Depressive Disorders

Depressive criteria

Depressed mood

Anhedonia: diminished interest

weight loss/gain

Insomnia or hypersomnia

psychomotor agitation or retardation

fatigue or loss of energy

feelings of worthlessness

dec concentration

recurrent thoughts of death

Atypical Depression

Characterized by mood reactivity, and symptoms that typically do not appear in MDD (INC appetite, hypersomnia, leaden paralysis, severe rejection sensitivity.

Anxious Depression

anxious distress during the majority of days.

Depressive episode characterized by at least 2 of the following

• feeling keyed up

• tense

• unusually restless

• diffuclty concentrating due to worry

• fear that someting bad will happen

• loss of self-control.

Mixed depression

manic features present but doesnt meet crtieria for bipolar disordr.

Persistent Depressive Disorder

Low-level depressive feelings for most days

• 2 years in adults

• at least 1 year in children & adolescents

Must have 2 or more of the following

• decreased appetite or overeating, insomnia or hypersomnia

• Low energy, poor self-esteem

• difficulty thinking, & hopelessness

Disruptive Mood

Dysregulations Disorder

constant & severe irritability

temper tantrums w verbal & behavioral outburst

trouble functioning in more than one setting (school, home, with peers)

SSRI- 1st line tx

[ sertraline, fluoxetine, duloxetine, escitalopram

s/e

• sweating, agitation, changes in appetite, HA, sexual dysfunction, tremor

• abrupt discotiuation can cause withdrawal symptoms- needs to be tapered off

• Assess for seritonin syndrome

seritonin syndrome s/s & ssri teaching w MAOI

• fever

• tachy, HTN

• abd pain

• diarrhea

• agitation

• hyperreflexia

• Discontinue SSRI for at least 2-5 weeks before starting MAOI

• if given together can cause ADVERSE EFFECT!

• cardiac shock, VERY HIGH FEVER, death

TEACH

• dont take St. john’s wart

TCA’s indications, s/s, monitor

• indicated for MDD

• s/e: lethargy, weight gain, hypotension, tachycardia, dry mouth, blurred vision, constipation, urinary retention.

MOST HAZARDOUS EFFECT IS

• CARDIAC TOXICITY, lethal in overdose

MAOI

indications

s/e

teaching

• rarely used, only indicated when depression hasn’t responded to any other tx, like SSRI, TCA’s

• indicated→ treatment-resistant MDD, bipolar depression, panic disorder or mixed anxiety-depression

• also for ppl w bipolar depression

MAOI- patient education

avoid___

report s/s

TEACH

• avoid tyramine

  • red wine, smoked meats, cheeses, MSG, beef & chicken liver

REPORT s/s of HTN crisis

• → Severe HA, INC bp, intracranial hemorrhage, convulsions, coma, death

Non-pharmacological tx

• CBT

• psychotherapy

• ECT

• TMS

ECT teaching & pre-post prep

• signed consent

• take meds

• IV & NPO

• VOID BEFORE

• check HR

POST

• check HR

• reorient patient- may cause confusion, temp memory loss & disorientation

Tx

• 6-12 treatments, given 3x week

S/E

• HA, nausea, confusion, disorientation, muscle soreness, memory loss