Care of a Patient with Depressive Disorder

Depressive Disorder

100

Classification of depression

define transient

subsides quickly, everyday disappointments

200

Classification of depression

define mild

normal grief response, short term

300

Classification of depression

define moderate

prolonged, chronic in nature

400

Classification of depression

define severe

despair, shutdown, flat affect

500

Major Depressive Disorder:

characteristics

depressed mood (worse in early a.m.), loss of interest/pleasure, exists for at least 2 weeks, no mania history, impaired functioning (social and occupational), no drugs or medical problems causing it, not due to normal bereavement 

Depressive Disorder

100

Major Depressive Disorder:

types

single or recurrent, mild, moderate, or severe, w/ psychotic/catatonic/melancholic features, seasonal pattern, postpartum onset

200

Persistent Depressive (dysthymic) Disorder:

cahracteristics

chronically depressed mood, but milder than MDD, most days, most months, for at least 2 years, "down in the dumps", overly sensitive, anxiety, low self-esteem, guilt, feel better in the a.m.

300

Persistent Depressive (dysthymic) Disorder:

types

early onset (<21) and late onset (>21), mild, moderate, severe

400

Medical plan of care for depression:

diagnosis

physical exam, examination of sleep patterns, drug screens, chem profile, thyroid studies, mental health assessment

500

Medical Management:

Antidepressants:

MAO inhibitors (MAOI) - side effects

isocarboxazide, phenelzine sulfate, tranylcypromine

side effects: dizziness, syncope, nausea, constipation, insomnia, sexual dysfunction, orthostatic hypotension, seizures

Depressive Disorder

100

Medical Management:

Antidepressants:

MAO inhibitors (MAOI) - interactions

foods with tyramine (aged cheeses, red wine, smoked/processed meats), SSRIs, cold/cough medications

**stop use 14 days before starting new antidepressants**

200

Medical Management:

Antidepressants:

Tricyclics (TCAs) - side effects

amitripyline, desipramine, clomipramine, doxepin, imipramine, nortriptyline, amoxapine

side effects: anorexia, dry mouth, blurred vision, altered BG, headache, constipation, urinary retention, weight gain, drowsiness, fatigue, insomnia, sexual dysfunction, gynecomastia

300

Medical Management:

Antidepressants:

Tricyclics (TCAs) - medical reactions

seizures, orthostatic hypotension, blood dyscrasias, dysrrhythmias, EPS symptoms

400

Medical Management:

Antidepressants:

Selective Serotonin Reuptake Inhibitors (SSRIs) - side effects

fluoxetine, citalopram, paroxetine, sertraline, escitalopram, fluvoxamine

side effects: nausea, dizziness, drowsiness, diarrhea, headache, weight gain/loss, sexual dysfunction

500

Medical Management:

Antidepressants:

Atypical Antidepressants - side effects

mirtazapine, trazodone, bupropion, aripiprazole, oleptrol

side effects: dry mouth, nausea, constipation, dizziness, drowsiness, headache, sweating, insomnia, tremors, sexual dysfunction

Depressive Disorder

100

Medical Management:

Antidepressants:

Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) - side effects

venlafexine, zodone, duloxetine

side effects: dry mouth, nausea, constipation, dizziness, drowsiness, headache, sweating, insomnia, tremors, sexual dysfunction

200

Medical Management:

Antidepressants:

Nurses consideration

cultural and aging considerations, assess for effectiveness and side effects, patient education (up to 4 weeks to be effective, do not stop abruptly, side effect management, talk to dr before starting new meds), safety (increase suicide risk, neuroleptic malignant syndrome, serotonin syndrome)

300

Medical Management:

Antidepressants:

Neuroleptic malignant syndrome - s/sx

muscle rigidity, high fever, diaphoresis, tachycardia, BP changes, coma

400

Medical Management:

Antidepressants:

Serotonin syndrome - s/sx

diarrhea, agitation, hyperthermia, muscle rigidity, seizures, cardiovascular collapse, death

500

Medical Management:

Electroconvulsive Therapy (ECT) - who's it used on and for how long?

severely depressed, suicidal, psychotic symptoms

6-12 sessions

Depressive Disorder

100

Medical Management:

Transcranial magnetic stimulation (TMS) - more or less effective than ECT, and for how long?

may be less effective than ECT

12-30 sessions

200

Medical Management:

Alternative therapies:

st. john's wort, vitamin B12, omega-3 fatty acids, exercise and yoga, animal therapy

300

Nursing Process:

Planning and Goals

Priority is to prevent self harm, assist to express grief, increase self-worth

400

Nursing Process:

Specific Interventions - Assist in meeting basic needs (examples)

be patient and don't rush them, avoid over-cheerfulness, simple demonstration or assistance as needed, monitor nutrition intake and elimination, measures to assist with sleep, need simple and structured schedule

500

Nursing Process:

Specific Interventions - Communication enhancement (examples)

listen and observe (accepting), brief, frequent contracts, offer self, one topic at a time (focusing), low key, keep all promises, simple choices, positive reinforcements