Depression ppt for real Flashcards
Exam 1
How many people in the US have had at least 1 major depressive episode
An estimated 21.0 million adults in the United States had at least one major depressive episode.
Who is major depressive higher in? What percent?
The prevalence of major depressive episode was higher among adult females (10.3%) compared to males (6.2%).
What group of adults is major depression most prevalent in?
The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (18.6.2%) (NIH, 2021)
Major Depressive Disorder: Minimum of 5 s/s of a depressed mood for 2 weeks or
more.- What is the acronym?
SIG E CAP
Major Depressive Disorder: Minimum of 5 s/s of a depressed mood for 2 weeks or
more.- What are they?
Sleep disorder (either increased or decreased)
Interest deficit (anhedonia)
Guilt (worthlessness, hopelessness, rumination)
Energy deficit
Concentration deficit
Appetite disorder (either increased or decreased)
Psychomotor agitation or retardation
Suicidality
Potential Causes for Depression
- Abuse
- Age; elderly, living alone, lack of social supports
- Certain Medications; isotretinion (used to treat acne), antiviral drug interferon-alpha and corticosteroids
- Conflict; disputes with family members or friends
- Death or loss; can increase the risk for depression
- Gender; women are twice as likely as men; hormonal changes
- Genes; family history
- Major events, serious illness, substance abuse
Treatment Goals for Major Depression: Priority care issues:
safety and assessment of suicide risk*
Treatment goals:
- Reduce or control symptoms and, if possible, eliminate signs and symptoms of the depressive syndrome
- Improve occupational and psychosocial function as much as possible
- Reduce the likelihood of relapse and recurrence
Depressive Disorders: Children and adolescents: What symptoms are most likely
Anxiety and somatic symptoms are more likely
Depressive Disorders: Children and adolescents: Behaviors
Decreased interaction with peers; avoidance of play and recreational activities
Depressive Disorders: Children and adolescents: Mood
- Irritable* rather than sad mood; high risk of suicide
DEPRESSIVE DISORDERS ACROSS THE LIFE-SPAN: Older Adults
Commonly associated with chronic illness; symptoms possibly confused with those of dementia or stroke
* Suicide peaks in middle age with second peak at age 75
In older adults, when are the suicide peaks?
- Suicide peaks in middle age with second peak at age 75
Nursing Assessment: General appearance and motor behavior
(psychomotor retardation, latency of response, psychomotor agitation)
Nursing Assessment: Mood and Affect
Anhedonia
Nursing Assessment: Thought process and content
(rumination, thoughts of suicide)
Nursing Assessment: Sensorium and intellectual processes
(impaired memory)
Nursing Assessment: Judgement and insight
(impaired judgment)
Nursing Assessment: Self concept
(feelings of worthlessness)
Nursing Assessment: Roles and Relationships
(the more severe the depression, the greater the difficulty)
Rating Scales for Depression
Patient Health Questionnaire (PHQ-9)
Clinician rating scale: Hamilton Rating Scale for Depression
Nursing Assessment: What else is included?
Physical systems review and thorough history of medical problems
- Medication history
- Physical examination
- Neurovegetative symptoms
Nursing Assessment: What is included in Medication History
prescribed and over-the-counter
medications; alcohol and mood-altering substances; herbal substances
Nursing Assessment: Neurovegetative symptoms
- Appetite and weight changes
- Sleep disturbance
- Tiredness, decreased energy, and fatigue
Nursing Assessment: Outcome identification and intervention
- Free from self-injury*
- Independently carry out activities of daily living
- Balance of rest, sleep, and activity
- Cognitive triad
- Social activities
- Return to occupation or school activities
- Medication compliance
Antidepressants: When does initial response develop?
Initial response develops after 1 to 3 weeks
When are maximal responses to antidepressants seen?
- Maximal responses may not be seen for 12 weeks
Antidepressant FDA black box warning
- FDA Black Box Warning/May increase suicidal tendencies during early treatment*
- Safety: ↑ risk of self harm with feeling better and having increased energy*
- Activation concerns
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Fluoxetine
- Sertraline
- Fluvoxamine
- Paroxetine
- Citalopram
- Escitalopram
Selective Serotonin Reuptake Inhibitors (SSRIs) Common side effects
- feeling agitated, shaky or anxious
- feeling or being sick
- diarrhea or constipation
- blurred vision
- dry mouth
- sexual dysfunction/decreased libido
- insomnia
- sweating
SEROTONIN/NOREPINEPHRINE
REUPTAKE INHIBITORS (SNRIS)
- Desvenlafaxine
- Duloxetine
- Levomilnacipran
- Venlafaxine
SEROTONIN/NOREPINEPHRINE
REUPTAKE INHIBITORS: Common side effects
- Nausea
- Headache
- Nervousness
- Sweating
- Insomnia*
- Hypertension*
- Sexual dysfunction
Tricyclic Antidepressants
- Amitriptyline (Elavil)
- Nortriptyline (Pamelor)
- Clomipramine (Anafranil)
- Imipramine (Tofranil)
- Doxepin (Silenor)
Management Pearls for Tricyclic Antidepressants
- Administer at bedtime to reduce daytime sedation
- Orthostatic hypotension: teach pts to sit or lie down when feeling lightheaded
Most dangerous adverse effect of Tricyclic Antidepressants
- Most dangerous adverse effect: Cardiac toxicity*
Tricyclic Antidepressants: side effects
Anticholinergic effects
Anticholinergic effects- that saying
Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter.
Tricyclic Antidepressants: Anticholinergic effects
- Hot as a hare: increased body temperature
- Blind as a bat: mydriasis (dilated pupils)
- Dry as a bone: dry mouth, dry eyes,
decreased sweat - Red as a beet: flushed face
- Mad as a hatter: delirium
Monoamine Oxidase Inhibitors
- Isocarboxazid (Marplan)
- Phenelzine (Nardil)
- Tranylcypromine (Parnate)
- Selegiline (Emsam)
How often are Monoamine Oxidase Inhibitors used?
Rarely used due to the side effect profile
What is a major side effects of MAOIs?
Hypertensive crisis from dietary tyramine
Hypertensive Crisis
- Severe headache, confusion
- Tachycardia, hypertension, profuse sweating
- Nausea and vomiting
- Stroke and death
How to prevent hypertensive crisis from MAOIs?
- Avoid age meats, bananas, smoked fish, cheese, wine, beer
Treatment for hypertensive crisis?
- Treatment: Intravenous vasodilator
- Labetalol, sodium nitroprusside, phentolamine
ATYPICAL ANTIDEPRESSANTS
- Bupropion (Wellbutrin)
When do effects of Bupropion occur?
- Antidepressant effects begin in 1 to 3 weeks. A delayed antidepressant effect.
- Can be given with Paroxetine to augment effect.
- Advantages
- No Weight gain
- No Sexual dysfunction
- No Sedation
- Assist with smoking cessation
Disadvantages - No as effective as SSRI
- Can increase anxiet
What can Bupropion be given with to augment effect?
Paroxetine
Advantages of Bupropion?
- No Weight gain
- No Sexual dysfunction
- No Sedation
- Assist with smoking cessation
Disadvantages of Bupropions?
- No as effective as SSRI
- Can increase anxiety
Bupropion Hydrochoride side effects
- Lowers seizure threshold* Do not give to an anorexic/bulimic patient or patient with a seizure disorder
- Insomnia, agitation, tremor
- Weight loss
- Nausea, GI upset, take w/food, constipation
- Blurred vision, dizziness, headache, dry mouth
- Tachycardia
What is associated with SSRIs?
Serotonin syndrome
Serotonin syndrome- when does it begin
- Often begins w/in 72 hours after treatment
Effects of Serotonin syndrome?
- Altered mental status (agitation, anxiety, confusion, disorientation, hallucinations, and impaired concentration)
- Fever, excessive sweating, incoordination, hyperreflexia, and tremor
- Concurrent use of MAOIs and other SSRI agents that raise serotonin*
- Can lead to death if medication is not discontinued*
- Spontaneously resolves after discontinuing the drug*
What happens if you take MAOIs with SSRIs?
- Concurrent use of MAOIs and other SSRI agents that raise serotonin*
Drug interactions of SSRIs
MAOIs
SSRIs
Saint John’s wort
MAOI + SSRIs
Risk of serotonin syndrome*W
What is required to take MAOIs and SSRIs
- Minimum 14 day wash-out period required when switching to or from an SSRI
SSRIs + SSRIs
Risk of serotonin syndrome when placed on two SSRIs*
SSRIs + St. John’s Wort
Risk of serotonin syndrome. Not FDA approved.
Sustained Release Drugs
SR stands for sustained release; it may
be taken twice per day
Extended Release Drugs
XL stands for extended release; it only needs to be taken once per day.
Other Medical Treatments and Psychotherapy
- Electroconvulsive therapy (ECT)
- Psychotherapy (combined with medications)
- Cognitive behavioral therapy (CBT): focus on cognitive distortions
