Depression

Major Depressive d/o Potential for pain and suffering in all aspects

of life Affects ALL ages May include: psychosis, catatonic symptoms,

and melancholy Dysthymia

Chronic Depression > 1year for children > 2 years for adults/ elderly

Premenstrual Dysphoric Depressed, anxious , moody Still being researched for data

Also to be considered: Seasonal affective disorder Postpartum depression

Depression may result from a complex interaction of causes, as evidences by high variability of: Symptoms Response to treatment and course of illness

Common Theories:-Biological-Psychosocial influences/ life events

CognitiveLearned helplessness

Tools Beck Depression Inventory Hamilton Depression Scale Geriatric Depression Scale Zung Depression Scale SAD Person’s Scale

National Mental Health Association http://www.depression-screening.org

Safety First Suicide Potential

Key Symptoms Depressed mood Anxiety Psychomotor agitation or retardation Somatic complaints Vegetative signs

Affect (sad, weeping)

Thought Processes (delusions, poor judgment)

Feelings (anger, anxiety, hopelessness)

Guilt (rumination over past failings)

Physical Behavior (lethargy, poor hygiene, posture )

Communication (slow speech, slow comprehnsion)

Transient “blues” tired, feel like your in a little slump

Mild Normal grief response, may cry, eating changes

Moderate dysthymic., a little hopeless, ?suicidal potential Losing interest in self, grooming, social etc

Severe Increased hopelessness, total despair, life

functioning affected, Suicidal? Homicidal?

Unrealistic expectations

Feelings originating from the client

Understanding of depression as a systemic illness with a complex interaction of causes

Risk for suicide

Hopelessness

Powerlessness

Disturbed thought process

Ineffective coping

Think – Pair- Share

Find a partner and come up with a one minute care plan ( ie outcome criteria/ interventions)

On you mark ..get set…go

(Prioritize your interventions)!!!

Sheila is a 35 year old IV therapist. She is grossly obese and has recently been suffering from shortness of breath on exertion. She has High BP, High Cholesterol and has noticed that a sore on her foot from a cut has not been healing. She has not been sleeping in her bed but on the couch so she can watch movies when she can’t sleep. She is tired, has a low tolerance for frustration, and feels constantly behind in all that she does.

She is divorced and is raising a teenage son. She just received an invitation to her high school reunion. She

Starts crying and con not stop all day. When her son gets home from school he calls an ambulance because his mother keeps talking about ending it all.

Client hx: she was head cheerleader in high school. She got married right out of school due to an unexpected pregnancy.

What are your priority assessments? Diagnosis? Why? Outcome Criteria for her that you would expect?

Remain safe Reports hope for the future Identifies precursors of depression Reports improved mood Plans strategies to reduce the effects of

precursors of depression

Did You get these as well???

Communication Counseling Encourage self care Therapeutic Milieu Health Teaching Medications Assess effects of Medications

Psychotherapy Cognitive Therapy Interpersonal Therapy

Social Skills Training Group Therapy

Classes of antidepressants First Line agents

Selective Serotonin Reuptake inhibitors (SSRIS) Heterocyclic antidepressants Tricyclic anti depressants (TCA)

Second line agents (interventions) Monoamine oxidase inhibitors (MAOIS) Electroconvulsive Therapy (ECT)

Block the reuptake of serotonin; thereby serotonin neurotransmission is enhanced

Indications: most widely used (Prozac, Celexa, Paxil, Zoloft)

Side Effects: Lower incidence of anticholinergic side effects than TCA’s

Adverse effects: agitation, sleep disturbance, Sexual dysfunction*

What does that mean? COMPLIANCE!!!

“Novel “ antidepressants (Wellbutrin/trazadone), They inhibit the reuptake of norepi/serotonin.

Neurotransmitters: Serotonin –norepinephrine reuptake inhibitors

(SNRI’s) ex. (Effexor/ Cymbalta) Selective norepinephrine reuptake inhibitors

(NRI’s) ex. (Vestra) Advantages Adverse Effects

Inhibit reuptake of norepinephrine and serotonin by increasing the amount of time that the neurotransmitters are available at the postsynaptic receptors

Examples: Pamelor, Tofranil, SinequanAdvantages

Adverse Effects Start low….go slow!!!! Contraindications (Cardiacs/ hx of

seizures/ pregnancy)

Neurotransmitter: increases norepi, tyramine, dopamine, serotonin in the system

This naturally raises the mood! Advantages: rare sedation, used for atypical

depression and panic d/o, OCD, PTSD Nardil, Parnate ( two most common) Adverse effects (Cardiac changes)

Avoid food with tyramine Drugs that interact with MAOI ( pg 349) Contraindications

Used when a rapid response is needed to prevent suicidal ideations, extreme agitation, poor response to a variety of meds.

Procedure Advantages Potential adverse reactions Article: Read ECT Article on Blackboard Also check out pg552 for pharmacology

chart

Integrative approaches for depression Light Therapy (First line treatment for SAD,

seasonal affective d/o) St John’s Wort ( herb) Exercise ( naturally increases mood)

Future of treatment Early screening for indicators Education for society Promotion of supplemental strategies by MD’s