depressive disorders (week 3)

common comorbidities

anxiety disorders

psychotic disorders

SUD

eating disorders

personality diorders

major depressive disorder (MDD)

a single episode of unipolar depression (not associated with mood swings form major depression to mania) resulting in significant change in clients normal functioning (social, occupational, self-care) accompanied by at least 5 specific clinical findings, which must occur every day for a minimum of 2 weeks and also most of the day

specific clinical findings

depressed mood

difficulty sleeping/ excessive sleeping

indecisiveness

decreased concentration

suicidal ideation

increased or decreased in motor activity

inability to feel pleasure

increase or decrease in weight more than 5% of total body weight over 1 month

psychotic features

presence of auditory hallucinations or presence of delusions

postpartum onset (postpartum depression)

a depressive episode that begins within 4 weeks of childbirth and can include delusions, which can put the newborns infant at high risk of being harmed by mother

seasonal affect disorder (SAD)

form of depression that occurs seasonally, usually during winter, when there is less daylight

light therapy is the first-line treatment

substance-induced depressive disorder

clinical findings of depression that are associated with the use of or withdrawal form drugs and alcohol

persistent depressive disorder

a milder form of depression that usually has an early onset (in childhood or adolescence) and lasts at least 2 years for adults (1 year for children).

contains atlas 3 clinical findings of depression and can later in life become MDD

premenstrual dysmorphic disorder (PMDD)

a depressive disorder associated with the luteal phase of menstrual cycle.

causes problems severe enough to interfere with the ability of a client to work or interact with others

emotional manifestations: mood swings, irritability, depression, anxiety, overwhelmed, difficulty concentrating

physical symptoms: lack of energy, overeating, hyperinsomia or insomnia, breast tenderness, aching, bloating, weight gain

treatment: exercise, diet, relaxation therapy

acute phase of MDD

treatment 6 - 12 week

potential need for hospitalization

decrease in depressive symptoms is the goal

assess suicide risk and implement safety precautions of 1:1 observation

continuation phase of MDD

treatment 4 - 9 months

relapse prevention through education, medication, and therapy is goal treatment

maintenance phase of MDD

can last for years

prevention of future depressive episodes is a goal of treatment

risk factors of MDD

family/ personal history of depression

females

age over 65

neurotransmitter deficiencies

stressful life events

presence of medical illness

postpartum period

comorbid anxiety or personality disorder

comorbid SUD

childhood trauma

expected findings of MDD

anergia

anhedonia

anxiety

sluggishness or inability to relax

vegetative findings (r/t eating patterns, bowels, sleep, decreased interest in sex)

somatic reports: fatigue, GI changes, pain

physical assessment findings of MDD

looks sad with blunted affect

poor grooming/ lack of hygiene

psychomotor retardation or psychomotor agitation

social isolation/ shows little or no effort to interact with slow speech, decreased verbalization, and delayed responses, seem too tired to talk and can sign often

client education for antidepressants

do not discountinue abruptly

can be several weeks or more to reach therapeutic benefits

avoid hazardous activities

notify provider of any SI
avoid alcohol

client education for SSRI

leading treatment for depression

ex. citalopram, fluoxetine, sertraline

nausea, headaches, CNS stimulation

sexual dysfunciton

weight gain can occur

concurrent use w/ St. johns wort increase risk of serotonin syndrome

observe for manifestations of serotonin syndrome

tricyclic antidepressant

ex. amitriptyline

change positions slowly d/t possible orthostatic hypotension (remember they dry out the body so blood doesn’t pump as fast)

minimize anticholinergic effects: chew sugarless gum, eat high fiber foods, increase fluid intake

monoamine oxidase inhibitors (MAOI)

do not get along with anything

ex. phenelzine

due to risk of hypertensive crisis avoid: food with tyramine (ripe avocados, figs, cheeses, beer, wine, etc.)

due to risk of medication interactions avoid: all medications including OTCs

atypical antidepressants

ex. bupropion (can cause serotonin syndrome)

observe for: headaches, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, or insomnia (notify provider if intolerable)

monitor intake and weight d/t appetite suppression

avoid administering if risk for seizures

SNRI

ex. venlafaxine, duloxetine

adverse affects: nausea, insomnia, weight gain, diaphoresis (sweating) and sexual dysfunction

caution when administering to pt who have hx of hypertension

st. Johns wort

potentially fatal serotonin syndrome if take w/ SSRI/ other antidepressant

avoid foods with tyramine

light therapy

first line treatment for seasonal affect disorder

inhibits secretion of melatonin

electroconvulsive therapy (ECT)

useful for depressive disorders resistant to other treatment

transcranial magnetic stimualtion

uses electromagnetic stimulation to stimulate focal areas of cerebral cortex

vagus nerve stimulation

implanted device that stimulates values nerve

for depression resistant to antidepressant drugs

cognitive behavioral therapy (CBT)

assit client to identify and change negative behavior and thought patterns

interpersonal therapy (IPT)

encourages the client to focus on personal relationships that contribute to the depressive disorder

exercise

30 minutes 3 - 5 days each week improve depression and helps prevent relapse