Depressive Disorders Flashcards
examples of SSRIs
–fluoxetine
–paroxetine
–sertraline
–citalopram
–escitalopram
examples of SNaRIs
–venlafaxine
–duloxetine
examples of tricyclic antidepressants
–imipramine
–doxepin
–amitriptyline
examples of MAOIs
–phenelzine
–tranylcypromine
–selegiline
epidemiology of depression
–women 2x more likely
–more common in White people
–worse in decreased light
–high recovery rate in kids when receiving treatment
biological factors of depression
–genetic
–biochem abnormalities (neurotransmitter imbalances, increased cortisol)
–hormonal disturbance
–inflammatory process
–Diathesis - stress model (predisposition to depression and stress can bring it out)
Psychological factors for depression
–cognitive theory (negative/unrealistic expectations of environment, self and future; unrealistic expectations lead to recurrent dissatisfaction)
–learning theory (learned helplessness, lack of coping)
contributing factors for depression in kiddos
–physical or emotional detachment by primary caregiver
–parental separation
–divorce
–death of loved one
–relocation
–academic failure
–physical illness
contributing factors for depression in teens
–conflicts between independence and maturation
–grief/loss = abandonment
contributing factors to depression in older adults
–social attitudes can lead to decreased self-esteem, helplessness, hopelessness
–financial problems
–life changes
–physical illness
–grief/loss (bereavement overload)
necessary symptoms for diagnosing MDD
Five (or more) in 2 week period:
–weight loss and appetite changes
–sleep disturbances
–fatigue
–psychomotor agitation or retardation
–worthlessness or guilt
–loss of ability to concentrate
–recurrent thoughts of death
PLUS one:
–depressed mood
–loss of interest or pleasure
chronic MDD
lasting more than 2 years
MDD specifics
–recurrent episodes common
–episode not attributed to psych effects
–absence of manic or hypomanic episode
additional symptoms in children and teens with MDD
–frequent vague, non-specific physical complaints
–frequent absences or poor performance in school
–being bored
–alcohol or substance abuse
–increased anger or hostility
–reckless behavior
depression symptoms in children up to 3 years old
–failure to thrive
–feeding problems
–lack of playfulness
–lack of emotional expression
–delay in speech or motor development
depression symptoms in children from ages 3-5
–prone to accidents
–phobias
–aggressiveness
–excessive self-reproach for minor infractions
depression symptoms in children ages 6-8
–vague physical complaints
–aggressive behavior
–cling to parents
–avoid new people and challenges
–behind in social skills/academic performance
depression symptoms in children ages 9-12
–morbid thoughts
–excessive worrying
–lack of interest socially
–think they have disappointed parents
DMDD specifics
–ages 6-18 years old
–onset before age 10
–anger and constant, severe irritability
–more common in men and children than adolescents
–temper tantrums with verbal and behavioral outbursts at least 3x weekly
–display irritability, anger, and temper tantrums in at least 2 settings
former name of persistent depressive disorder
dysthymia
symptoms for persistent depressive disorder
–low level depressive feelings most of the day, the majority of days
–symptoms for at least 2 years in adults
–at least 1 year in children and adolescents
MUST have 2 or more of:
–decreased appetite or overeating
–insomnia or hyperinsomnia
–low energy
–poor self-esteem
–difficulty thinking
–hopelessness
PMDD symptoms and timing
–symptoms in week prior to onset of woman’s menstruation
–mood swings
–irritability
–depression
–anxiety
–feeling overwhelmed
–difficulty concentrating
–lack of energy
–overeating
–hyperinsomnia or insomnia
–breast tenderness
–aching
–bloating
–weight gain
symptoms decrease significantly or disappear with onset of menstruation
primary care screening for depression
–patients presenting with somatic complaints
areas to assess patients for depression
–affect
–thought processes/content
–mood
–judgment/insight
–physical behavior/activity
–communication
–religious beliefs and spirituality
affect
observed responsiveness of a person’s emotional state
constricted affect
a little less than normal
blunted affect
limited expression
flat affect
does not demonstrate emotion
congruent/incongruent
do mood and affect match?
sad affect
–body language implies sadness
–eye contact downcast
–stooped posture
–facial expression
mood
person’s emotional state or feeling expressed in own words
psychomotor retardation
visible slowing of physical activity such as movement and speech having a mental, not organic, cause
examples of psychomotor retardation
–slow talking or long pauses before beginning to talk
–taking long time to cross a room or slow food chewing and waiting longer than usual between bites
what is psychomotor retardation associated with?
severe depression
psychomotor agitation
an increase in activity brought on by mental tension
examples of psychomotor agitation
–restlessness
–pacing
–tapping fingers or feet
–abruptly starting and stopping tasks
–meaninglessly moving objects around
what is psychomotor agitation associated with?
agitated depression
recovery model
–focus on patient’s strengths to improve health and reach full potential
–treatment goals mutually developed
–based on patient’s personal needs and values
–measurable
general antidepressant medication education
–may not see improvement for 4-6 weeks
–physiological symptoms before psychological
–improved sleep
–discontinuing meds may cause relapse
–not addictive
–abrupt stoppage will cause withdrawal
–NO ALCOHOL
SSRI indications
–first line therapy
–rare risk of serotonin syndrome
TCA warning
anticholinergic adverse reactions
possible side effects of SRIs
–drowsiness
–nausea
–insomnia
–diarrhea
–nervousness, agitation, or restlessness
–dizziness
–sexual problems
–tension headache
–blurred vision
SRI nursing implications
–effectiveness = 4-8 weeks
–side effects diminish in 4-6 weeks
–monitor for SI, agitation, fever, increased BP, mania
–sleep hygiene
–avoid caffeine if anxious
–relaxation techniques
serotonin syndrome symptoms
–agitation
–confusion
–restlessness
–lethargy
–delirium
–irritability
–dizziness
–hallucinations
–diaphoresis
–flushing
–fever
–tachycardia
–mydriasis
–myoclonus
–hyperreflexia
–tremors
–N/V/D
when does serotonin syndrome usually set in?
develop symptoms within 6 hours of either first dose of new med, a change in dosing, or intentional overdose
how to treat serotonin syndrome
–stop or reduce meds causing it
–benzos (agitation, seizures, muscle stiffness)
–oxygen
–IV fluids
–meds to control HR, BP
tricyclic antidepressant statistics
–increased danger of death by OD
–increased and potentially fatal CNS depression with ETOH
–less expensive
nursing implications for TCAs
–before initiating: check ECG and hx of seizure
–early treatment symptoms include early morning awakening, feeling worse in AM, worry and anxiety
nursing interventions for TCAs
–dry mouth
–GI upset
–diarrhea
–constipation
–insomnia
–orthostasis
–sexual side effects
–urinary hesitancy
action of MAOIs
blocks enzyme Monoamine oxidase which is used to metabolize the monoamines SE, NE, and dopamine
common MAOI side effects
–dry mouth
–nausea
–diarrhea or constipation
–HA
–drowsiness
–insomnia
–dizziness or lightheadedness
–skin reaction at patch site
less common MAOI side effects
–involuntary muscle jerks
–low BP
–reduced sexual desire or orgasm
–weight gain
–difficulty starting urine flow
–muscle cramps
–prickling or tingling sensation in skin
MAOI nursing implications
avoid tyramine rich foods to prevent hypertensive crisis
–aged, smoked meats
–aged cheese
–beans
–beers/ales/liquors
–rarely used with SSRIs due to possible serotonin syndrome
–avoid high consumption of caffeine
hypertensive crisis symptoms
–occipital headache
–palpitations
–N/V
–dyspnea/SOA
–mental status changes
–blurred vision
–sweating
–neck stiffness or soreness
–dilated pupils
–photophobia
–tachycardia or bradycardia
–CP
treatment of hypertensive crisis
–phentolamine (vasodilator)
–sublingual nifedipine (CCB)
–symptomatic and supportive
bupropion
–contraindicated in eating disorders and hx of seizures
–less sexual side effects
–considered energizing
–used in smoking cessation
trazodone
often given at bedtime for sedative effect as adjunct with another AD
mirtazapine
good for sleep
SSRIs for children and teens
–BB warning: increased risk of SI
–fluoxetine = first line
–low S/E
–improvement in 1-2 weeks
–up to 12 weeks for full effect
