13 Depressive Disorders Flashcards
depression
mood (affective) disorder
- widespread issue
- ranking high among causes of disability
- high risk of suicide
common morbidities w Depression
- anxiety disorder (70% of pt)
- psychotic disorder
- substance use disorder
- eating disorder
- personality disorder
Depressive Disorders recognized by DSM-5
1 Major Depressive Disorder 2 Seasonal Affective Disorder 3 Persistent Depressive Disorder 4 Premenstrual Dysphoric Disorder 5 Substance-Induced Depressive Disorder
Major Depressive Disorder
single or recurrent episode of unipolar depression
- not assoc w mood swings
- results in significant change in a client’s normal functioning
Major Depressive Disorder is assoc w atleast 5 of the following manifestations which must occur almost everyday for a min of 2 weeks
-depressed mood
-difficulty sleeping or excessive sleeping
-indecisiveness
decr ability to concentrate
-suicidal ideation
-incr/decr motor activity
-inability to feel pleasure
-incr/decr wt
MDD can be further diagnosed w more specific classification using the DSM-5
Psychotic Features
Postpartum onset
Psychotic Features
presence of auditory hallucination or delusion (client thinking they have a fatal disease)
Postpartum onset
beings w/in 4 wks of childbirth
-can include delusions
Seasonal Affective Disorder
form of depression that occurs seasonally
-usually winter bc less daylight
first line of tx for SAD
light therapy
Persistent Depressive Disorder
milder form of depressin
- usually early onset (child-adolescent)
- lasts atleast 2 yrs for adults
- contains at least 3 manifestations of depression
Premenstrual Dysphoric Disorder
- assoc w luteal phase of menses
- 2-6% of fem causes problems that can be severe enough to interfere w ability of pt to work/interact w others
Premenstrual Dysphoric Disorder
manifestations
-mood swing
-irritability
-depress
-anxiety
-difficulty concentrating
-lack energy
overeat
-hyper or insomnia
-breast tenderness
-aching
-bloating
-wt gain
Premenstrual Dysphoric Disorder
Tx
- exercise
- diet
- relaxation therapy
what is the most significant risk factor for depression?
family/personal hx
risk factors for depression
- fam hx
- personal hx
- female
- 65+ yo
- neurotransmitter deficiencies
neurotransmitter deficiencies that cause depression
serotonin (mood, sex, sleep, hunger, pain)
norepinephrine (attentn + behavior)
dopamine, acetylcholine, GABA, glutamate
expected findings in depression
- anergia
- anhedonia
- anxiety
- sluggish or unable to relac
- vegetative findings
- somatic reports [fatigue, GI, pain]
vegetative findings in depression
- change in eating
- sleep disturbance
- decr sexual activity
- change in bowel habits
anorexia is usually assoc w _____ + incr intake is assoc w ______
A: MDD
II: PMDD
physical assessment findings in depression
- blunted
- poor grooming/hygiene
- psychomotor retardation (more common)
- psychomotor agitation
- socially isolated
- slowed speech, decr verbalization, delayed response like too tired to speak
types of standardized screening
- hamilton depression scale
- beck depression inventory
- geriatric depression scale
- zung self rating
- pt health questionnaire
milieu therapy
- suicide risk
- self care
- communication
- maintenance of safe environment
- counseling
SSRI
drug names
- citalopram
- fluoxetine
- setraline
leading Tx for depression
selective serotonin reuptake inhibitors
SSRI
A/E
- nausea
- headache
- CNS stim (agitation, insomnia, anxiety)
- sexual dysfunction (contact provider)
- serotonin syndrome
- wt gain w long term use
avoid the use to ____ while on SSRI
st john’s wort
-incr risk of serotonin syndrome
tricyclic antidepressant
drug name
amitriptyline
tricyclic antidepressant
A/E
- ortho hypotension: move slowly
- antichol effect: chew sugarless hum, high fiber diet, incr fluid intake
monoamine oxidase inhibitors MAOI
drug name
phenelzine
MAOI: phenelzine
pt teachings
- due to HTN crisis, avoid foods high in tyramine
- avoid all meds including OTC w/o first discussing w provider
atypical antidepressant
drug name
bupropion
bupropion (atypcl antidprssnt)
teaching
- observe for: headache, dry mouth, GI distress, constipatn, incr HR, nausea, restless, insomnia
- monitor food intake + wt due to appetite suppresion
bupropion (atypcl antidprssnt)
CI
at risk for seizures
serotonin norepinephrine reuptake inhibitors SNRI
drug names
venlafaxine
duloxetine
SNRI: venlafaxine, duloxetine
A/E
- nausea
- insomnia
- wt gain
- diaphoresis
- sex dysfunction
SNRI: venlafaxine, duloxetine
caution
pt w Hx of HTN
st john’s wort
plant product
-relief of manifestations of mild depression
st john’s wort
A/E
- photosensitivity
- skin rash
- rapid HR
- GI distress
- ab pain
light therapy
exposure of the face to 10k-lux light box 30 min/day
types of alternative/complimentary therapies
- light therapy
- electroconvulsive
- transcranial magnetic stimulation
- vagus nerve stimulation
Interpersonal Therapy
encourages client to focus on personal relationship that contribute to depressive disorder
exercise on depression
- helps improve + prevent relapse
- 30 min 3-5x/wk
