depression Flashcards
Major depressive disorder (MDD)
medical illness affecting how you feel, think, and behave causing persistent feelings of sadness and loss of interest in previously enjoyed activities
Persistent depressive disorder (dysrhythmia) (PPD)
second most common presentation of depressive symptoms
prevalence of MDD
lifetime prevalence- 28.2%; 12-month prevalence of MDD- 6.7%
prevalence of PPD
lifetime of PPD with major depressive episode- 15.2%; lifetime of PPD with pure dysrhythmia- 3.3%
what is PPD with pure dysrhythmia?
milder but more chronic form of depression
MDD clinical manifestations
depressed mood; loss of interest/pleasure in usual activities; symptoms been present for a least 2 weeks; no history of manic behavior; cannot be attributed to use of other substances or another medical condition (ex. hypothyroidism, bipolar, CNS depressants); can experience psychosis; can be due to chronic pain
PPD clinical manifestations
sad or “down in the dumps”; no evidence of psychotic symptoms; essential feature is chronically depressed mood for most of the day, more days than not, and for at least 2 years; most of the time people can push through and still have occupational and social experiences unlike MDD
potential causes of depression disorders
other psychiatric disorders, chronic medical problems, hospitalization, certain medications, chronic pain, terminal illness
children/adolescents and depression
as young as 3 years old been diagnosed with MDD; incidence in ages 12-17 is 11.93% for at least one major depressive episode; following recovery from acute depressive episode 30-70% of children relapse; 20-50% of adolescents may relapse
older adults and depression
clinical depression occurs in 7% of general older population with significant disability to those affected
predisposing factors for developing depressive disorders
HX of prior episodes; family HX (especially 1st degree relatives); HX of suicide or suicide in family; member of LGBTQ; female; 40 years and younger; postpartum period; chronic medical illness; absence of social support; traumatic events/early trauma; alcohol/substance use disorder; HX of sexual abuse
the neurotransmitters involved in depression and how
monoamines, serotonin, norepinephrine, dopamine; abnormalities in the number of receptor sites
PET scan and effect of medication on brain
positron-emission tomography showed entire brain was more active following medication for recurrent depression especially in left prefrontal cortex
diathesis-stress model of depression
diathesis refers to the biological predisposition such as family HX and stress refers to psychological stressors or environmental stressor that trigger brain changes
biological model of depression
due to genetics, biochemical, alterations in hormonal regulation
bio/psychosocial theories of depression
cognitive theory- becks cognitive triad, learned helplessness, cultural considerations
becks cognitive triad
negative self-deprecating view of self; negative (pessimistic) view of the world; negative views about the future (negative reinforcement will continue)
assessment of pt with depression
suicidal assessment, ideation related to harm of others (SI/HI), detailed assessment
detailed assessment components
mood and affect, physical changes- clinical symptoms, cognition and thought content, self-care for nurses
assessment findings of someone with clinical depression
mood and affect- anxiety, worthlessness, guilt, anger, irritability, may not make eye contact, flat affect; thought content and processes- slow thinking, rumination on faults, indecisiveness, delusional thinking; physical signs and symptoms- psychomotor retardation, psychomotor agitation, vegetative signs of depression, sleep pattern changes; characteristic communication styles- monotone speech, require more time to respond
assessment guidelines of depressed individual
evaluate pt risk of suicide or harm to others; determine if depression is primary or secondary to another disorder, assess for HX of depression, assess support systems, assess for triggering events, complete psychosocial assessment
nursing diagnoses for depressed pt
depressed individuals are always at risk for suicide; others include despair, depressed mood, hopelessness, helplessness, risk for self-mutilation, self-care deficit
planning for depressed pt
focused on specific symptoms, safety is highest priority, recognize and help pt tolerate medication side effects, facilitate supportive nurse-pt relationship, account for presence of depression assessment findings (ex. veg. state, change in activity level)
evidence-based interventions for pt with depressive disorder
communication; health teaching/promotion; milieu therapy; first line psychotherapy interventions- CBT (first line), IPT, PST, CBT-I; mindful-based cognitive therapy; group therapy
CBT
cognitive behavioral therapy
IPT
interpersonal psychotherapy
PST
problem-solving therapy
CBT-I
cognitive behavioral therapy for insomnia
communication guidelines for interacting with pt with depressive disorder
pt may speak slow and be slow to comprehend, pt may be mute (extreme depression), sitting with pt in silences is valuable (can be very meaningful to pt)
evidence-based practice interventions for individuals with depressive disorder
pharmacological, biological, and integrative therapies; brain stim therapies; complementary and integrative therapies
pharmacological, biological, and integrative therapies
antidepressant medication therapy, antipsychotics, other durgsanti
antidepressant medications for therapy
SSRIs, SNRIs, SDRIs- norepi. dopamine reuptake inhibitors, TCAs, MAOIs
brain stimulation therapies
below are somatic treatments: ECT- electrical stim to brain, 3x a week then wean to 2x a week but never abruptly stop; Vagus nerve stim (VNS)- implant wraps around vagus nerve and does continuous stim for 30 seconds every so often during 24 hour day; transcranial magnetic stimulation (TMS)- outpatient; deep brain stimulation (DBS)- imbedded in brain
complementary and integrative therapies
light therapy- seasonal depression; St johns wort- organic mood stabilizer; s-adenosylmethionine (SAMe); peer support of individual diagnosed with MI
electroconvulsive therapy
induction of grand mal (gen.) seizure with application of electrical current; probes placed bilaterally in frontotemporal region or unilaterally on dominant side; dose of stim is based on pt seizure threshhold; seizure lasts about 15-25 seconds; usually every other day 3x a week; usually require 6-12 treatments
contraindications to ECT
increased intracranial pressure from a brain tumor, recent CVA, or other cerebrovascular lesions, etc.; individuals with MI, CVA, aortic or cerebral aneurysm, severe HTN, and CHF within past 3-6 months are at high risk
clinical use for ECT
effective in treating: treatment resistant depression, major depression with psychotic symptoms, pt with life-threatening psychiatric conditions such as salf-harm or acute mania, or pt who tried antidepressants but side effects are too bad or meds are ineffective
when ECT may be idicated
need for rapid definitive response because pt is suicidal or homicidal, pt extremely agitated or psychomotor retardation and stupor (catatonia or mania), severe mania, pt develops life-threatening illness d/t refusal of food and fluids, pt has HX of poor drug response and or HX of good ECT response, standard medical treatment has no effect
advantages of SSRIs
effective in depression with anxiety features and depression with psychomotor agitation, better tolerated, safer in event of OD, lower anticholinergic side effects
side effects of SSRIs
headaches, GI disturbance, insomnia, fatigue, initial anxiety, sexual problems, agitation, bleediing risk, risk of serotonin syndrome
advantages of TCAs
effective in depression and in symptoms like insomnia and anorexia, different TCAs effective for pt who are lethargic or who are experiencing agitation or restlessness
side effects of TCAs
weight gain, sedation, nausea, anticholinergic symptoms, orthostatic hypotension, cardiotoxic side effects
special precaution fro monoamine oxidase inhibitor (MAOI)
used as antidepressants for pt who have not responded to other antidepressant meds or have atypical depression; believed that MAOI prevent breakdown of norepinephrine, serotonin, and dopamine that increases levels of these amines in brain causing mood elevation; inhibit breakdown of dietary tyramine in liver (ingesting food with tyramine can cause HTN crisis and potential CVA and death)
evaluation of treatment of pt with depression
ongoing; outcomes compared with stated outcome criteria and short term and intermediate treatment goals; plan of care is revised when desired outcomes not met
