Mental Illness-Depression Flashcards
Definition of Mental Illness
clinically significant behavioral problems
associated with distress (painful symptoms)
causes disability (impairment in functioning)
A BIOLOGICAL ILLNESS THAT RESPONDS TO TREATMENT
Not to be confused with weakness of character
Facts about mental illness
leading cause of disability in the US stigma and bias are persistent problems its often chronic patients have physical complaints 70% of the mentally ill are treated in primary care TREATMENT IS NOT A CURE
Anti-Depressant medications
block the reuptake of norepinephrine, serotonic and some dopamine from the pre-synaptic neuron thereby increasing the amount of the neurotransmitter in the synapse
Mild Depression
counseling “talk therapy” may resolve the depressive episode.
Moderate to severe Depression
A combination of medication and counseling is the most effective approach.
Complete remission of symptoms
once a patient is in remission the antidepressant treatment should be continued for 6-12 months in order to promote complete recovery
33% of clients fail to fill their prescriptions
Those who do fill, less than 1/2 get a 2nd month of Tx. Less than 25% of clients who are prescribed meds take them for three months or longer.
SSRI-selective serotonin reuptake inhibitors
SNRI-seritonin norepineprine reuptake inhibitors
TCA- Tricyclic antidepressants
MOAI-Monoamine oxidase inhibitors
These are the classes of Anti-depressant medications
SSRI and SNRI-1st line treatment of major depressive disorder
Side effects: GI upset (have client take at night) sexual dysfunction nervousness HA Less common SE are: weight gain, bleeding elevated BG, LFT and lipids
Sexual Dysfunction and antidepressants
Often a reason to discontinue
Wellbutrin (bupropion) is one drug that has the fewest sexual side effects and is a NDRI (Norepinephrine-dpamine reuptake inhibitor)
Wellbutrin-bupropion
Contraindicated if the patient has a seizure
disorder
Will not cause much weight gain
this drug has less sexualy dysfuntion
For prescribing antidepressants
Form an alliance with client
discuss concerns and those of family
Choose an SSRI, SNRI or NDRI
For a second episode of Depression
Continue therapy for two years after complete remission of symptoms
SNRI are good for those with psychomotor retardation
with depression
SSRI’s, SNRI’s
safest in overdose situations. Avoid TCA for this reason
Start low, go slow
For adolescents- recheck weekly for 4 weeks and then every other week for a month
When prescribing think about follow up. Only fill for that time.
Suicide ideation is usually in the 1st few months
SNRI for those who are tired feeling
Tricyclics
2nd line for treating major depression
inexpensive
slow the gut so are good for IBS
Use caution if on SSRI as they can elevate levels
TCS’s-side effects
Anticholergic-dry mouth, blurred vision, memory problems Antiadrenergic-orthostatic hypotension antihistaminergic-sedation and weight gain cardiac dysrythmias unsafe with cardiac disease lethal in overdose May be helpful in those who can't sleep Especially not good for the elderly
SSRI’s
It will take 2-3 weeks to see an initial effect and up to 6 weeks to achieve a full effect.
Prozac
Zoloft
Paxil
Celexa
All come in generic form and are on the $4 list at wal-mat
Lexapro is newer and will be available in generic within the year.
Atypical antidepressants
Wellbutrin Triazolopyridine (Trazodone)-sedationg (helpful in those who can't sleep)
Mao Inhibitors
No prescribed much in primary care
They interact
Special diet-No tyramine foods
Must avoid over the counter medications cold and allergy medications
PMS and PMDD
treated with oral contraceptives or SSRI during the late luteal phase
Significant changes in estrogen levels during postpartum
increase risk for depressive, psychotic or bipolar episode
