Mood Disorders - Depression Pharmocological Therapy + Suicide

what is the black box warning for SSRIs

children, adolescents, and young adults may experience increased suicidal ideation

why is it important for the elderly to start low and go slow with psychopharm meds

they metabolize medications slower and you don't know how they'll react

in people 45+ what is important to remember if they are using pharmacological therapy

increased cerebral microbleeds

MAOIs inhibit the break down of:

NE, 5HT, DA, and tyramine

what are some common SE of MAOIs

- muscle cramps

- weight gain

- fatigue and sedation

- sexual dysfunction

- anticholinergic effects

- drug interactions

- *serious food/drug interactions with tyramine

what are two MAOIs

phenelzine and tranylcypromine

why do TCAs have a lot of noncompliance issues

due to their anticholinergic effects

how long do TCAs take to reach their max effect

4-8 weeks

TCAs are dangerous because they have the

potential for lethal OD

what are the two TCAs to know

amitriptyline and nortriptyline

what is the first line of defense for pharmacological therapy for depression

SSRIs

what is one of the potential problems associated with SSRIs

serotonin syndrome

what are the three SSRIs to know

fluoxetine, paroetine, escitalopram

what are SSRI SE

- tremors

- N/D

- HA

- insomnia/drowsiness

- sexual dysfunction

- bruxism

- anxiety/agitation

- hyponatremia

what are the SE of serotonin syndrome

S: shivering

H: hyperreflexia

I: increased temp

V: VS changes

E: encephalopathy

R: restlessness

S: sweating

what are the emergency measures for serotonin syndrome

- d/c med

- muscle relaxants > benzos/dantrolene

- serotonin blocking agents > cyproheptadine

- O2 and IVF

- drugs for HR and BP

- phenylephrine/epinephrine for hypotension

- cooling blankets for fever

- intubation PRN

what are some SNRIs

venlafaxine and duloxetine

what do SNRIs do

selective NE reuptake inhibitors

what are SNRIs commonly used for

depression and chronic pain

what are some common SE of SNRIs

nausea, dry mouth, constipation

what is a priority for someone on SNRIs

monitor BP

what are three atypical antidepressants and what are things to watch out for

- bupropion: decreases seizure threshold

- mirtazapine: causes weight gain and sedation

- trazadone: drowsiness, dizziness

what drug is used for treatment resistant depression, especially for suicidal patients

ketamine

what is electroconvulsive therapy (ECT) used for

psychosis, schizophrenia, catatonia, vegetative state, marked agitation

is ECT safe during pregnancy

yes

what are vegetative symptoms

physical S/S of depression: sleep problems, appetite/weight changes, fatigue/low energy, loss of interest or pleasure

what is light therapy, what does it do

influences melatonin, exposed to light source 30-60 minutes daily

who is St John's Wort not approved for

those who have MDD, pregnant women, children

suicide rates among american indian/alaskan natives from ages 15-24 is ________x the national average

1.5

are men or women more likely to attempt suicide, who is more successful

women more likely to try

men more likely to succeed

____________ students in grades 9-12 have a significantly higher suicide attempt than others

hispanic

what are some older adult risk factors of suicide

- social isolation

- living alone

- widowhood

- lack of financial resources

- poor health

- feelings of hopelessess

what are three neurobiological factors of suicide

low levels 5HT, chronically overactive fight or flight response, overactive HPA axis

what are some protective factors regarding suicide

- resilience

- social and problem solving skills

- connection

- social support

- willingness to participate in mental health care

- access to mental health care

what is an overt verbal cue

direct statements that clearly indicate suicidal thoughts or intent

what is a covert verbal cue

indirect or hidden hints that suggest suicidal thoughts

what does SAD PERSONS stand for

S: male Sex

A: age (<19 or >45)

D: depression or hopelessness

P: pervious suicide attempts/psychiatric care

E: excessive alcohol/drug use

R: rational thinking loss

S: separated, widowed, divorced

O: organized plan or serious attempt

N: no social support

S: stated future intent

with the SAD PERSONS scale >___ requires hospitalization

8

if someone requires a 1:1 this means they need

continual observation at arms length for actively suicidal patients

what is a common observation time

q15 min

what are some interventions of poisoning

- try to ID toxin if possible

- prevent further absoprtion > activated charcoal

- antidotes

- acetaminophen: acetylcysteine

- benzos

- opioids

define postvention

support provided after a suicide (attempt or death) - for family, friends, community affected by suicide

what are the 5 stages of grief

- denial

- anger

- bargaining

- depression

- acceptance

what will the medical team go over after a suicide

- overlooked clues

- poor judgement

- need changes to protocol?

- legal counsel

- ensure all documentation complete and accurate

what are the three things you always assess in a suicidal pt

plan, means, intent

why are men more successful when attempting suicide

choose more lethal means