Depression Disorder

SNRIs (serotonin-norepinephrine reuptake inhibitors) ACTION:

Inhibit the reuptake of serotonin and norepinephrine into the neuron-> more floating in the brain

SSRIs (selective serotonin reuptake inhibitors) ACTION

Inhibit the reuptake of serotonin back into the neuron -> serotonin floating around in the brain = improve mood :)

SSRI side effects

Insomina Low cardiotoxcity Less antichloegic N/HA Sexual Dysfunction

Seasonal Affective Disorders (SAD) Symptoms

Lethargy, irritability, decreased focus, change in appetite/loss of interest

SNRIs Symptoms

Loss of appetite Insomnia Sexual Dysfunction

Isocarboxazid (Marplan)

MAOI

Phenelzine (Nardil)

MAOI

DO NOT TAKE TCA'S WITH

MAOIs

Depression co-occurs with

MH DISORDERS: Anxiety PTSD Schizophrenia Spectrum SUD Eating Disorders OCD Personality disordes

ECT

Reverse symptoms of mental illness. Procedure done under general anesthesia; small electric currents passed through the brain, triggering a brief seizure

Persistent Depressive Disorder MNEMOINC FOR SYMPTOMS: SIG E CAPS

S- sleep disturbance and Sad Mood I-interest diminished G-guild feeling; feelings of worthlessness/helplessness E-energy decrease or fatigue and (self)-Esteem loss C-concertation diminished and indecisiveness A-appetite changes(decreased or increase) with weight changesP- psychomotor retardation(slowing) or agitation S- suicidal ideation

Whats the #1 GOALS FOR EVALUATINGTREATMENT FOR DEPRESSION

SAFETY

serotinin syndrome

SERIOUS SIDE EFFECT -SSRI & other meds mixed

Desvenlafaxine/Pristiq

SNRI

Duloxetine/Cymbalta

SNRI

Venlafaxine/Effexor

SNRI

Citlopram (Celexa)

SSRI

Escitalopram (Lexapro)

SSRI

Fluoxetine(Prozac)

SSRI

Paroxetine (Paxil)

SSRI

seratraline (zoloft)

SSRI

Major Depressive Disorder Onset/Duration

Separate episodes of 5 or more in a s 2 week period (symptoms of "on most days" for at least 2 week)

sleep, appetite, mood, pain, temp, low in depression, excess in anxiety, excess+Serotonin Syndrome

Serotonin

Major Depressive Disorder Level of functional

Severely reduced or minimal during the episode

most common antidepressant med side effect that causes pt to stop taking?

Sexual Dysfunction

serotinin syndrome SYMPTOMS: MNEMOIC- SHIVERS

Shivering • Hyperreflexia and myoclonus; muscular rigidity only in more severe cases • Increased temperature, • Vital sign instability, HIGH • Encephalopathy—mental status changes such as agitation, delirium, and confusion • Restlessness and incoordination—common because of excess serotonin activity • Sweating (diaphoresis)—an autonomic response to excessive serotonin stimulation

Identify Screening tools for Depressive Disorders

PHQ-2 PHQ-2 Beck Depression Inventory Suicide Risk Assessment

Seasonal Affective Disorders (SAD) Medical Intervention

exercise during daylight Phototherapy

What reduce risk of Serotonin Syndrome ?

"Washout period" When swithcing between antidepressants, there needs to be a 2-5 week "washout" period of the SSRI

MAOIS Pt teaching

-No tyramine(aged cheese, processed or pickled meats and fish, alcohol, figs, avocados, raisins, bananas) -NO OTC -14 Day washout period

SSRIs (selective serotonin reuptake inhibitors) MEDS PREFIX:

-tine -line -pram

Best way to stop antidepressants

-titrate off

Antidepressants take how many weeks to reach full effect

2-4 weeks to take full effect

What is a washout period?

A period of time during which pt is not on any antidepressant because they are switching drugs (especially for MAOIs) - if not done can cause serotonin syndrome

. Which antidepressive drug class is associated with severe food and medication interactions? A. MAOIs B. SSRIs C. SNRIs D. TCAs

A. MAOIs Many drug interactions and you have to avoid tyramine

Major Depressive Disorder Symptoms:

Anhedonia(sad/loss of pleasure), Appetite or weight changes, Decreased concentration, Unexplained pain, Suicidal thoughts

TCA's(Tricyclic Antidepressants) SYMPTOMS

Anticholinergic effects• Sedation• Weight gain • Dizziness, hypotension • Cardiotoxicity • Drug interaction precautionshigh*

-memory, learning, sleep/wake cycle, skeletal muscle movement, balances dopamine effects, deficient in Alzheimers, low in depression, low in erectile dysfunction as a side effect of antipsychotics

Acetylcholine

The most serious complication of depression? A. Social isolation B. Suicide C. Physical deformities D. Stroke

B. Suicide it occurs in 15% of untreated cases.

NDRI's (Norepinephrine-Dopamine Reuptake Inhibitors) ACTION

Blocks reuptake nonrepinephrine

MAOIS(MONOAMINE OXIDASE INHIBITORS) ACTION:

Blocks the destruction of serotonin norepinephrine, dopamine and tyramine

How long should a depressive episode last for it to be considered for diagnosis? A. 7 days B. more than 10 days C. 2 weeks D. 3-4 weeks

C. 2 weeks Major depression is a syndrome of a persistently sad mood lasting 2 weeks or longer.

Which patient would the nurse expect to prepare for ECT? A. A female patient with dysthymic disorder B. An elderly male with major depressive disorder and a history of stroke C. A middle-age, female patient with major depression and an immediate risk of suicide. D. A female patient with depression and hypomania due to cyclothymic disorder

C. A middle-age, female patient with major depression and an immediate risk of suicide. ECT may be used to treat major depression as well as certain psychotic disorders, particularly in situations of severe depression when psychotherapy and medications have been ineffective, when ECT poses a lower risk than other treatments do, or when the patient is at an immediate risk for suicide.

The following are correct nursing interventions for patients with major depression, except: A. Painting B. Newspaper reading C. Scrabble D. Music therapy

C. Scrabble Noncompetitive activities should be promoted for these patients.

TCA's(Tricyclic Antidepressants) TREAT

Depression Pain

movement, reward system, perception of reality, excess produces psychotic symptoms, excess in Schizophrenia, deficiency in depression and Parkinsons

Dopamine

Persistent Depressive Disorder Level of function

Functioning at a suboptimal level (do things most people do)

inhibitory states, increase to reduce anxiety,

Gamma-aminobutyric acid (GABA)

-excitatory states, impacts learning and memory, needs to be balanced with GABA to reduce psychotic states

Glutamate

Patients taking MAOI-inhibiting drugs must be on a tyramine-free diet to prevent

HYPERTENSIVE CRISIS

Bupropion/Wellbutrin

NDRI

vascular contriction (B/P), motivation, arousal levels reward, Excess in mania, anxiety, Schizophrenia, deficiency in depression

Norepinephrine

treatment-resistant depression

Occurs where depression does not respond to antidepressant

How to respond to Serotonin Syndrome

Stop serotonin Start anticonvulsants Start serotonin antagonist

SSRI black box warning

Suicidal ideation/plans in <24yo

What's no longer a 1st choice med for antidepressants?

TCA's(Tricyclic Antidepressants)

SNRIs Treat

Treat depression, anxiety, neuropathy, GAD

ECT is effective for

URGENT HELP IS NEEDED FOR MH Severe depression Catatonic schizophrenia Acute mania

patient was diagnosed with seasonal affective disorder (SAD). During which month would this patient's symptoms be most acute? a. January b. April c. June. d. September

a. January

An adult with depression was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? a. Social skills training b. Relaxation training classes c. Use of complementary therapy d. Learning desensitization techniques

a. Social skills training Social skills training is helpful in treating and preventing the recurrence of depression. Training focuses on assertiveness and coping skills that lead to positive reinforcement from others and the development of a patient's support system.

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment? a. Supporting physiologic stability b. Reducing disorientation and confusion c. Establishing random eye movement latency d. Assisting the patient to identify and test negative thoughts

a. Supporting physiologic stability During the immediate posttreatment period, the patient is recovering from general anesthesia, hence the need to establish and support physiologic stability.

Major Deprssive Disorder

affects how feel, think, and behave, causing persistent feeling of sadness and loss interest in previously enjoyed activities

A patient with depression tells the nurse, "Bad things that happen are always my fault." To assist the patient in reframing this overgeneralization, the nurse should respond: a. "I really doubt that one person can be blamed for all the bad things that happen." b. "Let's look at one bad thing that happened to see if another explanation exists." c. "You are being exceptionally hard on yourself when you imply you are a jinx." d. "What about the good things that happen; are any of them ever your fault?"

b. "Let's look at one bad thing that happened to see if another explanation exists." By questioning a faulty assumption, the nurse can help the patient look at the premise more objectively and reframe it as a more accurate representation of fact. The

A patient diagnosed with major depression says, "No one cares about me anymore. I'm not worth anything." Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient? a. "You look nice this morning." b. "You're wearing a new shirt." c. "I like the shirt you are wearing." d. "You must be feeling better toda

b. "You're wearing a new shirt." Patients with depression usually see the negative side of things. The meaning of compliments may be altered to "I didn't look nice yesterday" or "They didn't like my other shirt." Neutral comments such as an observation avoid negative interpretations. Saying "You look nice" or "I like your shirt" gives approval (nontherapeutic techniques). Saying "You must be feeling better today" is an assumption, which is nontherapeutic.

TCA's(Tricyclic Antidepressants) Action

blocks reabsorption of serotonin and epinephrine at presynapse

A patient experiencing depression says to the nurse, "My health care provider said I need 'talk' therapy, but I think I need a prescription for an antidepressant medication. What should I do?" Select the nurse's best response. a. "Which antidepressant medication do you think would be helpful?" b. "There are different types of talk therapy. Most patients find it beneficial." c. "Let's consider some ways to address your concerns with your health care provider." d. "Are you willing to give 'talk therapy' a try before starting an antidepressant medication?"

c. "Let's consider some ways to address your concerns with your health care provider."

A 28-year-old second-grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 years old. Which combination of factors in this scenario best demonstrates the stress-diathesis model? a. Cold climate coupled with history of abuse b. Current age of 28 coupled with family history of depression c. Family history of mental illness coupled with history of abuse d. Female gender coupled with the stressful profession of teaching

c. Family history of mental illness coupled with history of abuse

The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescribes a low-dose antidepressant. In consideration of published warnings about the use of antidepressant medications in younger patients, which action(s) should the nurse employ? (Select all that apply.) a. Notify the facility's patient advocate about the new prescription. b. Teach the adolescent about Black Box warnings associated with antidepressant medications. c. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. d. Remind the health care provider about warnings associated with the use of antidepressants in children and adolescents.

c. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior.

When counseling patients with major depression, an advanced practice nurse will address the negative thought patterns by using: a. psychoanalytic therapy. b. desensitization therapy. c. cognitive behavioral therapy. d. alternative and complementary therapies.

c. cognitive behavioral therapy. Cognitive behavioral therapy attempts to alter the patient's dysfunctional beliefs by focusing on positive outcomes rather than negative attributions. The patient is also taught the connection between thoughts and resultant feelings. Research shows that cognitive behavioral therapy involves the formation of new connections among nerve cells in the brain and that it is at least as effective as medication.

what can you do for tx resistant depression?

combo or adjuvant drug therapy. med and psychotherapy ECT, TMS, VNS, DBS, antipsychotics

Over the past 2 months a patient made eight suicide attempts, with increasing lethality. The health care provider informs the patient and family that electroconvulsive therapy (ECT) is needed. The family whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? a. "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." b. "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." c. "Yes, there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."

d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."

A patient tells the nurse, "No matter what I do, I feel like there's always a dark cloud following me." Select the nurse's initial action. a. Assess the patient's current sleep and eating patterns. b. Explain to the patient, "Everyone feels down from time to time." c. Suggest alternative activities for times when the patient feels depressed. d. Say to the patient, "Tell me more about what you mean by 'a dark cloud.'"

d. Say to the patient, "Tell me more about what you mean by 'a dark cloud.'"

Persistent Depressive Disorder Depress Mood

feeling low has become the norm, always unhappy Daytime fatigue

Medical condition with higher rates of Depressive Disorders

increased risk: those with chronic medical conditions. especially cardiac disease and diabetes. screen people post MI

Persistent Depressive Disorder

long standing symptoms of depression w/out experiencing elevated mood

Persistent Depressive Disorder Onset/Duration

low moderate most of the day, most days for 2 years

What is Seasonal Affective Disorders (SAD)

reduce exposer to daylight, body clocks being out of sync, produce excess melatonin produce by body at night

Antidepressant are a high risk for....

suicide

ECT Side effects

temporary memory loss and confusion Headache, muscle soreness, and nausea(resolves quickly)

Population at risk of Depressive Disorders

young females

Post op are for ECT

üMonitor vital signs immediately after the procedureüMaintain patent airway, protect from aspiration üAssist to get up slowly once fully conscious üMonitor confusion closely üMaintain close supervision for at least 12 hours üReorient

Signs of individuals withdrawing from antidepressants

□Anxiety □Agitation □Insomnia □Shock-like sensations □Weakness □Diaphoresis □Alterations in vital signs