Depression & meds Flashcards
What is the typical depressive disorder that is characterized by a depressed mood w/ or w/o psychosis, has no history of manic behavior & individual loses interest or pleasure in usual activities?
Major Depressive Disorder (MDD)
What neurotransmitters are involved in Depression?
Norepinephrine, Serotonin & Dopamine
What is the term used to describe an increase of a cellular component or (more receptors)?
Up-Regulation
What is important for executive functions of memory, reasoning, problem solving & planning?
Norepinephrine
How many weeks might it take for an antidepressant med to take effect?
6 weeks
What disorder is consistently chronically depressed w/ no bad days then good days impairs social & occupational function & cannot be attributed to substance use of another medical condition?
Major Depressive Disorder
What is the term used to describe going back to a normal amount of receptors?
Down-regulation
What neurotransmitter is involved in mood, appetite, libido & cognition?
Serotonin (SSRI’s)
What action do SSRI’s have in the brain?
Block reuptake of serotonin
Why might it take up to 6 weeks for an antidepressant to take effect?
bc of down-regulation, it needs to get back to physiological normalcy
How many weeks must symptoms be present in a pt. diagnosed w/ MDD?
At least 2 weeks
What disorder is referred to as sad or “down in the dumps”, is a more milder form of MDD bc individual is function-able & will still have thing to make them laugh, but has no evidence of psychotic symptoms?
Dysthymic Disorder
What is the mechanism by which antidepressant meds achieve their desired effect?
increase levels of serotonin & norepinephrine
What must the nurse be on alert for w/ a pt receiving antidepressants?
Negative symptoms-thoughts of suicide
How long is a pt w/ Dysthymic Disorder chronically depressed for?
most of the day, more days than not for at least 2 years
What disorder is considered more than PMSing, have a depressed mood, excessive anxiety, mood swings, & a decrease in interests in activities?
Premenstrual Dysphoric Disorder
What is the most potentially life-threatening adverse effect of MAOI’s?
Hypertensive crisis
What classification of a med is Evexor?
SNRI
How long do symptoms of premenstrual dysphoric disorder last for?
2 weeks of cycle
What classification is the medication marplan parnate?
MAOI
What classification is the medication welbutrin?
NDRI
When do symptoms of premenstrual dysphoric disorder begin, start to improve, & become minimal or absent?
begin- week prior to menses, improve- w/in few days after onset of menses, minimal/absent- week post-menses
What disorder is associated w/ intoxication/withdrawal of substances like beta blockers, opioids, or benzodiazepines & can cause significant distress/impairment in social/occupational or other areas of functioning?
Substance-induced Depressive Disorder
What disorder is a direct physiological effect of a general medical condition?
Depressive Disorder associated w/ another medical condition
Is depression life long?
NO!
What disorder may be caused by a deficiency in norepinephrine, serotonin & dopamine & excessive cholinergic transmission?
Depression
What classification are the medications Prozac & Zoloft?
SSRI’s
What classification are the meds Imipramine, Clomipramine & doxepin?
Tricyclic
What disorder may be caused by a possible failure w/in hypothalamic-pituitary-adrenocortical axis such as thyroid problems & pituitary problems from stress?
Depression-neuroendocrine disturbances
What is the triad of negative distortions in depression?
Negative expectations of the environment, self, & future
What is the predisposing factors that includes: med side effects, neurological disorders (CVA, brain tumors-temporal lobes), electrolyte disturbances, hormonal disturbances (thyroid, adrenal cortex, estrogen, progestogen), & nutritional deficiencies?
Physiological influences of depression
In the cognitive theory Beck views primary disturbances in depression as ______ rather than ______. & that depression is the product of negative thinking.
cognitive; affective
Stress can equal a?
cholinergic attack
What is the black box warning on antidepressants?
increase risk for suicide
At what ages do these symptoms occur in childhood depression: feeding problems, excessive tantrums, lack of playfulness, no emotional expressiveness, failure to thrive or delays in speech & gross motor development?
What is senescence?
the elderly
What medication use is successful in childhood depression?
SSRI’s
At what ages do these symptoms occur in childhood depression: accident proneness, excessive phobias, lack of attention & self-reproach (“I’m terrible & ugly)?
3-5
Loss by death, abandonment, divorce, neglect, move or lack in academics is what in relation to childhood depression?
Precipitating factors
What is the main focus of therapy for childhood depression?
Alleviate symptoms & strengthen coping skills
At what age do these symptoms occur in childhood depression: physical complaints (stomach/headaches), aggressive behavior, clinging behavior, lag in social skills & academic competence?
6-8
What is the best clue that differentiates depression from normal stormy adolescence behavior?
visible behavioral change that lasts for several weeks.
At what age do these symptoms occur in childhood depression: morbid thoughts, excessive worrying (maybe about parents dying), feeling of disappointment to parents & lack of interest?
9-12
What is needed, including meds, to help w/ adolescent depression?
support, Prozac, or Lexipro
At what age do these symptoms occur in childhood depression: anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out, substance abuse, restless & apathy?
Adolescence
What med should a nurse not use for depression in adolescence?
Paroxetine
At what age do these symptoms occur in depression: memory loss, confused thinking & apathy?
Elderly
Symptoms of depression in the elderly are often confused with the symptoms of what disorder?
Neurocognitive disorder
These side effects are associated w/ what medication: dry mouth, sedation, nausea, discontinuation syndrome?
Antidepressants
These side effects are associated w/ which med: Insomnia, agitation, headache, weight loss, sexual dysfunction, & serotonin syndrome?
SSRI’s & SNRI’s
These side effects are associated with which med: hypertensive crisis like severe headache, palpations, N/V, fever, sweating, chest pain & coma, or application site reactions like rash, itching, erythema, swelling, or urticarial lesions?
MAOI’s
The use of what medication is rarely used anymore because it has a poor risk-to-benefit ratio & can cause serious/chronic health problems?
Tricyclic’s
What is the term used to describe a severe form of depressive disorder where symptoms are exaggerated & interest or pleasure in all activities is lost?
Melancholia
What is an amino acid precursor of serotonin shown to enhance efficacy of antidepressant meds & on occasion to be effective as an antidepressant itself?
Tryptophan
What is the term used to describe depressive symptoms that occur as a consequence of a non-mood disorder or an adverse effect of certain medications?
Secondary depression
What theory did Freud use for his belief that melancholia occurs after the loss of a loved object & the hostility felt for that lost object is turned inward against the ego?
Psychoanalytic theory
What theory did Seligman use experiments w/ dogs & electrical stimulation then later theorized that learned helplessness predisposes people to depression imposing a feeling of lack of control over their life situation?
Learning theory
What theory suggests depressive illness occurs as a result of having been abandoned by or separated from significant other during 1st 6 months of life (mother is main source of security @ this time)?
Object loss theory
What is the term used to describe an individual experiencing so many losses in life that they are unable to resolve 1 grief response before another one begins?
Bereavement overload
In the continuum of depression which level is associated with: being depressed time to time bc of everyday disappointments in life, but can subside quickly?
Transient
In the continuum of depression which level is associated with: grief process is triggered in response to loss of a valued object & may subside in a few weeks?
Mild
In the continuum of depression which level is associated with: grief process is prolonged or exaggerated; fixed on anger stage & anger is turned inward on self, so unable to function w/o assistance?
Moderate
In the continuum of depression which level is associated with: intensification of symptoms associated w/ moderate level & may have loss of contact w/ reality, complete lack of pleasure in all activities & think about suicide?
Severe
What rating scales can be used to rate depression?
Hamilton, Zung, & Beck
Name this level on the continuum of depression: pt is sad, has the “blues” may be crying, can’t get mind off of their disappointment & is tired?
Transient
Name this level on the continuum of depression: gloomy, powerless, helpless, low self-esteem, no pleasure in activities. Has slow physical movements/speech, slumped posture, thinks of life’s failures/regrets, decrease in hygiene/grooming. Difficulty concentrating, negativism, pessimism, slow thinking. Is anorexic, hyper/insomnia, amenorrhea, decrease libido, lo energy level, better in AM get worse as day progresses?
Moderate
Name this level on the continuum of depression: pt. is denial of feelings, anger, anxiety & guilt. Is restless, tearful, regression, agitated & preoccupied w/ loss & may blame self/others. Is anorexia or over eating & has insomnia?
Mild
Name this level on the continuum of depression: Worthless, flat, apathy, emptiness, lonely. Has psychomotor retardation/behavior, agitated, purposeless movements, social isolation, delusional thinking, confusion, hallucination. Is sluggish digestion, constipated, urinary retention, impotence, weight loss, difficult falling asleep, worse in AM better as day progresses?
Severe
What phase of treatment for depression assesses the extent of illness then info is given to the pt. regarding nature of depression, symptoms, course & alternative treatment?
Phase 1
What phase of treatment for depression is when therapeutic alliance is terminated w/ emphasis on reassurance, clarification of emotional states, improvement of interpersonal communication, testing of perceptions & performance in interpersonal settings?
Phase 3
What phase of treatment for depression focuses on helping the pt. resolve complicating grief?
Phase 2
Name this automatic thought: “I’m the only one who failed.”
Personalizing
Name this automatic thought: “I’m a complete failure”
All or nothing
Name this automatic thought: “He thinks I’m foolish.”
Mind reading
Name this automatic thought: “Other questions were so easy. Any dummy could’ve gotten them right.”
Discounting positives
What is an induction of a grand mal seizure through application of electrical currents to the brain?
Electroconvulsive Therapy (ECT)
What is the most common side effect of ECT?
short term memory loss & confusion around time of therapy
Atropine sulfate or glycopyrrolate (Robinul) prevent aspiration & bradycardia for what & when should they be given intramuscularly?
Pre-treatment for ECT; 30 min before ECT
Propofol (Diprivan) or Etomidate (Amidate) are meds used for what?
short-acting anesthetic for ECT
Succinylcholine Chloride (Anectine) via IV is used to do what during the seizure of ECT?
muscle relaxer
What is the procedure used to treat depression by stimulating nerve cells in the brain through very short pulses of magnetic energy that do not cause seizures & is used for mood regulation?
Transcranial Magnetic Stimulation
What is MDD that reoccurs w/ seasonal patterns & may be r/t presence of hormone melatonin?
Seasonal Affective Disorder (SAD)
What therapy is the 1st line of treatment for winter “blues” & as an adjunct in chronic MDD or dysthymia w/ seasonal exacerbations & involves pt. sitting in front of box w/ 10,000 lux lights w/ eyes wide open?
Light therapy
These side effects are associated w/ what: headache, eye strain, nausea, irritability, photophobia, insomnia, & hypomania?
Light therapy
This drug elevates mood & alleviates other symptoms associated w/ moderate to severe depression by increasing concentration of norepinephrine, serotonin, & dopamine?
Antidepressants
What is the term used to describe absorption by a presynaptic nerve ending of a neurotransmitter that it has secreted & increases serotonin?
Reuptake
What neurotransmitter is involved in motivation, concentration & pleasure?
Dopamine
