Depression Flashcards
Major Depressive Disorder Dysthymic Disorder Premenstrual Dysphoric Disorder Substance-Induced Depressive Disorder Depressive Disorder Associated with Another Med. Cond.
Types of Depressive Disorders
characterized by depressed mood
Loss of interest or pleasure in usual activities
Symptoms have been present for at least 2 weeks
No hx of manic behavior
Can’t be attributed to use of substances or another medical condition
Major Depressive Disorder (MDD)
Sad or "down in the dumps" No evidence of psychotic symptoms Essential feature is a chronically depressed mood for -most of the day -more days than not -at least 2 years
Dysthymic Disorder
Depressed mood Anxiety Mood swings Decreased interest in activities *Symptoms begin during week prior to menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post-menses -last 2 weeks (day 15-28 in cycle) PMDD Sarafem Generic prozac ( fluoxetine); with anxiety
Premenstrual Dysphoric Disorder (PMDD)
Considered to be the direct result of physiological effects of a substance
-makes them feel good; release of neurotransmitters in the brain
Self medicating
Substance-Induced Depressive Disorder
Attributable to the direct physiological effects of a general medical condition
-appetite and sleep (increase or decrease)
Depressive Disorder Assoc with Another medical condition
Biological theories
- Genetics;
- Biochemical
- Neuroendocrine disturbances
- Physiological influences
- Psychosocial theories
Predisposing factors
Genetics; hereditary factor maybe involved
tendencies to become depressed runs in families.
Can beat this
*Once a major depressive disorder happens likely to have again.
Biological theory of Depression
Deficiency of norepinephrine, serotonin, and dopamine has been implicated
Excessive cholinergic transmission may also be a factor
-Body under stress; expends neurotransmitters
Biochemical Factors of depression
possible failure within the hypothalamic-pituitary-adrenocortical axis
-stressful anxious things happen to them
Possible diminished release of thyroid-stimulating hormone
Neuroendocrine disturbances
Cognitive theory:
Views primary disturbance in depression as cognitive rather than affective
3 cognitive distortions that serve as the basis for depression:
- Negative expectations of the environment
- Negative expectations of the self
- Negative expectations of the future
before neurotransmitters where discovered factors in depression
Psychosocial theories
Negative triad
(NTK!!)
Less than 3; feeding problems, tantrums, lack of playfulness and emotional expressiveness
- Age 3 to 5; accident proneness, phobias, excessive self-reproach (thinking terrible, nobody likes me)
- Age 6 to 8; physical complaints, aggressive behavior, clinging behavior (clinging not typical);
- Age 9 to 12; morbid thoughts and excessive worrying; wearing all black, anxious
Possibly percipitated by a loss
Need focus therapy: alleviate symptoms and strengthen coping skills; aggression management
Parental and family therapy
Punishment doesn’t work, esp ODD, work to earn something
Childhood Depression Symptoms
Anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out, substance abuse, restlessness, apathy
Best clue that differentiates depression from normal stormy adolescent behavior
-A visible manifestation of behavioral change that lasts for several weeks
-Most common precipitant to adolescent suicide
-Perception of abandonment by parents or close peer relationships.
Disconnect between suicidal threats and reality (no coming back)
Adolescence symptoms of depression
Bereavement overload-so many loses
High percentage of suicides among elderly
symptoms of depression often confused with symptoms of neurocognitive disorder
Treatment:
Antidepressant medication
Electroconvulsive therapy
Psychosocial therapies
Senescence
deterioration of age
May last for a few weeks to several months
Associated with hormonal changes, tryptophan metabolism, or cell alterations
Treatments: Antideppresants and psychosocial therapies Symptoms: Fatigue Irritability Loss of appetite Sleep disturbances Loss of libido Concern about inability to care for infant
Postpartum Depression
also called affect.
pervasive and sustained emotion that may have a major influence on a person’s perception of the world.
-depression, joy elation, anger and anxiety
-emotional reaction assoc. with an experience
Mood
an alteration in mood that is expressed by feelings of sadness, dispair, and pessimism. Loss of interest in unusual activities and somatic symptoms maybe evident.
-changes in appetite and sleep patterns are common.
“evil spirit”; old testament-depression sent to God to torment
Depression
was caused by an excess of black bile, heavily toxic substance prod. from the spleen or intestine, affecting brain hypocampus
melancholia
2 prevalent periods; spring and fall. pattern parallels suicide.
- temp & barometric pressure changes to human mental instability
- sociodemographic variables,
- serotonergic function involved in depression and suicide
Seasonality Depression
excessive estrogen to progesteron ratio implicated
hormonal disturbances
decrease in B1 *thiamine and B6 *pyridoxine, B12, niacin, Vit C, iron, folic acid, zinc, Ca, K+, can produce depression
nutritional deficiences
behaviors such as excessive crying, anorexia, withdrawal, psychomotor retardation, stupor, and generalized impairment in the normal growth and development.
Object loss theory
focuses on helping the ind. to alter mood by changing the way he or she thinks.
-ind. is taught to control neg. thoughts, distortions that leads to pessimism, lethargy, procrastination, and low self-esteem
cognitive therapy
depression; not functional
transient
uncomplicated grieving
mild depression
problematic disturbance (dysthymia)
moderate depression
intensified syptoms described in moderate depression
severe depression
1st go to medication for depression
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac, Sarafem)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Vilazodone (Vilbryd); also acts aas a partial serotonergic agonist
SSRI’s Selective serotonin reuptake Inhibitors
Norepinepherin;
Serotonin
Dopamine
*It is important to be able to connect symptoms present in the depression in order to understand which neurotransmitters are involved.
Neurotransmitters involved with Depression
important for executive functions (memory, reasoning, problem solving, planning)
Norepinepherin
mood, appetite, libido and cognition
Serotonin
motivation, concentration, and pleasure
Dopamine
Antidepressants half life, overall potency, and strength of dose can influence how fast and antidepressant works, chemistry and how healthy a person is. Down regulation to completely finish.
Up to 6 weeks for an antidepressant to work
taken back to original neuron; an increase in cellular component; increasing the response of a stimulus
Upregulation
negative feedback mechanism; process by which a cell decreases quality of a cellular component, ie. RNA, protein, # of receptors in a molecule
downregulation
the absorption by a presynaptic nerve ending of a neurotransmitter that it has secreted.
Reuptake
Ease depression by affecting naturally occuring chemical messengers (neurotransmitters)
-block reabsorption (reuptake) of the neurotransmitter, serotonin in the brain.
~changing the balance of serotonin seems to help brain cells send and receive chemical messages; increasing mood
Action of SSRI’s in the brain.
most potentially life-threatening adverse effects of MAOI’s
HTN Crisis
presynaptic reuptake of the neurotransmitters or block receptors at nerve ending
mechanism by which antidepressant meds achieve their desired effects
- suicidal thoughts, tremors, cardiac arrhythmias, sexual dysfunction and hypertension (block of norepinephrine)
- GI disturbance, increase agitiation, and sexual dysfunction (serotonin)
- psychomotor activation (dopamine)
- dry mouth, blurred vision, constipation and urinary retention (acetylcholine; tricyclic antidepressant)
- sedation, weight gain, hypotension (histamine)
*Suicidal to happy as ever-going to kill themselves; Key indicator to having a plan; black box warning
Side effects of antidepressants
Nurse to look out for
Foods high in tyramine; Na-perservatives; beef jerky, olives, cheese, wine,
headache, palpitations, nausea/vomiting, sweating; topical corticosteriods to prevent side effects
Ingestion of such substances while on an MAOI therapy could result in life threatening hypertensive crisis -14 day interval recommended before starting an MAOI All other antidepressants Sympathomimetics Stimulants Antihypertensives Meperidine and opioid narcotics Antiparkinsonian agents (Levodopa)
avoid maoi therapy
Aged cheeses (cheddar, swiss, camembert, blue cheese, parmesan, romano, brie)
raisins, fava beans, flat italian beans, chinese pea pods,
Red wines (chianti, burgundy, cabernet sauvignon)
smoked and processed meats
Caviar, pickled herring, corned beef, chix or beef liver
Soy sauce, brewer’s yeast, meat tenderizer (MSG)
High tyramine Content; Avoid when on a MAOI
Gouda cheese, processed American cheese, mozz, yougurt, sour cream, avocados, bananas
Beer, white wine, coffee, colas, tea, hot choc
Meat extracts, bouillon cubes
Chocolate
Moderate Tyramine Content; Avoid when on a MAOI
Pasteurized cheeses, cream cheese, cottage cheese, ricotta
Figs
Distilled spirits (in moderation)
Low Tyramine Content; Avoid when on a MAOI
Amitripyline Amoxapine Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin Imipramine (Tofranil) Nortriptyline (Aventyl) (Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil)
Tricyclics antidepressant meds
acetylcholines
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline Transdermal System (Emsam)
Monoamine Oxidase Inhibitors (MAOI’s)
Bupropion (Wellbutrin) Maprotiline Mirtazapine (Remeron) Nefazodone Trazodone
Heterocyclic
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
SNRI’s Serotonin-norepinephrine Reuptake Inhibitor
Olanzapine and fluoxetine (Sumbyax)
Chlordiazepoxide & amitriptyline (Etrafon)
Psychotherapeutic Combinations
Don’t mix with MAOI’s
decreased effects of Levodopa & guanethidine
Increase risk of seizures with concomitant use of maprotiline and phenothiazines
TCA interactions
blurred vision constipation urinary retention orthostatic hypotension reduction of seizure threshold tachycardia, arrhythmias photosensitivity weight gain
Side effects of Tricyclics and Heterocyclics
Insomnia; agitation headache weightloss sexual dysfunction serotonin syndrome; change in mental status, restlessness, muscle rigidity
side effects with SSRI’s and SNRI’s
