depression

depression (MDD)

-loss of interest in usual activities for a period of a least 2 weeks

-sadness, hopelessness, irritability, somatic, sleep disturbances, changes in appetite, poor concentration, low energy

**anhedonia

treatment of MDD

SSRI's, TCAs, atypical antidepressants, CBT, ECT

persistent depressive disorder (dysthymic disorder)

-less severe

-last beyond 2 years with relief periods shorter than 2 months

-treated like MDD + CBT or ECT

learned helplessness

-cognitive theory (skewed core view of self/ environment/ future)

-negative life views

-sociocultural theory (stressors)

risk factors of depression

-fam history

-female

-Hx of child abuse/ trauma

-unemployment

-poverty

-low education

-lack of social supports

-bullying

primary prevention & examples

-preventing illness before it happens

-diet, exercise, sleep, avoid smoking

-stress management & healthy coping

-encourage meaningful social relationships

secondary prevention & examples

-screening! (early ID)

-counseling about risks for depression, referring individuals with suspected depression for diagnosis and treatment

tertiary prevention

-stopping spread or worsening

-collaborative care & establishment of community focused programs that target high-risk individuals

depression vs. grief

-grief= emptiness, still have self worth, still can experience positive feelings, subsides over time

-depression= hopelessness, need clinical interventions to improve, comes with triggers, loss of pleasure and self worth

diagnostic testing for depression

-complete exam **rule out thyroid disease, can mimic

-evaluate existing medical conditions for side effects/ contraindication

patient education for SSRIs

-4 weeks

-no alcohol

-seratonin syndrome!

atypical antidepressants **look at med sheet

-buproprion

-nefazodone

-trazodone

(depression SAD, smoking cessation)

-increase risk of seizures **hold bupropion for alcohol withdrawal

-increased risk of suicidal thoughts

-heptatoxicity

-no for pediatric patients!

bupropion

-inhibits update of dopamine & norepinephrine

-also used for smoking cessation

-lowers seizure threshold

SO

****hold for alcohol withdrawal

nursing interventions for atypical antidepressants (6)

-w food

-weigh client weekly

-monitor for other meds that promote seizure activity

-monitor for psychosis, hallucinations, delirium & CNS effects

-monitor for suicidal thoughts/ behaviors

-monitor heptatoxicty

administration of atypical antidepressants

-tablets, sustained release & extended release

-ensure client swallows extended and sustained release tablets whole

-give w food if GI upset occurs

SNRIs

-avoid alcohol

-avoid MAOIs 14 days before starting

-liver function

-cardiac stuff (baseline sodium, monitor BP)

TCAs

-amtriptyline

-imipramine

-doxepin

-notriplyine

-desipramine

-can take 10-14 days, effects may not be seen until 4-8 weeks

-depression & depressive episode of BPD

adverse reactions of TCAs

-drowsiness/ sedation

-orthostatic hypotension

-anticholinergic effects

-increased risk for suicide

-withdrawal manifestations w/ abrupt cessation

-high risk for OD

OD of TCAs

-prepare for gastric lavage and administer sodium bicarb for dysthymias

considerations for TCAs

**monitor BP and HR for orthostatic changes (hold and notify)

**can cause anticholinergic effects

-obtain baseline EKG(contraindicated for patients in recovery for MI)

-lowers seizure threshold (monitor pts. with epilepsy)

-long term! don't stop abruptly, taper over 2 weeks to prevent withdrawal

**only give enough for 1 week supply

anticholinergic effects & interventions

-dry mouth

-urinary retention

-constipation

-blurred vision

-photophobia

NI: increase fluids, more fiber, sugarless gum, sunglasses

TCAs administration

-orally at bedtime

MAOIs

-phenelzine isocarboxazid, trancylpromine, selegiline

**(depression that has not responded to other classes, depression in BPD)

**if this doesn't work, ECT

considerations for MAOIs (5)

-interact & lots of side effects

-***tyramine can cause high BP or hypertensive crisis

-takes 2-4 weeks to work

**in combo with SSRI and SNRIs can cause serotonin syndrome

-suicidal ideation in children and young adults

-titrate down

if hypertensive crisis occurs with MAOIs

-IV phentolamine or sublingual nifedipine

tyramine rich foods

**MAOIs (also for 2 weeks after discontinuing)

-aged cheese, pepperoni, salami, avocados, figs, smoked fish, beer and wine

psychotherapy

lifespan children and adolescents

age group symptoms of depression

toddlers- regressive

preschoolers- self destructive play themes

school age- decrease academic performance, increase/ decrease physical activity, somatic complaints, loss of friends

adolescent- decreased social, poor school performance, poor self care, difficulties w parents/ teachers ,focus on violence

depression older adults

-NOT a normal part of aging

-loss of driving

-rule of hypoglycemia

**lower starting doses bc they metabolize and excrete drugs at slower rates than younger adults

manifestations: memory problems, social withdrawal, sleep disturbances, loss of appetite, irritability

nursing process

**safety is biggest thing, risk of suicide always considered

-patients may not meet daily hygiene needs/ nutrition

observation & patient interview depression

-saddness, anhedonia

-tearful, emotional outbursts

-impaired concentration, difficulty making decisions, poor memory, impaired problem solving

-ask about past depressive/ manic/ hypomanic episodes

-family hx

physical exam for depression

-somatic concerns often presenting complain

-fatigue, sleep disturbances, changes in appetite/ weight

-abdominal pain, headache, body aches

-lack of sexual desire

-constipation (slowing metabolism due to inactivity)

-physical issues= exacerbated when depression is present

assess for comorbidities

-medical illness --> contributing factor (chronic illness)

-metabolic, endocrine, oncologic, autoimmune

-substance use can complicate depression

-assess prescription and OTC meds to see if depression is side effect

priority problems

-risk of suicide/ self harm

-situational or chronic low self-esteem

-helplessness

-social isolation

-inadequate health maintenance

-inadequate coping

implementation

-make something appropriate for cognitive and physical state

-promote activities for patient success

-general positive observations, NO overly energetic compliments

-teach assertiveness

-instill hope, decision making fosters independence, reframe! ID positive supports