Depression PPT Pt. 1

what are the ranges of depressive symptoms?

from transient to severe

who are affected more with depression?

Women are affected more - almost twice as likely to be diagnosed

what’re the statistics for suicide?

Seniors also have a high burden with white older men having high suicide rates

what does risk of suicide increase?

with family or personal history of attempts, anxiety disorder or panic attacks, substance use disorder, psychosis, poor self esteem, lack of social support or chronic medical condition

what do all antidepressants carry?

a “black box” warning from the FDA for children and adolescents

how long can it take for medications to reach therapeutic levels for depression?

several weeks

what should people avoid on antidepressants?

alcohol

what should you remember with regards to communication for depression?

make observations instead of asking direct questions, use simple concrete sentences, and give the client time to respond

what can happen to pts when their depression lifts?

the client may now have the energy to carry out their self harm plan – watch for sudden lifts in mood

what’s the oldest and one of the most frequently diagnosed psychiatric illnesses?

depression

what are transient symptoms?

normal, healthy responses to everyday disappointments in life. (An occasional feeling of sadness or downheartedness is common among healthy people and considered to be a normal response to everyday disappointments in life)

when does pathological depression occur?

when adaptation to stressors is ineffective. (and the symptoms are significant enough to impair functioning.)

define depression

• an alteration in mood that is expressed by feelings of sadness, despair, and pessimism. There is a loss of interest in usual activities, and somatic symptoms may be evident. Changes in appetite and sleep patterns are common

• “an inability to construct a future.”

define mood

pervasive and sustained emotion that may have a major influence on a person’s perception of the world

what are the following examples of:

depression, joy, elation, anger, and anxiety.

mood

what’s “affect”?

described as the external, observable emotional reaction associated with an experience.

what is depression with regards to mood?

• an alteration in mood that is expressed by feelings of sadness, despair, and pessimism.

• There is a loss of interest in usual activities, and somatic symptoms may be evident.

• Changes in appetite, sleep patterns, and cognition are common.

what’s the lifetime prevalence of depression

17% which makes it the most prevalent psychiatric disorder.

what’s one of the leading causes of disability in the U.S.?

Major depressive disorder (MDD)

what is the gender statistic for depression?

• more prevalent in women than in men by about 2 to 1.

• higher in women than it is in men by almost 2 to 1

Depression is more common in young ______ than young ________.

women ; men

what, with regards to marital status, are the trends for depression?

Single and divorced people are more likely to experience depression than married persons or persons with a close interpersonal relationship

what, with regards to social class, are the trends for depression?

Lower economic status and education levels associated with higher levels of depression.  May be related to access to care.

what, with regards to race, are the trends for depression?

No consistent relationship between race and affective disorder has been reported.  May be misdiagnosed due to cultural or language differences.

when is seasonal depression more common?

in the fall and winter months.

what are the characteristics of seasonal affective disorder?

not a separate diagnosis.  Light therapy results inconsistent or inconclusive

what is a huge CAUTIONARY tale for putting a severely depressed person on antidepressants?

this is when they’re at the statistically highest rate for suicide— they have enough energy to enact their plan (look out for words such as “I’m 100% better. I’m all healed”)

what is the following exemplifying:

• Major Depressive Disorder

• Dysthymic Disorder

• Substance-Induced Depressive Disorder

• Depressive Disorder Associated With Another Medical Condition

types of depressive disorders

what is the general criteria for Major Depressive Disorder (MDD)?

• Characterized by depressed mood

• Loss of interest or pleasure in usual activities

• Symptoms with impaired  social and occupational functioning have been present for at least 2 weeks

• No history of manic behavior

• Cannot be attributed to use of substances or another medical condition

what is a very important feature of diagnosis MDD (Major Depressive)?

they Must never have been a maniac episode or a hypo-manic episode to meet the DSM’s diagnosis criteria.

what is a test that will be performed for MDD?

TSH Tests (thyroid)

what does a high TSH indicate with regards for MDD?

the thyroid gland is failing because of a problem that is directly affecting the thyroid (primary hypothyroidism)

what does a low TSH indicate with regards for MDD?

that the person has an overactive thyroid that is producing too much thyroid hormone (hyperthyroidism)

what is the criteria for a Dysthymic Disorder dx?

• Sad or “down in the dumps”, milder than MDD

• No evidence of psychotic symptoms

• Essential feature is a chronically depressed mood for

  • Most of the day

  • More days than not

what’s the tx for Dysthymic Disorder?

antidepressants (mild) and talk therapy

define Premenstrual Dysphoric Disorder?

Depressed mood, excess anxiety, mood swings, and deceased interest in activities in the week before menses, improving during, and absent after menses.

define Substance-Induced Depressive Disorder

Considered to be the direct result of physiological effects of a substance

define Depressive Disorder Associated With Another Medical Condition?

Attributable to the direct physiological effects of a general medical    condition – not stroke, traumatic brain injury, thyroid, etc

what’s the following:

35-year-old woman - 7 weeks after delivery – spouse reports she is not caring for herself or infant.  Hasn’t left the house in 3 weeks.  Showers only when reminded.  Verbalizes that she will never be a good mother. 

postpartum depression

what’s the following:

67-year-old woman taking new metoprolol and a statin medication for 5 weeks.  Reporting fatigue and lack of motivation 

substance-induced depression

what’ the following:

19-year-old female reporting short temper, increased frustration, and social isolation the second week of every month

premenstrual depression

what’s the following:

81-year-old man – wife and siblings deceased .  Thyroid stimulating hormone 15 U/ml

medicallyrelated depression

what’s the following:

27-year-old woman – working full time – complaining to roommate about how “awful” her life is every evening after work.  Appears active and social on the weekends.  

dyshthymic depressin

what are some biological theories that are depressive risk factors?

• Genetics - Hereditary factor may be involved, family links & Biochemical influences

• Deficiency of norepinephrine, serotonin, and dopamine

• Excessive cholinergic transmission may also be a factor

what are some physiological theories that are depressive risk factors?

• §Medication side effects

• § Neurological disorders

• § Electrolyte disturbances

• § Hormonal disorders

• § Nutritional deficiencies

• § Other physiological conditions

• §Inflammation (autoimmune and others)

what’s the cause of depression?

The cause of depression is unclear, and no single theory or hypothesis offers a clear-cut explanation for the disease. Evidence continues to mount in support of multiple causations.

what are the normal levels of TSH?

2-10

what can hypothyroidism cause?

depression

what’re the symptoms of depression for a child younger than 3 yo?

feeding problems, tantrums, lack of playfulness and emotional expressiveness

what’re the symptoms of depression for a child 3-5 yo?

accident proneness, phobias, excessive self-reproach

what’re the symptoms of depression for a child 6-8 yo?

physical complaints, aggressive behavior, clinging behavior, less social skills

what’re the symptoms of depression for a child 9-12 yo?

morbid thoughts and excessive worrying

what can cause childhood depression?

likely a loss

what are the different therapies for childhood depression?

• §Focus of therapy: alleviate symptoms and strengthen coping skills

• §Parental and family therapy, medications, mostly outpatient treatment

what’re the symptoms of depression in adolescents?

• §Anger, aggressiveness 

• Running away

• §Delinquency 

• Social withdrawal

• §Sexual acting out 

• Substance abuse

• §Restlessness, apathy

what’s the Best clue that differentiates depression from normal stormy adolescent behavior

visible manifestation of behavioral change that lasts for several weeks

what’re the most common precipitant to adolescent suicide

Perception of abandonment by parents or close peer relationship

what’s the tx of adolescent depression?

• Supportive psychosocial intervention

• Antidepressant medication - fluoxetine (Prozac),escitalopram (Lexapro), sertraline (Zoloft) common

• All antidepressants carry an FDA black box warning for increased risk of suicidality in children and adolescents.

what is transient depression?

level of the continuum not necessarily dysfunctional ; “the blues”

what are the different manifestations of transient depression?

• §Behavioral: some crying

• §Cognitive: some difficulty getting mind off one’s disappointment

• §Physiological: feeling tired and listless

• §Subsides quickly

what are the symptoms of mild depression?

• Affective: anger, anxiety

• Behavioral: tearful, regression

• Cognitive: preoccupied with loss

• Physiological: anorexia, insomnia

what’s moderate depression associated with?

dythymic disorder

what are the symptoms of moderate depression?

• Affective: helpless, powerless, gloomy, hopeless

• Behavioral: slowed physical movements, slumped posture, limited verbalization, self destructive behavior, change in hygiene

• Cognitive: slowed thinking processes, difficulty with concentration, obsessive thoughts, speech/behavior may show suicidal ideation

• Physiological: anorexia or overeating, sleep disturbance, headaches, chest pain, low energy, fatigue,

what are the affective symptoms of moderate depression?

helpless, powerless, gloomy, hopeless

what are the behavioral symptoms of moderate depression?

slowed physical movements, slumped posture, limited verbalization, self destructive behavior, change in hygiene

what are the affective symptoms of severe depression?

feelings of total despair, worthlessness, flat affect

what are the behavioral symptoms of severe depression?

psychomotor retardation, curled-up position, absence of communication, no grooming, isolation

what are the cognitive symptoms of severe depression?

prevalent delusional thinking, with delusions of persecution and somatic delusions; confusion; suicidal

what are the physiological symptoms of severe depression?

general slow-down of the entire body, sleep trouble, no appetite, constipation

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what are some ways to measure outcomes for a depressed pt?

• §Has experienced no physical harm to self

• §Discusses the loss with staff and family members

• §No longer idealizes or obsesses about the lost entity

• §Sets realistic goals for self

• §Attempts new activities without fear of failure

• §Is able to identify aspects of self control over life situation

• §Expresses personal satisfaction and support from spiritual practices

• §Interacts willingly and appropriately with others

• §Is able to maintain reality orientation

• §Is able to concentrate, reason, and solve problems

what are the nursing interventions (planning/implementation) for depression?

• Maintaining client safety

• §Assisting client through grief process

• §Promoting increase in self-esteem

• §Encouraging client self-control and control over life situation

• §Helping client to reach out for spiritual support of choice

• §Assistance in confronting anger that has been turned inward on the self

• §Ensuring that needs related to nutrition, elimination, activity, rest, and personal hygiene are met

what would you educate a family about the nature of depression?

•Stages of grief and symptoms associated with each stage

•What is depression?

•Why do people get depressed?

•What are the symptoms of depression?

what would you educate a family about the managing depression?

•Medication management

•Assertive techniques

•Stress-management techniques

•Ways to increase self-esteem

•Electroconvulsive therapy

what would you educate a family about support services for depression?

•Suicide hotline

•Support groups

•Legal/financial assistance

what are some outcomes to assess for evaluating a depressive pt for recovery (aka what would you want to see at discharge)?

fulfilling the following:

•Has self-harm to the client been avoided?

•Have suicidal ideations subsided?

•Does the client know where to seek assistance outside the hospital when suicidal thoughts occur?

•Has the client discussed the recent loss with the staff and family members?

•Is he or she able to verbalize feelings and behaviors associated with each stage of the grieving process and recognize own position in the process?

•Have obsession with and idealization of the lost object subsided?

•Is anger toward the lost object expressed appropriately ?

•Does client set realistic goals for self?

•Is the client able to verbalize positive aspects about self, past accomplishments, and future prospects?

•Can the client identify areas of life situation over which he or she has control?

what’re the different treatment modalities for depression?

• Individual psychotherapy

• Group therapy

• Family therapy

• Cognitive therapy

• Light therapy

why does individual psychotherapy happen for depression

to determine extent of depression, plan to help client resolve grief, establish a therapeutic alliance with others, reassurance, improved communication

why does group therapy happen for depression

discuss issues, gain peer support, receive education, gain perspective, gain hope

why does family therapy happen for depression

restore family function, education

why does cognitive therapy happen for depression

control negative thought distortions

why does light therapy happen for depression

effective for short term SAD mixed evidence, more effective with other treatments

what’s electroconvulsive therapy?

• Mechanism of action: thought to increase levels of biogenic amines

• For intractable depression that does not respond to treatment or medication

what’re the risks for electroconvulsive therapy?

mortality; permanent memory loss; brain damage

what’re the meds for electroconvulsive therapy?

pretreatment medication; muscle relaxant; short-acting anesthetic

what’re the side effects of electroconvulsive therapy?

temporary memory loss and confusion

what’re the nursing actions for a pt w depression?

• Ask direct questions – Have you thought about killing yourself?  Are you still feeling that way?  Do you have a plan?

• Survey the environment and belongings (search)

• Be present

• Be accepting of negative/all feelings (anger, sadness, grief)

• Maintain close observation (one on one, line of sight, Q15 checks)

• Careful medication administration (check mouth for swallowing)

• Establish rapport, use active listening

• Encourage participation and independence

• Allow responsibility and autonomy as able

• Demonstrate hope but not unrealistic or false reassurance

• Use a moderate tone – overly cheerful shows what is expected of the client

• Simple, direct sentences

• Promote rest and sleep

what’re some key things in your assessment for a pt w depression?

• Appetite and weight changes

• Sleep disturbances

• Fatigue, decreased energy

• Skin for wounds

• Memory or cognition concerns

• Medication side effects

• Self-concept

what are the following examples of:

•Amitriptyline (brand: Elavil)

•Amoxapine (brand: Asendin)

•Desipramine (brand: Norpramin)

•Doxepin (brand: Sinequan)

•Imipramine (brand: Tofranil)

•Nortriptyline (brand: Pamelor)

tricyclics

what are the side effects of tricyclics?

Drowsiness, Blurred vision, Constipation, Dry mouth, Orthostatic hypotension, Urine retention, Weight loss, Increased appetite, Excessive sweating, Tremor, Sexual problems, do not stop abruptly.

what’re the following examples of:

•Fluoxetine (brand: Prozac)

•Sertraline (brand: Zoloft)

•Paroxetine (brand: Paxil)

•Citalopram (brand: Celexa).

•Escitalopram (brand: Lexapro)

SSRIs

what’re the side effects of SSRIs?

Nausea, vomiting, or diarrhea, Headaches, Dry mouth, Insomnia, Blurred vision, Dizziness, Agitation or nervousness, Upset stomach, Serotonin syndrome, do not take with St. Johns Wort, do not top abruptly. 

what’re the following examples of:

•Duloxetine (brand: Cymbalta)

•Venlafaxine (brand: Effexor)

•Desvenlafaxine (brand: Pristiq)

SNRIs

what’re the side effects of SNRIs?

Nausea, Dry mouth, Dizziness, Headache, Excessive sweating, Tiredness, Constipation, Insomnia, Changes in sexual function, loss of appetite, may raise BP, may increase bleeding, may cause serotonin syndrome

what’s the following exemplifying:

•Selegiline (brand: Emsam)

•Isocarboxazid (brand: Marplan)

•Phenelzine (brand: Nardil)

•Tranylcypromine (brand: Parnate)

MAOIs

what are the side effects of MAOIs?

Dry mouth, Nausea, diarrhea or constipation, Headache, Drowsiness, Insomnia, Dizziness or lightheadedness, Skin reaction at the patch site, Involuntary muscle jerks, Low blood pressure, Reduced sexual desire or function, Weight gain, Difficulty starting a urine flow, Muscle cramps, Prickling or tingling sensation in the skin, no tyramine (aged foods = hypertensive crisis), wait 2 weeks before taking any other antidepressant

what are PQH2s (pathion healthcare questionaire 2)?

useful screening tools for depression (NOT diagnostic)

what do you NEED to teach your pt abt when taking tricyclics (TCAs)?

• orthostatic hypotension,

• anticholinergic effects,

• sedation,

• toxicity,

• increased suicide risk (toxic at low doses)

what do you NEED to teach your pt abt when taking selective serotonin reuptake inhibitors (SSRIs)?

• sexual side effects,

• insomnia or agitation,

• weight gain,

• serotonin syndrome (high fever, confusion, hyperreflexia, tremors),

• hyponatremia,

• sedation, rash