Depression Flashcards
Depression is characterized by what?
A sad despondent mood
Many symptoms are associated with depression, but what are the four main ones?
- Lack of energy
- Abnormal eating
- Sleep disturbances
- Feelings of despair
What are the risk factors of depression?
- Older than 65
- Stressful life events
- Poor social support; being unmarried
- Dysfunctional family relationships
- Family or previous personal history of mental illness
- Substance abuse
What are the ways to help prevent depression?
No definitive way however these help:
- Exercise
- Proper diet and rest
- Avoiding drugs and illicit drugs
What is MDD?
Major depressive disorder
What are the feelings that a patient may described if they have major depressive disorder?
- Sadness
- Discouragement
- Hopelessness
What are the clinical manifestations of major depressive disorder?
- Change in several aspects of individuals emotional state and function (2 week time period)
- Report of somatic complaints or increased anger
- May consist of a single episode or may reoccur
In order to be diagnosed with Major Depressive Disorder the patient must have 5 or more of these clinical manifestations.
- Depressed mood
- Sleep disturbance
- Anhedonia
- Weight increase or decrease
- Increase or decrease in motor activity
- Fatigue
- Feelings of guilt, worthlessness, self-blame
- Diminished ability to concentrate
- Suicidal ideation
Persistent depressive disorder is also called what?
Dysthymic disorder
What are the clinical manifestations of Persistent depressive disorder?
- Chronic depression for most days at least for 2 years.
- Tends to be chronic
- no more than 2 months symptom free
Are symptoms of persistent depressive disorder more severe than major depressive disorder?
No they are less severe
What age ranges tend to experience persistent depressive disorder?
- Childhood
- Adolescence
- Early adulthood
When does Seasonal Affective Disorder usually occur?
In winder months
What may help modulate rhythms in patients with Seasonal Affective Disorder?
Natural light
What does SAD stand for?
Seasonal Affective Disorder
How is Seasonal Affective Disorder described?
Depressive disorder that relates to seasons
What medication is indicated for SAD?
Buproprion
What may Buproprion do for patient with SAD?
Prevent major depressive episodes
What may influence medication therapy in patients with depressive mood disorders?
Existing medical illnesses
There may not be a test to determine depressive mood disorders but what is available to help diagnose the patient?
Screening tools
A diagnosis of depressive mood disorders is done by whom?
A licensed mental health provider
A collaborative team to treat patients with depressive mood disorders consists of whom?
- RN
- MD
- Pharmacist
- Psychologist
- Family
What is the most effective psychotherapy approach for depression?
Cognitive-behavioral therapy
Psychotherapy is usually used in addition to what?
Medication
Psychotherapy is used alone for patients who have what?
Mild depression
Psychotherapy helps clients do what?
Manage specific symptoms and promote coping skills
Through psychotherapy a patient can learn how to promote coping skills like what?
Postive, helpful patterns of thinking and behavior
What does CBT stand for?
Cognitive behavior therapy
What pharmacologic therapy is used to treat depressive disorders?
Antidepressant medications
Finding the correct antidepressant medications per patients is typically found through what?
Trial and error
How long should a patient be on an antidepressant medication?
Until they are symptom free and should slow discontinue the medication
What class does Imipramine belong to?
Tricyclic antidepressant
What class does Phenelzine belong to?
Monoamine oxidase
What class does Fluoxetine belong to?
Selective serotonin reuptake inhibitors
What are the indications of use of Imipramine?
- Depression
- Enuresis
- Neuropathic pain
What is the method of action for Imipramine?
Inhibit reuptake: norepinephrine and serotonin
What are the contraindication/cautions used for Imipramine?
- CV disease
- Recent MI
- Liver dysfunction
- Angle closure glaucoma
- Urinary retention
- History of seizures
- Pregnancy
- Manic depression
What are the adverse effects of Imipramine?
- Orthostatic hypotension
- Arrhythmias
- Sedation
- Bone marrow depression
- Anticholinergic effects
What are considered anticholinergic effects?
- Constipation
- Blurred vision
- Urinary retention
- Dry mouth
What are the drug to drug interactions of Imipramine?
- MAOIs
- SSRIs
- St. John’s wort
- CNS depressants
- Antihypertensives
- Sympathomimetics
- Oral anticoagulants
How long does it take for a patient to have a therapeutic effect when taking Imipramine?
2-6 weeks
True or False:
It is perfectly okay to take any type of drugs without notifying your provider is you are prescribed imipramine?
False:
Notify provider before taking other drugs
What should you avoid if you are taking Imipramine?
Alcohol and other CNS depressants
What should you teach a patient if they are prescribed Imipramine?
- Change positions slowly
- Do not drive until sedative effect known
- Take at bedtime if sedation occurs
What drug would you give a patient experiencing depression related to alcohol and cocaine withdrawal?
Imipramine
What is the peak of imipramine?
2-4 hours
What is the mechanism of action for Fluoxetine?
Inhibits CNS neuronal reuptake of serotonin with little effect on norepinephrine
What are the indications for use for Fluoxetine?
- Depression
- OCD
- Panic attacjs
- Bulimia
- PMDD
- Posttraumatic stress disorder
- Social phobias or anxiety
What are the contrraindicaitons/cautions for Fluoxetine?
- Pregnancy
- Lactation
- Impaired renal or hepatic function
- Cardiac disease
- Diabetes
- Severely depressed or suicidal patients
What are the adverse effects for Fluoxetine?
- Headache
- Drowsiness
- Dizziness
- Insomina
- Anxiety
- Tremor
- Chest pain
- Agitation
- Sexual dysfunction
- Palpitations
- Increased appetite
- Hyponatremia
What are the drug to drug interactions for Fluoxetine?
- MAOIs
- TCAs
- St. Johns Wort
How long until the patient will have full benefit from Fluoxetine?
Several weeks
What is important to monitor for in a patient who is taking Fluoxetine?
Changes in behavior and therapy effectiveness
What should you get baselines of and monitor for patients who are taking Fluoxetine?
LFT
Weight
Electrolytes
What should you educate your patients on if they are taking Fluoxetine?
- Notify provider before taking other drugs
- Report side effects; may increase seizures in those with a history
- Do not stop drug suddenly
- Take with food in morning
- Exercise, restrict caloric intake to avoid weight gain.
What are the two considerations when prescribing a patient Fluoxetine ?
Serotonin syndrome and Discontinuation Syndrome
What is Serotonin syndrome?
Overstimulation with serotonin caused by giving other drugs that increase serotonin
What are the signs and symptoms of serotonin syndrome?
- Elevated heart rate and blood pressure
- Agitation
- Sweating
- Hyperthermia
- CV collapse
- Coma
- Seizures
What is discontinuation syndrome?
From abrupt d/c of drug
-Flu like symptoms
How can you avoid discontinuation syndrome?
Taper over weeks before d/c
What is the onset for fluoxetine?
Slow
What is the peak for fluoxetine?
6-8 h
What class does Phenelzine belong to?
Monoamine oxidase inhibitors (MAOIs)
What is the mechanism of action for Phenelzine?
Irreversibly inhibit MAOs, allowing norepinephrine, serotonin, and dopamine to accumulate in the synaptic cleft
What is the indication for use of Phenelzine?
Depression- for those unresponsive to or unable to take other anti depressive agents
What are the adverse reactions for Phenelzine?
- Dizziness
- Nervousness
- Mania
- Hyperreflexia
- Tremors
- Confusion
- Insomnia
- Agitation
- Liver toxicity
- Nausea/vomiting
- Constimation
- Anorexia
- Weight gain
- Dry mouth
- Orthostatic hypotension
- Hypertension
How long until the patient will have a therapeutic effect for Phenelzine?
4-8 weeks
What are the contraindications/ cautions for use of Phenelzine?
- Pheochromocytoma
- CV disease
- HTN
- Glaucoma
- Increased intracranial pressure
- Renal or hepatic impairement
What are the drug to drug interactions with Phenelzine?
- Antidepressants
- Sympathomimetics
- Insulin or oral anti diabetic agents
- CNS depressants
- Opioid analgesics
- General anesthetics
What foods interact with Phenelzine and what happens?
Tyramine containing foods cause a hypertensive crisis
What is the onset for Phenelzine?
Slow
What is the duration for Phenelzine?
48-96 h
What are the other types of therapies that can treat depression?
- Electoconvulsive therapy (ECT)
- Transcranial magnetic stimulation
- Alternative or Complementary therapies like St. Johns Wort.
What should the nurse focus her process on in patients with depression?
- Safety
- Therapeutic communication
- Meeting functional needs like daily hygiene, sleep, nutrition
What should you assess for in a patient suspected to have depression?
-Symptoms of depression, and a history of manic episodes
What are the symptoms of depression?
- Feelings of sadness, tearful, emotional
- Fatigue
- Anhedonia
- Feelings of worthlessness
- Impaired concentration
- Excessive sleep
- Impaired concentration, decision-making ability
- Appetite changes or GI complaints
- Somatic concerns
Other than symptoms of depression what else should the nurse assess for in a patient suspected to have depression?
Comorbities
Why should you assess for comorbidities in a patient with depression?
To rule out possibility of underlying medical condition like a chronic illness or life-threatening illness
What can complicate depression?
Use of certain legal and illegal drugs
When assessing a child for depression What should you do?
- Rule out physical illness
- Question parents and caregivers
Who carries out the initial diagnostic evaluation on a child with depression?
Child psychologist or psychiatrist
What are useful tools for diagnosis of a child with depression?
- Children’s depression inventory 2
- Reynolds Child Depression scale
- Beck depression inventory
What should you include in your assessment for an older adult with depression?
- Realize it may be challenging due to polypharmacy
- Use the geriatric depression scale or cornell depression scale
Who is the Geriatric Depression Scale used for?
Older adults with cognitive impairements
Who is the Cornell Depression Scale used for?
Adults with severe cognitive impairments
What are the diagnoses associated with a patient who has depression?
- Risk for self-directed violence
- Situational Low Self-Esteem or Chronic Low Self-Esteem
- Hopelessness
- Social Isolation
- Ineffective Health Maintenance
What are the client goals for a patient with depression?
- Remain free of injury
- Refrain from attempts to injury self and others
- Participate in recreational activities
- Comply with treatment regimen
- Articulate steps to feeling better, before beginning to feel better
In order for the patient with depression to reach the goal you have set out for them- what must you implement?
- Adopt emotionally neutral attitude while maintaining confidence that client will feel better
- Be aware of personal feelings and moods
Why must you be aware of your own personal feelings or moods when dealing with a patient who has depression?
Because you could be at risk for emotional contagion
When adopting an emotionally neutral attitude with a patient with depression what should you also be doing?
- Not trivializing the patients feelings
- Instill hope
- Improve self-esteem
Upon evaluation of a patient with depression- what should you be able to document?
- Client meets daily functional needs appropriately
- Client does not demonstrate or express suicidal ideation
- Client describes hopefulness for future
- Client is able to resume normal activity patterns such as returning to work or school
The nurse is caring for a client who is experiencing a major depressive episode. The nurse monitors the client for signs of urinary retention and constipation, knowing that these problems are possible due to which of the following:
- Inadequate dietary and fluid intake
- Psychomotor retardation and medication
- Lack of exercise
- Poor dietary choices
- Inadequate dietary and fluid intake
