Chapter 14 - Depressive Disorders (Psych) EAQ's

A patient diagnosed with depression admitted with suicidal ideation is prescribed amitriptyline. The patient asks, "Why did the health care provider give me a prescription for only seven days of this medication?" Based on the understanding of the medication, what is the nurse's reply? 1 "Amitriptyline is lethal in overdose, so this is a safety precaution." 2 "Amitriptyline is very expensive, so you will have to buy fewer at a time." 3 "The health care provider wants to see which side effects occur within the first week of administration." 4 "The health care provider is interested in how you respond to the first week of medication before extending the prescription."

1 "Amitriptyline is lethal in overdose, so this is a safety precaution." Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring the patient to visit the health care provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only one week. Side effects are always a consideration, but not the most important consideration with TCAs. Text Reference - p. 260, Table 14.6

Which statements are associated directly with Beck's cognitive triad? Select all that apply. 1 "I'm not worth much; I can't do anything right." 2 "Things will only get worse; they never get better." 3 "I'll never find anyone who loves or values me." 4 "I don't think other people are worthless." 5 "Good luck happens to good people."

1 "I'm not worth much; I can't do anything right." 2 "Things will only get worse; they never get better." 3 "I'll never find anyone who loves or values me." Three assumptions constitute Beck's cognitive triad: (1) a negative, self-deprecating view of self; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement (or no validation for the self) will continue in the future. Statements such as "I don't think other people are worthless" and "Good luck happens to good people" lack the negative assumptions associated with the cognitive triad. Text Reference - p. 248

Which child or teenager is demonstrating classic depression-related behavior? Select all that apply. 1 A 4-year-old who cries frequently for no apparent physical reason 2 A 6-year-old who demands to sleep with mom when dad is away 3 An 8-year-old who consistently declines offers to play with schoolmates 4 An 11-year-old who cries when a beloved family pet runs away 5 A 15-year-old who becomes verbally abusive to siblings

1 A 4-year-old who cries frequently for no apparent physical reason 3 An 8-year-old who consistently declines offers to play with schoolmates 5 A 15-year-old who becomes verbally abusive to siblings As children grow and develop, they may display a wide range of moods and behaviors, making it easy to overlook signs of depression. For example, a very young child may cry, a school-age child might withdraw, and a teenager may become irritable in response to feeling sad or hopeless. The 6-year-old who demands to sleep with mom when dad is away and an 11-year-old who cries when a beloved family pet runs away are examples of acute grief or anxiety rather that depression. Text Reference - p. 252

Which antidepressant drug can be prescribed to depressed patients who also suffer from narrow-angle glaucoma? Select all that apply. 1 Bupropion 2 Amitriptyline 3 Desipramine 4 Isocarboxazid 5 Tranylcypromine

1 Bupropion 4 Isocarboxazid 5 Tranylcypromine Bupropion is a norepinephrine dopamine reuptake inhibitor that can be prescribed to treat depression in patients with narrow angle glaucoma. It blocks the synaptic reuptake of norepinephrine and dopamine instead of the muscarinic receptors. Isocarboxazid is a monoamine oxidase inhibitor that inhibits the monoamine oxidase enzyme. It does not antagonize the muscarinic actions, so it can be prescribed to patients with narrow angle glaucoma. Tranylcypromine is a monoamine oxidase inhibitor. It does not cause side effects like blurred vision, so it is safe to be prescribed. Tricyclic antidepressants such as desipramine and amitriptyline must be avoided in depressed patients with narrow angle glaucoma. Tricyclic antidepressants are muscarinic receptor antagonists and thus cause blurred vision. These drugs would worsen the condition of narrow angle glaucoma. Text Reference - p. 261

What are the side effects of vagus nerve stimulation (VNS)? Select all that apply. 1 Cough 2 Delusions 3 Neck pain 4 Paresthesia 5 Tachycardia

1 Cough 3 Neck pain 4 Paresthesia Patients who have undergone VNS may have side effects, including paresthesia, neck pain, and cough due to the position and implantation of the VNS device on the vagus nerve. The electrode used for stimulation is placed close to the laryngeal and pharyngeal branch of the left vagus nerve. Stimulation of these nerves causes coughing. The vagus nerve has an inhibitory effect on the heart; therefore bradycardia, not tachycardia, is a symptom associated with vagus nerve stimulation. Vagus nerve stimulation does not alter the neurotransmitter levels in the brain, so the patient does not have delusions. Text Reference - p. 265

A patient who had undergone a hysterectomy has low self-esteem and avoids taking food. Which appropriate method does the nurse choose to reduce anorexia? 1 The nurse allows family members to remain with the patient during meals. 2 The nurse gives food low in fiber to the patient. 3 The nurse gives a large quantity of low-calorie food to the patient. 4 The nurse gives tea and coffee frequently to the patient.

1 The nurse allows family members to remain with the patient during meals. Low self-esteem and reduced food intake are symptoms of depression. Patients can be encouraged to take food in the presence of their family members as it increases their self-esteem. Taking food rich in fiber helps reduce constipation. Small amounts of high-calorie and high-protein food should be given frequently to meet the patient's nutritional demands. The patient must not be given tea or coffee frequently as they cause insomnia. Text Reference - p. 256, Table 14.5

What statements regarding depression is true? Select all that apply. 1 Depression can be seen in association with other mental and physical disorders. 2 While depression coexists with other disorders, it does not impact these disorders. 3 The symptomology of depression is relatively similar regardless of age or culture. 4 Social relationships can suffer when an individual is depressed. 5 Depression can range from mild to severe in its effect on individuals.

1 Depression can be seen in association with other mental and physical disorders. 4 Social relationships can suffer when an individual is depressed. 5 Depression can range from mild to severe in its effect on individuals. Depression can exist alone or in conjunction with other disorders and illnesses. Depression can present differently in different populations and different age groups and can be manifested on a continuum from mild to severe. One thing is consistent; depression results in significant pain and suffering that disrupts social relationships, performance at school or on the job, and the ability for a person to live a full and happy life. Depression also has a negative impact on physical well-being and the course of other medical diagnoses. This chapter includes basic information and therapeutic tools that will facilitate the care of patients with depression. Text Reference - p. 245

Which statements are true regarding serotonin syndrome? Select all that apply. 1 Discontinue all selective serotonin reuptake inhibitors (SSRIs) for two to five weeks before starting a monoamine oxidase inhibitor (MAOI) 2 Believed to be associated with under-activation of serotonin receptors 3 Symptoms include hypertension and delirium 4 Death can result from severe symptomology 5 Hypothermia and septic shock are severe manifestations of the disorder

1 Discontinue all selective serotonin reuptake inhibitors (SSRIs) for two to five weeks before starting a monoamine oxidase inhibitor (MAOI) 3 Symptoms include hypertension and delirium 4 Death can result from severe symptomology A patient should discontinue all SSRIs for two to five weeks before starting an MAOI. Symptoms include abdominal pain, diarrhea, sweating, fever, tachycardia, elevated blood pressure, altered mental state (delirium), myoclonus (muscle spasms), increased motor activity, irritability, hostility, and mood change. Severe manifestations can induce hyperpyrexia (excessively high fever), cardiovascular shock, or death. Serotonin syndrome is thought to be related to over-activation of the central serotonin receptors caused by either too high a dose or interaction with other drugs. Text Reference - p. 260, Box 14.3

A patient who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The patient mentions that he or she will take the medication along with the St. John's wort he or she uses daily. The nurse should 1 Explain the high possibility of an adverse reaction 2 Suggest that the patient also use a sun lamp daily 3 Caution the patient to drink several glasses of water daily 4 Agree that taking the drugs at the same time will help the patient to remember them daily

1 Explain the high possibility of an adverse reaction Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. Text Reference - p. 266

A patient diagnosed with depression begins a new prescription for phenelzine. Which food is safe for this patient to consume? 1 Fresh fish 2 Pepperoni 3 Chocolate 4 Guacamole

1 Fresh fish Phenelzine is a monoamine oxidase inhibitor antidepressant medication. It is important to avoid foods high in tyramines. Fresh fish is safe. Pepperoni and chocolate are foods high in tyramines, which may cause a hypertensive crisis. Guacamole is made from avocados. Text Reference - p. 260, Table 14.6

A patient with depression was prescribed fluvoxamine. On regular examination, the nurse identifies that the patient is having serotonin syndrome. Which symptoms in the patient support the nurse's assumption? Select all that apply. 1 Hyperactivity 2 Reduced heart rate 3 Altered mental states 4 Abnormally high fever 5 Reduced blood pressure

1 Hyperactivity 3 Altered mental states 4 Abnormally high fever Fluvoxamine is a selective serotonin reuptake inhibitor. It can cause potential side effects such as serotonin syndrome due to overactivation of central serotonin receptors. Serotonin syndrome is characterized by hyperactivity, altered mental state, and hyperpyrexia characterized by excessively high fever. It is also characterized by elevated blood pressure and increased heart rate. Text Reference - p. 260, Box 14.3

Depression sometimes occurs secondary to another medical condition. Which conditions are likely to cause depressive symptoms? Select all that apply. 1 Lupus 2 Stroke 3 Urolithiasis 4 Chronic pain 5 Hypertension

1 Lupus 2 Stroke 4 Chronic pain The prevalence of depression in people who have suffered a stroke may be as high as 50%. Chronic pain is also positively correlated with depression, as are autoimmune disorders such as lupus. Urolithiasis, or bladder stones, is not associated with depression. Hypertension is also not associated with depression unless it is a symptom of a more serious issue. Text Reference - p. 244

The nurse has developed a plan for a patient with a severe sleep pattern disturbance to spend 20 minutes in the gym exercising each afternoon. Which intervention should be scheduled upon returning to the unit? 1 Rest 2 Group therapy 3 A protein-based snack 4 Unstructured private time

1 Rest A depressed patient usually has little energy. After even a short exercise period, the patient may feel exhausted and need rest. Text Reference - p. 256, Table 14.5

A patient diagnosed with major depressive disorder has vegetative symptoms. Which nursing diagnosis is most applicable to these symptoms? 1 Self-care deficit 2 Spiritual distress 3 Disturbed thought processes 4 Risk for self-directed violence

1 Self-care deficit Vegetative signs of depression include grooming and hygiene deficiencies; significantly reduced appetite; and changes in sleeping, eating, elimination, and sexual patterns. Spiritual distress, disturbed thought processes, and risk for self-directed violence relate to assessment findings in depression associated with other symptoms, not vegetative signs of depression. Text Reference - p. 252

A patient says to the nurse, "Life doesn't have any joy in it anymore. Things I once did for pleasure aren't fun." What term would the nurse use to document this complaint? 1 Dysthymia 2 Anhedonia 3 Euphoria 4 Psychomotor retardation

2 Anhedonia Anhedonia is a common finding in many types of depression. It refers to feelings of a loss of pleasure in formerly pleasurable activities. Dysthymic disorder is characterized by chronic low-level depression while euphoria is an extreme sense of joy. Psychomotor retardation is related to physical movement not emotion. Text Reference - p. 252

A pastor who has training in psychotherapy is caring for a patient who does not believe in pharmacological treatments. On one visit, the patient tells the pastor that he or she wants to "return to heaven." The pastor knows the patient has firearms. What is the pastor's best course of action? 1 The patient requires emergency intervention. 2 The pastor should inform the patient's family. 3 There is no way for the pastor to stop the patient. 4 The pastor should inform the patient that suicide is a sin.

1 The patient requires emergency intervention. When a patient details a plan for suicide emergency intervention is required. This may include involuntary admission for observation. The pastor and patient may believe that suicide is a sin, but this may not be enough for a patient with disordered thinking. The pastor can involve the family if possible as part of emergency intervention. The pastor should do everything he or she can to stop the patient. Text Reference - p. 248

A nurse caring for a patient with depression instructs the patient to rest after group activity. The nurse provides warm milk to the patient in the morning and at night. What change does the nurse find in the patient after implementation of this these interventions? 1 The patient sleeps properly. 2 The patient interacts with the nurse. 3 The patient maintains good hygiene. 4 The patient has an increased appetite.

1 The patient sleeps properly. Depressive patients often have insomnia. The nurse should ensure that patients rest adequately after group activity. This helps to reduce fatigue, which can intensify the symptoms of depression. The patient can be given warm milk at night to induce sleep. Encouraging the patient to interact with the nurse or practice good hygiene or improving the patient's appetite may be treatment goals but they are not directly related to the nurse's intervention with warm milk. Text Reference - p. 256, Table 14.5

When the nurse remarks to a depressed patient, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to 1 Wait quietly for the patient to reply 2 Prompt the patient if the reply is slow 3 Repeat the question if the patient does not answer promptly 4 Review the patient's medical record to support the patient's response

1 Wait quietly for the patient to reply Depressed patients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply. Text Reference - p. 254, Table 14.3

A patient hospitalized for major depression has been taking sertraline for the past week and has verbalized increased energy and improved sleep. What is the highest priority question the nurse should ask? 1 "Do you think your depression is less severe?" 2 "Are you having any thoughts of harming yourself?" 3 "Have you experienced any side effects from this drug?" 4 "How has your appetite changed since starting this drug?"

2 "Are you having any thoughts of harming yourself?" The patient is starting to experience increased energy, but suicidal thoughts may still remain. The patient may now have the energy for self-harm. It is important to assess for other side effects, such as appetite changes and depression, but suicide is the highest priority. Text Reference - p. 253

Which statement would show acceptance of a depressed, mute patient? 1 "I will be spending time with you each day to try to improve your mood." 2 "I would like to sit with you for 15 minutes now and again this afternoon." 3 "Each day we will spend time together to talk about things that are bothering you." 4 "It is important for you to share your thoughts with someone who can help you evaluate your thinking."

2 "I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the patient without making demands is a good way to show acceptance. Text Reference - pp. 253-254

Given a choice of the following entrees, the patient prescribed a monoamine oxidase inhibitor (MOA) can safely eat 1 An avocado salad plate 2 A fruit and cottage cheese plate 3 Kielbasa and sauerkraut 4 A liver and onion sandwich

2 A fruit and cottage cheese plate Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, hypertensive crisis, and eventually a cerebrovascular accident. Text Reference - p. 262, Table 14.7

Which individual demonstrates the greatest risk for experiencing major depression? 1 A teenaged male who failed to make the football team 2 A young adult female who recently gave birth to her first child 3 An older adult female who retired after 25 years of factory work 4 A middle-aged male who is a self-employed small business owner

2 A young adult female who recently gave birth to her first child The lifetime risk for major depression is 7% to 12% for men and 20% to 30% for women. Among women, rates peak between adolescence and early adulthood. It is particularly important to screen for depression among women of reproductive age, especially those who have children or plan to become pregnant. Although the teenaged male and the retired female do have characteristics that put them at risk for depression (e.g. disappointment, being a teenager, retirement, being female), they are less at risk than the young adult female who recently gave birth. The middle-aged male's risk for major depression is relatively small. Text Reference - p. 246, Box 14.1

Which assessment technique will the nurse use when attempting to substantiate a patient's diagnosis of major depression? 1 Assesses the patient for signs of anorexia 2 Asks the patient, "Have you ever been depressed like this before?" 3 Assesses the patient for behaviors associated with drug abuse 4 Asks the patient, "Are you having any problems falling or staying asleep?"

2 Asks the patient, "Have you ever been depressed like this before?" Although most untreated episodes of major depression last 6 to 24 months, more than 50% of those who have one episode will eventually have another, and 25% of patients will have chronic, recurrent depression. Although anorexia, drug abuse, and dysfunctional sleep patterns may be comorbid conditions associated with depression, they are not strong risk factors for developing the disorder. Text Reference - p. 245

Dysthymia cannot be diagnosed unless it has existed for 1 At least one year 2 At least two years 3 At least six months 4 At least three months

2 At least two years Dysthymia is a chronic condition that by definition has to have existed for longer than two years. Text Reference - p. 243

Which nursing diagnosis would be least useful for a depressed patient who shows psychomotor retardation? 1 Constipation 2 Death anxiety 3 Activity intolerance 4 Self-care deficit: bathing or hygiene

2 Death anxiety A patient with psychomotor retardation has vegetative signs of depression and often is constipated, too tired to engage in activities, and lacks the energy to attend to personal hygiene. Depressed patients usually do not have death anxiety. They are more likely to welcome the idea of dying. Text Reference - p. 252

What statement about the comorbidity of depression is accurate? 1 Depression most often exists in an individual as a single entity. 2 Depression commonly is seen in individuals with medical disorders. 3 Substance abuse and depression are seldom seen as comorbid disorders. 4 Depression may coexist with other disorders, but is rarely seen with schizophrenia.

2 Depression commonly is seen in individuals with medical disorders. Depression commonly accompanies medical disorders. Depression existing most often as a single entity, seldom seen with substance abuse, and rarely seen with schizophrenia are false statements. Text Reference - p. 246

Subsyndromal depression primarily occurs in which population? 1 Adults 2 Elderly 3 Children 4 Teenagers

2 Elderly Subsyndromal depression is most prevalent in older adults. It occurs when the patient experiences some, but not all, of the symptoms that are seen in a major depressive episode. Children, adolescents, and adults are less susceptible to subsyndromal depression. Text Reference - p. 246

A nurse counsels a patient diagnosed with depression to begin a mild exercise regime. What is the physiologic basis of the nurse's recommendation? 1 Exercise reduces inflammation. 2 Exercise stimulates serotonin production. 3 Exercise will stabilize the client's sleep pattern. 4 Exercise eliminates toxins from the client's body.

2 Exercise stimulates serotonin production. Exercise stimulates serotonin production, which will help improve the patient's mood. Exercise has biological, social, and psychological effects on symptoms of depression. Inflammation may be a factor in depression, but exercise is not targeted at this aspect of the disorder. While exercise may contribute to improved sleep, it will not necessarily stabilize the sleep pattern. Exercise improves circulation, but does not necessarily eliminate toxins. Text Reference - p. 266

A young adult patient reports to the nurse that her premenstrual symptoms have worsened. She has read about premenstrual dysphoric disorder (PMDD) and thinks she may have the condition. Which statement about the disorder is true? 1 PMDD symptoms worsen after menopause. 2 Fluoxetine is one potential treatment option. 3 The disorder will not resume after a pregnancy. 4 PMDD means she will always have severe depression.

2 Fluoxetine is one potential treatment option. Fluoxetine can be used to treat PMDD. PMDD does not necessarily mean a patient will always have severe depression. The disorder can manifest as long as a woman is menstruating, including during the postnatal period. Symptoms generally decrease after menopause unless the patient receives hormone replacement therapy. Text Reference - p. 244

In the absence of a previous suicide attempt, the nurse is most concerned about a patient's risk for self-harm when the male patient shares which information? 1 His wife divorced him six months ago. 2 He was diagnosed with major depression 10 years ago. 3 His mother experienced postpartum depression after his birth. 4 He often spends days alone in a cabin located miles away from the main road.

2 He was diagnosed with major depression 10 years ago. Although previous suicide attempts indicate risk, the longer the time one spends depressed is a major factor in determining the long-term risk of suicide. Divorce triggers depression in some individuals but is not the greatest risk factor among those provided, as not all those experiencing a divorce become depressed. A history of depression in an immediate family member is considered a risk factor but is not the greatest risk factor provided as it does not affect the patient directly. Social isolation is considered a risk factor but is not the greatest risk factor among those provided. Episodic solitude may be normal in this individual. Text Reference - p. 248

Which statement about antidepressant medications, in general, can serve as a basis for patient and family teaching? 1 They tend to be more effective for men. 2 Onset of action is from one to six weeks. 3 Recent memory impairment is observed commonly. 4 They often cause the patient to have diurnal variation.

2 Onset of action is from one to six weeks. People are accustomed to fast results from medication: 30 minutes for aspirin, 24 hours for antibiotics. Information is necessary to prevent discouragement and maintain compliance. Text Reference - p. 258

Which food is safe for a patient taking monoamine oxidase inhibitors (MAOIs)? 1 Avocados 2 Pineapple 3 Chocolate 4 Cheddar cheese

2 Pineapple Patients taking MAOIs must avoid foods containing tyramine. Most fruits, like pineapple, are safe to eat while taking MAOIs, as they have low levels of tyramine. Avocados, especially overripe ones, are high in tyramine. Almost all dairy products like cheddar cheese contain tyramine. Chocolate is also a food to avoid. Text Reference - p. 262

A depressed male patient tells the nurse he is in the 'acute phase' of his treatment for depression. The nurse recognizes that the client has been in treatment 1 For more than four months 2 That is directed toward relapse prevention 3 That focuses on prevention of future depression 4 To reduce depressive symptoms

4 To reduce depressive symptoms The acute phase of depression therapy (6-12 weeks) is directed toward the reduction of symptoms and restoration of psychosocial and work function and may require some hospitalization. Text Reference - p. 253

In a clinical study for a new antidepressant drug, the nurse was asked to select patients for the study. Which parameters should the nurse assess to include the patient in the study? Select all that apply. 1 Blood pressure 2 Serotonin levels 3 Cortisol levels in urine 4 Urine output and fluid intake 5 Corticotrophin-releasing hormone

2 Serotonin levels 3 Cortisol levels in urine 5 Corticotrophin-releasing hormone Patients with depression have increased cortisol levels in the urine and elevated corticotrophin-releasing hormone. Depression is also caused due to the dysregulation of neurotransmitters, mainly serotonin levels. Blood pressure, urine output, and fluid intake levels are not related to depression. Text Reference - p. 247

What is the major reason for hospitalization for depressed patients? 1 Inability to go to work 2 Suicidal ideation 3 Loss of appetite 4 Psychomotor agitation

2 Suicidal ideation Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. Inability to go to work, loss of appetite, and psychomotor agitation describe symptoms of major depression but are not by themselves the major reason for hospitalization. Text Reference - p. 248

Which statements about the physical activity of a patient diagnosed with major depression are true? Select all that apply. 1 Psychomotor agitation results in purposeful, goal-oriented activity. 2 The individual may present with a reduction in psychomotor activity. 3 Psychomotor agitation is demonstrated in cases of major depression. 4 A slow pace and stooped posture is characteristic of psychomotor retardation. 5 Fidgeting is a characteristic psychomotor activity associated with depression.

2 The individual may present with a reduction in psychomotor activity. 3 Psychomotor agitation is demonstrated in cases of major depression. 4 A slow pace and stooped posture is characteristic of psychomotor retardation. 5 Fidgeting is a characteristic psychomotor activity associated with depression. Physical activity also is affected in major depression. Normally one thinks of depressed patients as having psychomotor retardation, a reduction in the amount of physical activity. This type of symptom results in less motor movement; when the patients do move, they move more slowly and posture frequently is stooped with the head down; however, patients with major depression also may have psychomotor agitation. When this occurs, the patient appears restless, changes position often, and may wring his or her hands and fidget. This is not goal-directed activity, and the patient does not feel energized. Text Reference - p. 245

When preparing a patient for electroconvulsive therapy (ECT), the nurse discusses with the patient that: 1 Maintenance treatments are seldom required. 2 The initial course of therapy requires 6 to 12 treatments. 3 This form of therapy is particularly successful for positive symptoms of schizophrenia. 4 The initial therapy involves an ECT treatment repeated once a week for a prescribed time period.

2 The initial course of therapy requires 6 to 12 treatments. A usual course is 6 to 12 treatments given two or three times per week. Maintenance ECT usually involves weekly treatments for the first month after remission, with gradual tapering to monthly ECT treatments. ECT is not typically used in the treatment of schizophrenia. Text Reference - p. 264

While caring for a patient with HIV, the nurse finds that the patient is at risk for self-mutilation. Which symptoms would have led the nurse to this conclusion? Select all that apply. 1 The patient does not pray. 2 The patient has suicidal ideation. 3 The patient has a reduced appetite. 4 The patient has a feeling of worthlessness. 5 The patient is unable to perform simple tasks.

2 The patient has suicidal ideation. 4 The patient has a feeling of worthlessness. Comorbid depression can be seen in patients with HIV. Self-mutilation is a common indication of depression. It is characterized by feelings of worthlessness and suicidal ideation. Depression can cause a decrease in appetite and nutritional imbalance in the patient. However, a decreased appetite does not indicate a risk for self-mutilation. The patient not praying is not a symptom of risk for self-mutilation. The inability to perform a simple task indicates reduced concentration and interest. Text Reference - p. 251

A patient with late-luteal-phase dysphoric disorder is prescribed fluoxetine. What information should the nurse give the patient? 1 To stop the medication immediately if the side effects are severe 2 To consult their primary healthcare provider if there is loss of libido 3 To take acetaminophen if there is fever 4 The drug may cause dry mouth and blurred vision

2 To consult their primary healthcare provider if there is loss of libido Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), which is a class of drug known for having low side effects. The nurse should advise the patient to consult the primary healthcare provider about any side effects, such as loss of libido or sexual dysfunction. Stopping the drug abruptly may cause serotonin withdrawal, so the patient should be advised not to stop the drug without first consulting the healthcare provider. Acetaminophen or any other over-the-counter drugs should not be taken without consulting the primary healthcare provider, as it can lead to drug interactions. SSRIs are known to have low occurrence of side effects, and they do not cause dry mouth or low vision as some older antidepressants do. Text Reference - p. 261, Box 14.4

The nursing diagnosis of imbalanced nutrition—less than body requirements—has been identified for a patient diagnosed with severe depression. The most reliable evaluation of outcomes will be based on the patient's 1 Energy level 2 Weekly weights 3 Observed eating patterns 4 Statement of appetite

2 Weekly weights The patient's body weight is the most reliable and objective evaluation of success in treating this nursing diagnosis. Text Reference - p. 156, Table 14.5

Which complaint regarding sleep would the nurse expect from a patient diagnosed with major depression? 1 "I usually take a nap for about 30 minutes in the afternoon." 2 "It takes me about 15 minutes to fall asleep. I often have vivid dreams." 3 "I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." 4 "I often fall asleep in the middle of an activity. When I wake up, I feel better."

3 "I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." Change in sleep patterns is a cardinal sign of depression. Often, people experience insomnia, wake frequently, and have a total reduction in sleep, especially deep-stage sleep. One of the hallmark symptoms of depression is waking at 3 or 4 AM and then staying awake or sleeping for only short periods. Napping, vivid dreams, and falling asleep in the middle of an activity identify normal sleep variations and narcolepsy. Text Reference - p. 252

Which statement by a patient indicates understanding of the medication teaching provided concerning a prescribed selective serotonin reuptake inhibitor (SSRI)? 1 "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." 2 "I will not take any over-the-counter medication while on this medication." 3 "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." 4 "I will report increased thirst and urination to my health care provider."

3 "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." High fever, fast heartbeat, or abdominal pain describe symptoms of serotonin syndrome, a life-threatening complication of SSRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over the counter medications if sanctioned by the health care provider, and would not have been educated to report increased thirst and urination as a side effect of SSRI. Text Reference - pp. 258-260

Which individual has the highest risk for major depression? 1 35-year-old married male who recently lost his job 2 6-year-old child who suffers from frequent ear infections 3 55-year-old single female recently diagnosed with rheumatoid arthritis 4 16-year-old male whose family recently moved from one state to another

3 55-year-old single female recently diagnosed with rheumatoid arthritis The correct response incorporates the most risk factors for depression. Primary risk factors include female gender, being unmarried, low socioeconomic class, early childhood trauma, a negative life event (especially loss and humiliation), family history of depression, ineffective coping ability, postpartum time period, medical illness, absence of social support, and alcohol or substance abuse. Text Reference - p. 246, Box 14.1

A nurse is caring for a patient with severe depression. After 4 months of treatment, the nurse tells the patient, "Depression is an illness that is beyond a person's voluntary control." In which phase of treatment is this an appropriate statement by the nurse? 1 Acute phase 2 Orientation phase 3 Continuation phase 4 Maintenance phase

3 Continuation phase There are three phases of treatment for depression: the acute phase, the continuation phase, and the maintenance phase. After 4 to 9 months of treatment patients are in the continuation phase, during which they are educated about depression in hopes that they will better adhere to the treatment plan and avoid relapse. Explaining depression is beyond a person's control is an example of this teaching. The other stages of treatment have different goals, such as the acute phase (the initial 12 weeks) in which the patient is given interventions to simply reduce symptoms of depression. After 1 year of treatment, patients are typically in the maintenance phase, where they may already be well educated about depression and the treatment focuses on avoiding further complications due to relapse of the illness. The orientation phase is not one of the three phases of the treatment. It is a part of the group development phase in which patients are encouraged to interact with each other. Text Reference - p. 253

The nurse cares for a patient diagnosed with major depressive disorder. Assessment findings include psychosis and repeated threats to murder members of the immediate family. Which treatment modality is most likely for this patient? 1 Light therapy 2 St. John's wort 3 Electroconvulsive therapy 4 Cognitive behavioral therapy

3 Electroconvulsive therapy The patient described in this scenario demonstrates psychosis and homicidal thinking. While medication is generally the first line of treatment for ease of use, electroconvulsive therapy may be a primary treatment when a patient is suicidal, homicidal, or psychotic. Light therapy is appropriate for a person diagnosed with seasonal affective disorder. Cognitive behavioral therapy is used in the treatment of depression, but is more effective in the maintenance phase. St. John's wort is an over-the-counter herb sometimes used for its antidepressant effects; however, the urgency and acuity of this patient's symptoms necessitate use of an intervention that will produce more immediate effects. Text Reference - pp. 263-264, Figure 14.3

What assessment data are primary risk factors for depression? Select all that apply. 1 Married 2 Male gender 3 History of alcohol abuse 4 Middle class socioeconomic class 5 History of physical abuse as a child

3 History of alcohol abuse 5 History of physical abuse as a child Primary risk factors of depression include female gender, being unmarried, low socioeconomic class, early childhood trauma, and alcohol or substance abuse. Text Reference - p. 246, Box 14.1

A depressed patient tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can identify this cognitive distortion as an example of 1 Self-blame 2 Catatonia 3 Learned helplessness 4 Discounting positive attributes

3 Learned helplessness Learned helplessness results in depression when the patient feels no control over the outcome of a situation. Text Reference - p. 252

Beck's cognitive theory suggests that the etiology of depression is related to 1 Sleep abnormalities 2 Serotonin circuit dysfunction 3 Negative processing of information 4 A belief that one has no control over outcomes

3 Negative processing of information Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue. Text Reference - p. 248

A patient is prescribed tricyclic antidepressants. What should the nurse check for in the patient's case history before administering the drug? 1 Suicidal ideation 2 Loss of appetite 3 Oral contraceptive use 4 Insomnia

3 Oral contraceptive use Medications such as oral contraceptives, antihypertensive reagents, monoamine oxidase inhibitors and anticoagulants may react with tricyclic antidepressants. It can cause potent side effects due to drug interaction. The nurse should check for their administration in the patient's case history and inform the primary healthcare provider. Suicidal ideation, loss of appetite, and insomnia are common symptoms of depression. Text Reference - p. 261

A depressed patient is noted to pace most of the time, pull at his or her clothes, and wring his or her hands. These behaviors are consistent with 1 Senile dementia 2 Hypertensive crisis 3 Psychomotor agitation 4 Central serotonin syndrome

3 Psychomotor agitation These behaviors describe the psychomotor agitation sometimes seen in patients with the agitated type of depression. Text Reference - p. 252

What will the nurse do to address the potential risk for depression among a population? 1 Provide a depression screening at a local afterschool program site. 2 Present educational programming on depression to a senior citizen group. 3 Routinely assess all chronically ill patients for depression during their admission interview. 4 Include the signs of postpartum depression in the discharge packet for each new mother.

3 Routinely assess all chronically ill patients for depression during their admission interview. A high incidence of depression is found among all patients hospitalized for medical illnesses. These depressions are largely unrecognized and untreated by general health care providers. Studies suggest that about one third of medical inpatients report mild or moderate symptoms of depression and up to one fourth may have major depression. Chronic medical conditions often are associated with depression. A depression screening is becoming more common because research suggests the incidence of depression in school age children is significant. Presenting educational programs on depression to senior citizens is becoming more common because research suggests the incidence of depression in the older adult is significant. Including depression information to new mothers is becoming more common because research suggests the incidence of depression in postpartum women is significant. Text Reference - p. 267

Assessment of the thought processes of a patient diagnosed with depression is most likely to reveal 1 Good memory and concentration 2 Delusions of persecution 3 Self-deprecatory ideation 4 Sexual preoccupation

3 Self-deprecatory ideation Depressed patients never feel good about themselves. They have a negative, self-deprecating view of the world. Text Reference - p. 248

It is likely that a patient diagnosed with seasonal affective disorder will begin to experience fewer symptoms in the 1 Fall 2 Winter 3 Spring 4 Summer

3 Spring Seasonal affective disorder occurs during the months when sunlight diminishes. Patients may begin to feel effects in the late fall and will be affected throughout the winter. They improve during the spring and feel well during the summer. Text Reference - p. 266

A depressive patient is prescribed monoamine oxidase inhibitors. The nurse gives the diet chart to the patient. Which food does the patient consume according to the diet chart? 1 The patient eats lot of cheese. 2 The patient eats bananas. 3 The patient eats yogurt. 4 The patient eats dried fish.

3 The patient eats yogurt. The patient eats yogurt as it contains less or no tyramine and is safe. Monoamine oxidase inhibitors (MAOIs) increase the levels of tyramine. So a patient on MAOIs should consume foods which have no or very low levels of tyramine, as an increase in tyramine levels can cause high blood pressure and hypertensive crisis. The patient avoids eating cheese, bananas, and dried fish as they contain high levels of tyramine. Text Reference - p. 262, Table 14.7

A depressive patient is prescribed transcranial magnetic stimulation (TMS). What information should the nurse give to the patient's guardians before performing TMS to the patient? 1 The patient will have slight memory loss after the therapy. 2 The patient will be made unconscious during the therapy. 3 The patient will experience scalp numbness after the therapy. 4 The patient will be confused and disoriented for a few weeks after the therapy.

3 The patient will experience scalp numbness after the therapy. MRI-strength magnetic impulses are used in transcranial magnetic stimulation (TMS) to stimulate the focal areas of the cerebral cortex, which causes increased neuronal firing. The nurse should inform the patient's guardians that it has some common side effects, such as scalp tingling, which may feel like numbness on the scalp. No neurological deficits or memory loss are seen due to TMS, unlike electroconvulsive therapy. The patient is not made unconscious but kept awake and alert during the therapy. No confusion or disorientation has been reported as a result of this therapy. Text Reference - pp. 264-265, Figure 14.4

An 8-year-old patient has been showing signs of disruptive mood regulation disorder, including irritability, tantrums, and anger. What other factor must be considered to confirm the diagnosis? 1 The symptoms must be present daily. 2 The symptoms must occur at school. 3 The symptoms must occur in two different settings. 4 The symptoms must be noticed by members of the family.

3 The symptoms must occur in two different settings. The symptoms of disruptive mood regulation disorder must occur in at least two separate settings, such as the home and school. The symptoms typically occur three or more times a week, not daily. Some children with this disorder manage to maintain control at school. Although family is most likely to notice symptoms, teachers and peers may notice them as well. Text Reference - p. 243

Which assessment data supports the suspicion that a depressed patient is demonstrating self-directed anger? Select all that apply. 1 Multiple failed marriages 2 Declared bankruptcy twice 3 Three pack a day cigarette smoker 4 Diagnosed as being morbidly obese 5 Hospitalized for alcohol detoxification

3 Three pack a day cigarette smoker 4 Diagnosed as being morbidly obese 5 Hospitalized for alcohol detoxification Anger in depression may be directed toward the self in the form of suicidal or otherwise self-destructive behaviors (e.g., alcohol abuse, substance abuse, overeating, smoking, etc.). Multiple marriages and financial problems are not characteristic examples of self-directed anger. Text Reference - p. 252

A nurse is performing an assessment of a patient with breast cancer. During the assessment, the nurse says to the patient, "You are wearing a pretty dress." What is the reason for giving this statement? The patient was 1 irritable 2 looking very worried 3 not interacting with the nurse 4 frequently looking at her outfit

3 not interacting with the nurse Patients with depression tend to remain silent and are unwilling to interact with people. By telling the patient that she is wearing a pretty dress, the nurse is encouraging the patient to interact by drawing her attention to the surroundings. This helps the patient to emphasize and focus on reality. If the patient is frequently looking at her attire, then the nurse should draw the patient's attention to the present discussion by saying, "It's time to discuss your illness." If the patient looks worried, the nurse should ask the patient, "What is bothering you?" This can help the nurse to know the patient's perceptions and feelings. If the patient looks irritable, the nurse should ask, "What are you irritated at?" This would help the nurse understanding the patient's feelings. Text Reference - p. 254, Table 14.3

Which statement made by a depressed patient would provide insight into a common feeling associated with depression? 1 "I still pray and read my Bible every day." 2 "I've heard others say that depression is a sign of weakness." 3 "My mother wants to move in with me, but I want to be independent." 4 "I still feel bad about my sister dying of cancer. I should have done more for her!"

4 "I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; wanting independence and feeling that depression is a weakness do not describe a common accompaniment to depression. Text Reference - p. 251

An adult was hospitalized three days ago with a diagnosis of major depression with suicidal ideation. Which comment by this patient best reflects an improvement in the depression? 1 "I am hungry all the time." 2 "My family can get along fine without me." 3 "Group therapy may be helpful to others but I find it tiresome to listen." 4 "I talked with my family about ways we can celebrate holidays together."

4 "I talked with my family about ways we can celebrate holidays together." The correct response indicates this patient is looking toward the future, which would not occur in the presence of continued suicidal thinking. An improved appetite is a positive finding but could be attributed to medication side effects or other events; it is not the best answer. Saying one's family can get along without him or her and not wanting to go to group therapy indicate hopelessness and continued severe depression. Text Reference - p. 254, Table 14.2

A patient has been taking citalopram for two years for depression. The patient's outcomes have been achieved and the patient wants to discontinue the medication. Which information should the nurse provide? 1 "Citalopram is an antidepressant medication that usually is taken for life." 2 "Stopping this medication all of a sudden can cause serotonin syndrome." 3 "Because your depression is alleviated, you may discontinue the medication." 4 "It's important for you to gradually stop taking this drug over two to four weeks."

4 "It's important for you to gradually stop taking this drug over two to four weeks." Selective serotonin reuptake inhibitors (SSRIs) should be tapered off gradually over a period of two to four weeks to avoid a withdrawal syndrome. Symptoms of the withdrawal syndrome include headache, gastrointestinal upset, dizziness, insomnia, anxiety, and flulike symptoms. Serotonin syndrome is a potentially life-threatening consequence of drug interactions with SSRIs. Text Reference - p. 259, Table 14.6

A patient diagnosed with chronic severe depression has been prescribed a series of electroconvulsive therapy (ECT) treatments. The nurse's initial intervention is to ask: 1 "Would you feel more relaxed about the treatments if I stayed with you?" 2 "What can I do to help you feel more comfortable about these treatments?" 3 "Do you know very much about the benefits and drawbacks of ECT treatments?" 4 "Will you let me know if you want or need to talk about these ECT treatments?"

4 "Will you let me know if you want or need to talk about these ECT treatments?" An essential role of the nurse is to allow the patient an opportunity to express feelings, including concerns associated with myths or fantasies involving ECT. "Will you let me know if you want or need to talk about these ECT treatments?" does not present any barriers to communication and so allows the patient to express his or her feelings and concerns. The question about the nurse staying with the patient makes assumptions about the patient's concerns and so is a barrier to effective communication. The questions about helping the patient feel more comfortable and concerning the benefits and drawbacks of ECT make assumptions about the patient's needs and so are barriers to effective communication. Text Reference - p. 264

What is the best question for the nurse to ask when attempting to assess for the presence of depression in an elderly patient? 1 Are you having crying spells every day? 2 What is your family history related to depressive illnesses? 3 Would you say you are currently having a major depressive episode? 4 How do you compare your activities and health now to six months ago?

4 How do you compare your activities and health now to six months ago? Elderly patients may not acknowledge depression directly. Changes in somatic and interpersonal activities often give clearer evidence of depression. Text Reference - pp. 252-253

A nurse is teaching a group of nursing students about antidepressants that act by increasing the availability time of noradrenaline and serotonin at the postsynaptic receptors. Which medication would you expect to see prescribed? 1 Bupropion 2 Vilazodone 3 Sertraline 4 Imipramine

4 Imipramine Imipramine belongs to the class of tricyclic antidepressants that act by increasing the availability time of noradrenaline and serotonin at the postsynaptic receptors. An increase in the serotonin and norepinephrine levels can cause mood elevation. Bupropion belongs to norepinephrine dopamine reuptake inhibitors. It blocks the synaptic reuptake of norepinephrine and dopamine. Vilazodone is a selective serotonin reuptake inhibitor and serotonin receptor agonist. It acts by blocking the synaptic reuptake of serotonin and activated serotonin receptors. Sertraline is a selective serotonin reuptake inhibitor. It blocks the synaptic reuptake of serotonin. Text Reference - p. 260, Table 14.6

A pregnant patient is diagnosed with seasonal affective disorder. What appropriate action does the nurse include in the patient's treatment plan? 1 Administer St. John's wort (Hypericum perforatum) regularly. 2 Administer selective serotonin reuptake inhibitors regularly. 3 Advise the patient to rest and avoid strenuous activity. 4 Instruct the patient to get exposed to a light source for 30 to 45 minutes daily.

4 Instruct the patient to get exposed to a light source for 30 to 45 minutes daily. Light therapy is the best treatment for seasonal affective disorder. It increases the melatonin secretion by the pineal gland. It is ideal to expose the patient to a light source for 30 to 45 minutes. It helps in elevating the mood of the patient with seasonal affective disorder. St. John's wort (Hypericum perforatum), though it is an herb, should not be given to pregnant patients as it may not be safe. Selective serotonin reuptake inhibitors must not be used as they may have teratogenic effects on the fetus. Exercise enhances the mood, so the nurse must encourage the patient to exercise regularly. Text Reference - p. 266

A patient was admitted to an intensive care unit after reporting chest pain, an elevated heart rate, and a very high body temperature. The patient's family reported to the nurse that the patient was taking antidepressants. They also reported that the patient started having chest pain after eating avocados and cheese. Which antidepressant medication was the patient likely taking that would have caused this interaction? 1 Duloxetine 2 Trazodone 3 Desipramine 4 Isocarboxazid

4 Isocarboxazid Some foods, such as cheese, are rich sources of tyramine, which increases the production of serotonin in the body. Patients who are taking isocarboxazid, which is a monoamine oxidase inhibitor (MAOI), should avoid eating foods rich in tyramine because this substance can interact with MAOI drugs and cause adverse effects, such as hypertensive crisis and pyrexia (high body temperature). These reactions are seen within a few hours after consuming the contraindicated foods. The symptoms of hypertensive crisis are chest pain and increased or reduced heart rate. Desipramine is a tricyclic antidepressant and does not cause hypertensive crisis. Trazodone is a serotonin antagonist and reuptake inhibitor (SSRI), and its side effects are sedation and nausea. Hypertensive crisis is not a side effect associated with SSRIs. Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI); its side effects are nausea, headache, and dry mouth. Text Reference - p. 260, Table 14.6

The nurse cares for an adult who repeatedly says, "My dead relatives try to talk to me and penetrate my body." This comment is most associated with which of the following disorders? 1 Seasonal affective disorder 2 Disruptive mood dysregulation disorder 3 Substance-induced depressive disorder 4 Major depressive disorder with psychosis

4 Major depressive disorder with psychosis Depressive disorders are classified according to symptoms or the situations under which they occur. During a major depressive episode, the person's ability to think clearly is negatively affected and evidence of delusional thinking may be seen. Delusional thinking is an aspect of psychosis. Seasonal affective disorder is characterized by marked seasonal differences in mood associated with decreased daylight. Substance-induced depressive disorder applies when symptoms of a major depressive episode arise in association with drug or alcohol intoxication or withdrawal. Disruptive mood dysregulation disorder relates to children and refers to situations in which a person has frequent temper tantrums, resulting in verbal or behavioral outbursts out of proportion to the situation. Text Reference - pp. 251-252

Antidepressants administered alone can cause an adverse reaction in patients with bipolar disorder. What additional drug class should be prescribed? 1 Sedative 2 Anxiolytic 3 Antipsychotic 4 Mood stabilizer

4 Mood stabilizer When administered solely to patients with bipolar disorder antidepressants can cause a psychotic episode. A mood-stabilizing drug should be given concurrently. Anxiolytic medication may be prescribed as well, but only if symptoms of anxiety are present. Sedatives serve no purpose in this situation. Antipsychotics would be of use if a psychotic episode occurs but not as a prophylactic measure. Text Reference - p. 258

When the health care provider mentions that a patient has anhedonia, the nurse can expect that the patient: 1 Has poor retention of recent events 2 Experienced a weight loss from anorexia 3 Has difficulty with tasks requiring fine motor skills 4 Obtains no pleasure from previously enjoyed activities

4 Obtains no pleasure from previously enjoyed activities Anhedonia is the term for the lack of ability to experience pleasure. Text Reference - p. 252

A nurse is caring for a depressed patient who is prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse reports to the primary health care provider that the patient has delirium, seizures, and elevated blood pressure after taking the medication. The primary health care provider prescribes a new medication and says to the nurse, "Stop the previous prescribed medications immediately, and administer this medication to the patient after 5 weeks." Which new drug has been prescribed to the patient? 1 Paroxetine 2 Citalopram 3 Vilazodone 4 Phenelzine

4 Phenelzine This patient who has taken an SSRI drug has serotonin syndrome, which is characterized by elevated blood pressure, delirium, and seizures. In this situation the SSRI drug must be stopped immediately and should be replaced by another antidepressant drug, such as a monoamine oxidase inhibitor like phenelzine. Monoamine oxidase inhibitors like phenelzine cannot be administered until 2 to 5 weeks after discontinuing a selective serotonin reuptake inhibitor. If phenelzine is immediately administered without a waiting period, the effects of serotonin syndrome may be enhanced due to drug accumulation. Citalopram, paroxetine, and vilazodone are all selective serotonin reuptake inhibitor drugs and thus cannot be prescribed to the patient. Text Reference - p. 260

A depressed, socially withdrawn patient tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by 1 Asking, "Is this part of the reason you think no one likes you?" 2 Saying, "That is the most unrealistic thing I have ever heard." 3 Querying, "Tell me what things you think you are not able to do correctly." 4 Suggesting, "Let's look at what you just said, that you can 'never do anything right.'"

4 Suggesting, "Let's look at what you just said, that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the patient's willingness to participate. Text Reference - p. 255, Table 14.4

A nurse is performing an assessment of a patient with depression who is prescribed antidepressants. The patient reports to the nurse, "I have to drink a lot of water now as I am feeling very thirsty and I'm not able to pass urine properly." What does the nurse interpret from these observations? 1 The patient is nonadherent to the medications. 2 The patient is experiencing food-drug interactions. 3 The patient is experiencing side effects of mirtazapine. 4 The patient is experiencing side effects of amitriptyline.

4 The patient is experiencing side effects of amitriptyline. The patient with depression may be prescribed amitriptyline, which is a tricyclic antidepressant. The side effects of amitriptyline are dry mouth, urinary retention, and hypotension, which may make the patient crave water. If the patient is nonadherent to the medications, then the patient will have depressive symptoms, like loss of appetite and insomnia rather than dry mouth and urinary retention. Photosensitivity or rash would be indications of food-drug interaction. The side effects of norepinephrine and mirtazapine, or serotonin-specific antidepressants, include weight gain and sexual dysfunction rather than dry mouth. Text Reference - p. 260, Table 14.6