Affective Disorders-Depression

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What is a mood disorder?

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-a condition whereby the current emotional mood is distorted or inappropriate to the circumstances
-they can be severe and prolonged
-affect occupational and interpersonal functioning

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Depression is...

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Unhappiness that is pathologically intense and interferes with daily functioning

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Depression can be caused by

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1.Death in the family
2.Separation and divorce
3.Physical illness
(chronic or terminal)

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Statistics about depression to be familiar with

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1.#1 mental health problem in US
2.Most common psychiatric illness in the elderly
3.25% of population will experience in their life
4.About 121 million people
5.Women are treated more often than men
6.15% will choose suicide
7.Common in history-famous people suffer from it
8.Occurs at all ages

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Anaclitic Depression

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-Usually occurs in children who became depressed after being separated from their mothers for a period of three months or longer during the second six months of life
-response to lack of warmth from another person (apathy)

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Adolescents differ from adults in regards to depression because they have 2 diffuse symptoms..

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1.sexual promiscuity
2.dropping out of school

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Etiologies of Depression

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1.Loss triggers depression
2.Aggression (depression is anger turned inward)
*Believed to be related to a combination of etiological factors (dynamic causation)

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Cognitive Theory for Depression

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-Ellis & Beck (irrational belief theory)
-depression results from irrational/illogical thinking (ie:neg. view of self and others)

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Biological Theories of Depression

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1.Biochemical: results from deficit of neurotransmitters (norepinephrine and serotonin)
2.Biophysical: secondary to meds (hormones, etc); decreased thryoid level; related to diet (vitamins and minerals)

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Psychosocial Theories of Depression

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Learned helplessness: Stress and anxiety
depression is a learned behavior

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Genetic Theories of Depression

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1.Heredity
2.Twin Studies (72% identical twins, fraternal twins 14%)
3.Limited studies show a genetic marker

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Dysthymic Disorder

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-chronic depression or loss of interest in most usual activities
-doesn't interfere with daily functioning

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Characteristics of Dysthymic Disorder

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1.mild-moderate depression
2.occurs most days, never absent for more than 2 months
3.similar to "normal" behavior
4.no mania present
5.little social/occupational impairment
6.onset-early teens & later life
7.could develop major depressive episodes
8.lifelong struggle

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Maladaptive Behaviors used with Dysthymic Disorder

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-gambling
-criminal behavior
-promiscuity
-unwanted pregnancy
-overwork
-increased spending
-increased sexual behavior
-religious obsession
-often turns to substance abuse to battle despair feelings

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Major Depressive Disorder Characteristics

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-may be psychotic
50% will have another episode
-dx twice as much in women

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Major depression can be described as

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1.agitated-psychomotor agitation-increased activity
2.retarded-slowed down activity
3.endogenous-caused by internal factors
4.exogenous/reactive-caused by external factors

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Nursing Process Assessment for Major Depression

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Anhedonia: inability to find pleasure in anything
Affect: poor posture, look older, sad, dejected, crying often
Thought Process:
1.highest priority suicidal thoughts!
2.decreased problem solving and clear thinking
3.poor judgment
4.indecisive
5.slower thinking
6.decreased memory
7.ruminate about problems
8.limited thought/verbal content
9.delusions
10.feelings of failure
11.no chance of improvement
12.think in absolute terms
13.resist change

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Nursing Process Assessment (cont)

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Assess intellectual processes
1.Perception
2.Consciousness
3.Orientation
4.Insight
Assess Feelings
1.60-70% have anxiety
2.worthlessness
3.guilt
4.helplessness
5.hopelessness
6.anger
Assess Physiologic Activity
1.altered sleep patterns
2.change in appetite
3.weight change
4.constipation
5.menstrual irregularities
6.decreased sexual desire
7.impotence
8.fatigue
9.lethargy

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Nursing Process Assessment
(cont)

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Assessing psychomotor activity
1.agitation
2.retardation
Assessing Grooming
1.dress and hygiene
2.look disheveled
Assessing Vegetative signs
-change in: bowel patterns, eating patterns, sleep patterns

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Masked Depression

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depends on:
-culture, age & gender, hereditary, socioeconomic background

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Masked depression in adults signs and symptoms

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-somatic complaints
-compulsive gambling, work, eating
-accident prone
-risk-takking lifestyle
substance abuse

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Nursing Diagnosis/Goals for depression

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*Risk for suicide
Physical Needs: sleep, nutrition
altered thought process
disturbances in self-esteem
spiritual distress
impaired social interactions
ineffective ind. coping

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Treatments-Medications for Depression

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-Tricyclics
-2nd Generation Antidepressants
-SSRI
-SSNRI
-MAOI

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Tricyclics

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-TCA's
inhibit reuptake of norepinephrine and serotonin
70% respond favorably
IE: imipramine, amitriptyline

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Antidepressants

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advantage over TCA's-fewer side effects, especially cardiac and anticholenergic
IE: trazodone, bupropion

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SSRI

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prevents reuptake of serotonin only
there are many different receptors
IE: fluoxetine, sertraline, cital, paroxetine

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SSNRI

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blocks reuptake of serotoning and norepinephrine
IE: duloxetine, mirtazapine

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Side Effects of most antidepressants

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sedation
arrythmias

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MAOI

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inhibit MAO from degrading serotonin and norepinephrine that have been retaken up
*use when other drugs are ineffective
IE: phenelzine, tranylcpromine
-orthostatic hypotension, wgt. gain, cardiac changes

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ECT

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only indicated in severe vegetative depression non responsive to other treatment

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Transcranial Magnetic Stimulation

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-use of short pulses of magnetic energy to stimulate nerve cells
-aimed at front left of brain
-alters brain chemistry
-treatment schedule: 10-30 treatments in 2-6 weeks
-SE: mild headaches

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Vagus Nerve

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-VNS
-device is implanted in left chest, wires to left vagus nerve
-correction of chemical imbalance in the brain
-SE: hoarseness, sore throat
*not approved by FDA for use in trating depression and epilepsy

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Magnetic Stimulation Therapy

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-very new
-in experimental stage
-no data to support
-induces a seizure, similar to ECT

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Types of psychotherapy

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individual
group
family
*all effective if used concurrently with anti-depressants

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Cognitive Psychotherapy

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uses specific cognitive interactions to alter negative thoughts

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Behavioral Psychotherapy

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teach more effective coping skills that increase

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Cognitive Behavioral Therapy

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cognitive restructuring problem-solving skills

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CBT

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combines behavioral and cognitive

behavioral: weaken connections between problems situations and habitual reactions

cognitive: change negative thoughts to regain control over thoughts