Mental Illness-Depression

Question 1

Definition of Mental Illness

Answer 1

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

Question 2

Facts about mental illness

Answer 2

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

Question 3

Anti-Depressant medications

Answer 3

block the reuptake of norepinephrine, serotonic and some dopamine from the pre-synaptic neuron thereby increasing the amount of the neurotransmitter in the synapse

Question 4

Mild Depression

Answer 4

counseling “talk therapy” may resolve the depressive episode.

Question 5

Moderate to severe Depression

Answer 5

A combination of medication and counseling is the most effective approach.

Question 6

Complete remission of symptoms

Answer 6

once a patient is in remission the antidepressant treatment should be continued for 6-12 months in order to promote complete recovery

Question 7

33% of clients fail to fill their prescriptions

Answer 7

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.

Question 8

SSRI-selective serotonin reuptake inhibitors
SNRI-seritonin norepineprine reuptake inhibitors
TCA- Tricyclic antidepressants
MOAI-Monoamine oxidase inhibitors

Answer 8

These are the classes of Anti-depressant medications

Question 9

SSRI and SNRI-1st line treatment of major depressive disorder

Answer 9

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

Question 10

Sexual Dysfunction and antidepressants

Answer 10

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)

Question 11

Wellbutrin-bupropion

Answer 11

Contraindicated if the patient has a seizure
disorder
Will not cause much weight gain
this drug has less sexualy dysfuntion

Question 12

For prescribing antidepressants

Answer 12

Form an alliance with client
discuss concerns and those of family
Choose an SSRI, SNRI or NDRI

Question 13

For a second episode of Depression

Answer 13

Continue therapy for two years after complete remission of symptoms

Question 14

SNRI are good for those with psychomotor retardation

Answer 14

with depression

Question 15

SSRI’s, SNRI’s

Answer 15

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.

Question 16

Suicide ideation is usually in the 1st few months

Answer 16

SNRI for those who are tired feeling

Question 17

Tricyclics

Answer 17

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

Question 18

TCS’s-side effects

Answer 18

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

Question 19

SSRI’s

Answer 19

It will take 2-3 weeks to see an initial effect and up to 6 weeks to achieve a full effect.

Question 20

Prozac
Zoloft
Paxil
Celexa

Answer 20

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.

Question 21

Atypical antidepressants

Answer 21

Wellbutrin
Triazolopyridine (Trazodone)-sedationg (helpful in those who can't sleep)

Question 22

Mao Inhibitors

Answer 22

No prescribed much in primary care
They interact
Special diet-No tyramine foods
Must avoid over the counter medications cold and allergy medications

Question 23

PMS and PMDD

Answer 23

treated with oral contraceptives or SSRI during the late luteal phase

Question 24

Significant changes in estrogen levels during postpartum

Answer 24

increase risk for depressive, psychotic or bipolar episode

Question 25

paxil

Answer 25

Cannot be used in pregnancy

Question 26

Sertraline-Zoloft

Answer 26

is one of the safest and most studied for treating depression during pregnancy and breastfeeding

Question 27

Prozac-

Answer 27

Not recommended for breastfeeding mothers

Question 28

Risks of antidepressant during pregnancy

Answer 28

Cardiac malformations (especially 1st trimester)
newborn hypertension in 3rd trimester-SSRIS
nenatal withdrawal syndrome
low birth weight
suicidal ideation for the first two weeks of therapy n those under 25
medical/legal risks

Question 29

Anti-depressants during lactation-1st line

Answer 29

Zoloft and Pacil and Fluvox

Question 30

General considerations for people

Answer 30

If tired-try Prozac- SNRI
depression and anxiety-Paxil or lexapro
Pain relief-maybe Cymbalta ar a TCA
Cymbalta-maybe if they are in continenet or tx for diabetic neuropathy
Remeron may be good for those who need to gain weight, agitated or have insomnia

Question 31

Antidepressants in children

Answer 31

Only one safe for children under 8 is Fluoxetine (Prozac)
At 12 others are approved. Remeber the black box warning. Once an adolescent is started, f/u in one week and then every 2 weeks then after a month based on symptoms

Question 32

Anti-depressants in the elderly

Answer 32

SSRI and SNRI-drugs of choice. TCA’s and MAOI’s are contraindicated. Due to decreased renal clearance, reduced hepatic function start at one -third or one half of the adult dose.

Question 33

Discontinuation Syndrome

Answer 33

Flu-like symptoms
fatigue
Myalgia
decreased concentration, etc
Happen with a med with short half life more often like Paxil. Prozac has longer half-life so not as likely

Question 34

Serotonin syndrome

Answer 34

Could happen with combinations like
SSRI & MAOIs
Drug and herbal interactions
SSRI’s and St. Johns Wort

Question 35

What is the worst that can happen

Answer 35

you activate a latent case of bi polar