depressive disorders (2) Flashcards
alteration in mood that is expressed by feelings of sadness, despair, pessimism
-loss of intrest
-somatic symptoms
-changes in appetite and sleep
depression
when is depression normal?
the symptoms are a transient and healthy response to loss or change
when is depression pathological?
when adaptation fails to occur or is ineffective, unable to care for self
which disorders fall under persistent depressive disorder
-premenstrual dysphoric disorder
-substance/medication-induced depressive disorder
-depressive disorder due to other med condition (hypothyroid)
how do you help depressive disorder due to another medical condition
fix the condition
what kind of depression does seasonal affective disorder fall under
major depressive disorder
what kind of depression consists of feelings of low-level depression for most of the day and a majority of days over 2 years (plus 2 other symptoms)
persistent depressive disorder
what are some of the symptoms that can be used to indentify persistent depressive disorders
-poor apetite / overeating
-insomnia/hypersomnia
-low energy/fatigue
-poor concentration or difficulty making decisions
-hopelessness
is persistent depressive disorder severe enough for a hospital
no
what are some symptoms of premenstrual dysphoric disorder (PMDD)
-mood swings
-irritability or anger
-depressed mood
-anxiety, tension, on edge
-decreased interest
-difficult concentration
-lethargy, lack of energy
-appetite change
-hypersomnia, insomnia
-breast tenderness
what are the 2 manin diagnostic criteria for major depressive disorder
-derpessed mood most of the day nearly every day
-anhedonia (lack of pleasure)
how many symptoms must be present to diagnose MDD and how long do they need to last
5 or more, last for at least 2 weeks with change in functioning
what is used to specify episodes of MDD?
diagnostic specifiers (single or recurring, mild/mod/severe, with or without psychotic or catatonic features, etc.)
what are the 2 main neurotransmitters in depression
serotonin and norepinephrine
what are the 3 cognitive distortions that serve as the basis for depression
1) negative xpectations of the environment
2) negative expectations of the self
3) negative expectations of the future
what aspects of life does mild depression affect?
diet, sleep, hygeine
what aspects of life does moderate depression affect?
put on medication, risk for suicide
what are the 4 kinds of treatment fro depression
-psych treatment (therapy)
-pharmacology
-ECT
-brain stimulation therapy
what is the older kind of antidepressant med
MAOIs
what were the first drugs made specifically for depression
MAOIs
examples of MAOIs
Phenelzine (NArdil), tranylcypromine (PARnate), isocarboxazid (MARplan)
what is important to restrict in people taking MAOIS?
tyramine containing foods
examples of food to RESTRICT in people taking MAOIs
aged cheese, raisin, fava beans, red wine, caviar, smoked/processed meat, soy
examples of food to LIMIT in people taking MAOIs
gouda /american / mozzarella, yogurt, sour cream, avocado, banana, over-ripe fruit, beer, white wine, coffee, cola, tea, hot chocolate, choclate, meat extracts
what can happen when you eat tyramine when on MAOIs
hypertensive crisis
what are symptoms of hypertensive crisis
headache, n/v, tachycardia, fever, diaphoresis, epistaxis, CP, SOB, vision changes
treatment of hypertensive crisis
gastric lavage (NG) / activated charcoal, IV vasodilators
what other meds should you not take with MAOIs
-other antidepressants!!! (fatal)
-sympathomimetics (cold meds), stimulants, antihypertansives, meperidine / opioids, antiparkinson
how long do you have to wait before starting a new antidepressant after being on MAOIs
14 days
examples of tricyclic antidepressants
ending in “mine”
Imipramine
what is important to rememebr in suicidal patients on MAOIs or tricyclic antidepressants?
very fatal in overdose, cardiac arrythmias like vfib / vtach
example of SSRIs
-fluoxetine (prozac)
-sertraline (zoloft)
-paroxetine (paxil)
-citalopram (celexa)
-escitalopram (lexapro)
-fluvoxamine (luvox)
which SSRI causes the least amout of sexual dysfunction
escitalopram
big side effects of SSRI
sexual dysfunction, discontinuation syndrome
can you stop SSRIs abrupt?
no
what occurs when more than 1 drug is used that increases serotonin levels or when high doses are used
serotonin syndrome
serotonin syndrome triad symptoms
1) altered mental status
2) autonomic hyperactivity (tachycardia, fever/flushing, dry mucous mems, hyper/hypotension)
3) neuromuscular abnormality (tremor, hyperreflexia, myoclonus, shivering)
what can serotonin syndrome lead to
-seizures, coma, death if not recognized
which kind of antidepressant increases norepi and serotonin
SNRIs
which SNRI has a lot of effects
venlafaxine (effexor)
which SNRI is good for menopause
desvenlafaxine (pristiq)
what is an example serotonin partial agonisy reuptake inhibitor (SPARI)
vilazodone (viibryd)
describe dosing and frequency of viibryd (SPARI)
decreased dose, once daily with food, dreams/nightmares
describe the progressive dosing of the SPARI drug viibryd
starting dose is not therapeutic, then progresses to therapeutic dose, then the max dose
10 -> 20 -> 40
what med helps with treatment resistance
serotonin modulator (vortioxetine (trintellix))
what effects do serotonin modulators do?
help with resistance (decrease aggression, increase sex drive, increase cognition, onset 2-4 weeks)
example serotonin antagonist and reuptake inhibitor (SARI)
trazodone (desyrel)
why is trazodone (SARI) so commonly used?
1 prescribed, helps with sleeping, good with old people
which med is used as adjunctive antidepressant therapy “booster”, can help with sexual dysfunction and apathy from SSRI
norepinephrine dopamine reuptake inhibitor (NDRI), bupropion (wellbutrin)
which med can be given at HS to sedate, stimulates appetitie, often used in alzheimers
noradrenergic and specific serotonergic antidepressants (NaSSAs), mirtazapine (remeron)
what is the black box warning of antidepressanbts?
may cause increase suicidal thoughts and behaviors
what new med is for resistant depression, adjunctive use
NMDA antagonist, esketamine intranasal (GIVEN IN HEALTHCARE ONLY)
why should patients continue to take antidepressants even if they dont seem to work?
can take a while to work (4-6 weeks)
describe the med plan for antidepressants (3 steps)
-give each med a 3 month trial
-stay on med 6-9 months after s/sx stop
-3rd reoccurence = lifelong therapy recommended
describe what ECT is
induction of a grand mal seizure through the application of electrical current to brain
are people undergoing ECT put on anesthesia?
yes
how long should an ECT seizure last?
25 sec - 1 min
describe frequency and duration of ECT treatment
2-3 times per week for 4-6 weeks
indications of use for ECT
-severe depression
-vegetative symptoms with derpession
-psychotic
-mania
-schizo
what is the only absolute contraindication for ECT
increased intracranial pressure
should patients be NPO before ECT
yes
pre-op role of nursing
safety / IV / meds
role of nurse during ECT
-connect devices
-airway
-oxygen
-VS
-record and observe
which form of brain stimulation uses bursts of magnetic energy applied to the brain, no seizure activity
transcranial magnetic stimulation (TMS)
which brain stimulation implants an electrode onto the vagus nerve and sends electrical impulse to vagus nerve and thus to brain, all implanted surgically
vagus nerve stimulation
which brain stimulation implants electrodes in the brain and generators subcutaneously: electrical impulses are continuously generated and sent to the brain. it was used first in parkinsons, shows promise for depression and OCD treatment
deep brain stimulation (DBS)
what is the relevance of st johns wort with depression?
can not take SSRIs while using
