of metal is the only contraindication - Adverse reactions: Headache and lightheadedness, neurological deficits or memory problems, Seizures rarely, Most are mild and include scalp tingling and discomfort at the administration site

vagus nerve stimulation

- Originally used to treat epilepsy - Decreases seizures and improves mood - Electrical stimulation boosts the level of neurotransmitters - Side effects: Voice alteration (nearly 60% of patients), Neck pain, cough, paresthesia, and dyspnea, which tend to decrease with time

Nursing care after ECT

- Priority # 1: physiological stability - Reducing disorientation and confusion - May have short term memory loss or confusion. - Do not operate machinery or make important decisions.

deep brain stimulation (DBS)

- Surgically implanted electrodes (in the brain) - Stimulates those regions identified as underactive in depression - More invasive than VNS as electrodes are placed directly into the brain

prementrual dysphoric disorder (PMDD)

- Symptom cluster in last week prior to onset of a woman's period - includes mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating - Symptoms decrease significantly or disappear with the onset of menstruation

electroconvulsive therapy (ECT)

- The most effective depression treatment - Psychotic illnesses = second most common indication - ECT the primary treatment in severe malnutrition, exhaustion, and dehydration due to lengthy depression - Safer than meds with certain medical conditions - Delusional depression - Failure of previous medication trials - Schizophrenia with catatonia

phase of depression management

- acute: 6-12 wks - continuation: 4-9 months - maintenance: 1 yr or more

Monamine Oxidase Inhibitors (MAOIs)

- adverse effects: hypertensive crisis, insomnia, confusion - nursing considerations: Rarely used, require close monitoring, potentially fatal drug & food interactions, OTC interactions, contraindicated in people taking SSRI's, Tyramine-Restricted Diet - Diet Example: most fresh fruits and vegetables, fresh meat - Avoid: Yeast products, processed meats, avocados

Tricylic Antidepressants

- anticholinergic adverse reactions

Etiology of Depression

- biological factors: Genetic disposition, Biochemical, Stressful life events, Alterations in hormonal regulation, Inflammatory process, Diathesis-stress model (Genetic, biochemical, personality structure, Life events) - psychological factors: cognitive theory (optimist vs pessimist), learned helplessness (lack of resilience)

Selective Serotonin Reuptake Inhibitors (SSRIs)

- first-line therapy - rare risk of serotonin syndrome - monitor fo initial increase in suicidal thoughts

A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding? A. Psychomotor retardation B. Psychomotor agitation C. Vegetative sign D. Anhedonia

A. Psychomotor retardation

Jeff was just diagnosed with a major depressive disorder. Which medication is the health care provider most likely to start the patient on? A. SSRI B. SNRI C. Tricyclic antidepressant D. Monoamine oxidase inhibitor

A. SSRI

Which question would be a priority when assessing for symptoms of major depression? A. "Tell me about any special powers you believe you have." B. "You look really sad. Have you ever thought of harming yourself?" C. "Your family says you never stop. How much sleep do you get?" D. Do you ever find that you don't remember where you've been or what you've done?"

B. "You look really sad. Have you ever thought of harming yourself?"

Which assessment finding in a patient with major depression represents a vegetative sign? A. Restlessness B. Hypersomnia C. Feelings of guilt D. Frequent crying

B. Hypersomnia

Jeff's parents have described his lack of interest in things he used to enjoy, like games with his friends, and his classes, which he used to like. This may be best described by the term A. Inappetance B. Impotence C. Indolence D. Anhedonia

D. Anhedonia