Depression Flashcards
Depression
- Symptoms associated w/ depression include:
- Sad, despondent mood, lack of energy
- sleep disturbances, abnormal eating pattern
- feelings of despair, guilt, hopelessness
Postpartum Depression
Intense mood changes associated w/ hormonal changes
Seasonal Affective Disorder (SAD)
Enhanced release of melatonin due to lower light levels
Psychotic Depression
Intense mood shifts; unusual behaviors
Major Depressive Disorder
-Dx
In order to dx depression, there must be a depressed affect + 5 of the following symptoms for a minimum of 2 weeks:
- difficulty sleeping or sleeping too much
- Extremely tired; w/out energy
- Vague physical symptoms
- Inability to concentrate or make decisions
- Feelings of despair, guilt, misery; lack of self worth
Treatment of Depression
Severe depressive illness requires both
MEDICATION & PSYCHOTHERAPY
Role of the Nurse
-Depression
- Rule out medical and neurologic causes
- Ask about alcohol and drug use; suicidal ideation
- Obtain family hx of depressive illness
- Obtain drug hx
- Obtain V/S, liver & renal function tests, cardiovascular status, body weight
- Monitor therapeutic blood levels
Anti-Depressant Drugs
-General Points
Depression is a chemical imbalance involving: Serotonin, Dopamine, Norepinephrine
- Avoid alcohol w/ meds
- Takes 1 to 4 weeks for therapeutic effect
- NEVER discontinue abruptly
Anti-depressants
-What to monitor??
- V/S
- Neuro and cardio status
- Underlying psychoses
- Liver function and hematologic status
- Pt safety
Foods Containing Tyramine
- Avocados, Bananas, Raisins
- Cheese
- Beer & wine
- Beef or chicken liver, Pepperoni
- Fava Beans
- Soy Sauce & Yeast
- CHOCOLATE
Tricyclic Antidepressants
-Mechanism of Action
- Decrease reabsorption of norepinephrine and serotonin
Tricyclic Anti-depressants
-Used For:
- Major depressive episodes
- Panic disorders
- OCD
Tricyclic Anti-depressants
-Examples
- amitriptyline (Elavil)
2. doxepin (Sinequan)
Tricyclic Anti-depressants
-Contraindications
- Severe coronary artery disease CAD
- Cardiac dysrhythmias
- BPH
- Narrow Angle Glaucoma
Tricyclic Antidepressants
-Adverse effects
OVERDOSE IS USUALLY LETHAL
(Sympathetic Effects)
1. Dry mouth, tremors, headache, weight gain
2. Urinary difficulty, constipation, blurred vision
3. Seizures
Tricyclic Anti-depressants
-Patient Teaching
- Takes 2-4 weeks to achieve therapeutic effect
- Orthostatic hypotension
- SUCK ON CANDY OR CHEW GUM FOR DRY MOUTH
- Administer at bed time
SSRI
Selective Serotonin Reuptake Inhibitors (1st line medication) 1. Decreases REM sleep 2. Potentiates opioid analgesics 3. Inhibit appetite 4. DO NOT USE W/ MAOI's
SSRI
-Examples
Tolerated by Elderly due to fewer side effects
Prozac Paxil Zoloft Celexa Lexapro
SSRI
-Adverse effects
Very few undesirable effects
-Agitation, anxiousness, overstimulation, insomnia, jitteriness
SSRI
-Patient Teaching
- Do not start w/in 2 weeks of MAOIs
- Avoid use of alcohol, OTC, and herbs
- Monitor liver function and seizure disorders
- Takes 1-4 weeks to achieve therapeutic effect
MAOI
Monoamine Oxidase Inhibitor
1. Very effective (Second line agents)
- Main drawback is HYPERTENSIVE CRISIS
MAOI
-contraindications
- Impaired Renal or Hepatic function
- CAD, CHF
- Hypertension
- Foods containing TYRAMINE & CAFFEINE
- Pregnancy and lactation
MAOI
-Adverse effects
- Orthostatic hypotension
- Weight gain, Edema
- Sexual dysfunction
- Foods high in TYRAMINE & CAFFEINE can lead to HYPERTENSIVE CRISIS
MAOI
-Patient Teaching
- Monitor for Suicidal Ideation
- Monitor for Hypertensive crisis
- Avoid foods high in tyramine and limit caffeine
- Avoid alcohol
- Change position slowly
- Takes 1-4 weeks to achieve therapeutic effect
Wellbutrin, Effexor
-Indications
- Inhibits the reuptake of dopamine
2. Blocks serotonin and norepinephrine reuptake
Wellbutrin, Effexor
-Contraindications
- Hx of head trauma & CNS tumor
- Seizure disorder
- Heart attack or unstable angina
- Hepatic or renal insufficiency
- Pregnancy and Lactation
Wellbutrin, Effexor
-Adverse Effects
- Nausea, decreased appetite, dry mouth, weight loss
- Agitation and anxiety (CNS stimulation)
- SEIZURE ACTIVITY
- Headache, tremor, insomnia
Wellbutrin, Effexor
-Pt Teaching
- Monitor for suicidal ideation
2. Monitor for hypertensive crisis
Anxiolytics
- Drugs having ability to relieve anxiety
2. Used when anxiety begins to significantly affect daily activities
Classes of Med’s used to treat:
-Anxiety & Sleep Disorders
- Antidepressants
- Benzodiazepines
- Barbiturates
- Nonbenzodiazepine/nonbarbiturate CNS depressants
CNS Agents used to treat Anxiety and Insomnia
2 Major Classes:
- Benzodiazepines
- Barbiturates
Sedatives
Ability to sedate or relax a patient
Hypnotics
ability to induce sleep
Sedative-hypnotic:
Calming effect at lower doses and sleep at higher doses
Anti-anxiety medication
-Cautions
- Elderly
- Suicidal Potential
- Impaired renal or liver function
Insomnia
Acts of sleeping and waking synchronized to many different bodily functions
Insomnia sometimes associated with anxiety
Short-term Insomnia
- Short term or behavioral insomnia sometimes attributed to stress
Long-Term Insomnia
- Long-term insomnia often caused by depression, manic disorders, chronic pain
- NONPHARMACOLOGIC means should be attempted prior to drug therapy
Rebound Insomnia
- Caused by discontinuation of long-used sedative drug
- Older pt’s more likely to experience medication-related sleep problems
Electroencephalogram (EEG)
Tool used for Dxing sleep disorders, seizure activity, depression, and dementia
Identifies two types of sleep:
- NREM
- REM
Normal Sleep Pattern
Involves REM and NREM
- Occur every 90 minutes
- NREM sleep 4 stages
- REM sleep follows NREM sleep
- Dreams occur in REM sleep
NREM Stage 1
- Stage of drowsiness lasts between 1 and 7 min
2. Pt can be easily awakened
NREM stage 2
Pt can still be easily awakened
45% to 55% of total sleep time
Stage 3 NREM
Move into or out of deeper sleep
- Heart rate and BP fall
- GI activity rises
NREM Stage 4
- Deepest stage of sleep
- Nightmares occur in children
- Sleepwalking is also common in this stage
- HR and BP remain LOW. GI activity remains high
REM Sleep
- Characterized by eye movement and loss of muscle tone
- Dreaming takes place
- Mind is very active and resembles a normal waking state
Stage 4 NREM
-Sleep Deprivation
- Pt’s deprived of stage 4 NREM sleep experience depression, apathy and fatigue
REM sleep deprivation
Lack of REM sleep causes Sleep debt
-Pt becomes frightened, irritable, paranoid, and even emotionally disturbed
