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51 Cards in this Set

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What are the symptoms (5 or more) that indicate MDD (Major Depressive Disorder)?
* depressed mood most of the time
* Anhedonia (inability to find meaning or pleasure in existing)
* appetite or sleeping pattern change
* Anergia (lack of energy)
* Feelings of worthlessness
* Decreased concentration or indecisiveness
* suicidal ideation
What are the symptoms (2 or more) that indicate DD (Dysthymic Disorder)?
* Possible early onset
* Less severe than MDD
* Change in appetite or sleep pattern
*low energy/chronic fatigue
* decreased self esteem
* poor concentration or difficulty making decisions
* feelings of hopelessness or despair
What is the difference between MDD and DD?
* DD often has early and insidious onset
* The main difference between the two is the duration and severity of the symptoms
Primary Risk Factors for Depression
* history of prior episodes of depression
* family history
* history of suicide attempts or familial suicide
* female gender
* under 40 years of age
* postpartum period
* presence of medical illness
* absence of social support
* negative, stressful life events
* active alcohol or substance abuse
4 Common Theories of Depression
1. Biological Factors (genetic predisposition and biochemical abnormalities with serotonin and norepinephrine)
2. Psychodynamic influences (life events and stressors--early life trauma)
3. Beck's Cognitive Theory (depressed people process things negatively)
4. Martin Seligman's Theory of Learned Helplessness
3 parts to Beck's Cognitive Triad
Depressed persons process information in negative ways. 3 thoughts that are responsible for depression
1. negative view of self
2. pessimistic view of world
3. negative reinforcement will continue into future
3 parts to Beck's Cognitive Triad
Depressed persons process information in negative ways. 3 thoughts that are responsible for depression
1. negative view of self
2. pessimistic view of world
3. negative reinforcement will continue into future
What is MDD with psychotic features?
depression w delusions or hallucinations
What is MDD with postpartum onset
onset within 4 weeks following birth--risk of harm to infant
What is MDD with seasonal characteristics
episodes begin mostly in fall and winter
What is MDD with chronic features
lasting 2 years or longer
What is DD or MDD with atypical features
mood reactivity (cheered up with positive events) and rejection sensitivity that are always present and result in functional impairment; other symptoms may be: hypersomnia, hyperphagia (overeating), leaden paralysis (feeling weighed down by extremities)
What is double depression
Dysthmia is superimposed on MDD
What is mixed anxiety depression?
Significant distress or impairment in functioning--symptoms of anxiety disorder comorbid with depression
* symptoms of anxiety occur in an average of 70% of cases of major depression
What is recurrent brief depression?
Meets criteria for depressive episode, but lasting 1 day to 1 week--CARRIES high risk for suicide
What is premenstrual dysphoric disorder
More severe symptoms than PMS
What is minor depression?
Sustained depressed mood without full depressive syndrome--pessimistic attitude and self pity
What to include on a depression assessment
1.Assessment of Suicide Potential
2. Affect
3. Thought processes
4. Feelings
5. Physical Behavior
6. Communication
The goal of cognitive-behavioral therapy with major depression disorder is to...
Change the way clients think by assisting client in:
1. identifying and testing negative conditions
2. developing alternative thinking patterns
3. rehearsing new cognitive and behavioral responses
Describe the 3 phases in the treatment and recovery from major depression
1. ACUTE (6-12 weeks) reduction of symptoms and restoration of ADLs
2. CONTINUATION (4 - 9 mos.) prevention of relapse through pharmacology, education and psychotherapy
3. MAINTENANCE (1 or more years) prevention of further episodes of depression
Name the 3 first line psychopharmacological/somatic treatments for MMD
1. Selective Serotonin Reuptake Inhibitors (SSRIs)
2. New atypical antidepressants
3. Cyclic antidepressants (tricyclic antidepressants)
Name the 2 second line psychopharmacological/somatic treatments for MMD
1. Monoamine oxidase inhibitors (MAOIs)
2. Electroconvulsive therapy (ECT)
What does serotonin do in the body?
In the CNS, serotonin plays an important role in the regulation of anger, aggression, body temperature, mood, sleep, vomiting, sexuality, and appetite. Low levels of serotonin have been associated with several disorders, namely increase in aggressive and angry behaviors, clinical depression, Obsessive-compulsive disorder (OCD), migraine, irritable bowel syndrome, tinnitus, fibromyalgia, bipolar disorder, and anxiety disorders.
What do serotonin reuptake inhibitors do?
Increases the levels of serotonin in the body by preventing the reuptake process, leaving serotonin to act for an extended period at the synaptic binding sites in the brain.
What conditions are SSRIs used as the first-line therapy?
All types of depression EXCEPT 1)psychotic depression (ECT first choice), 2) melancholic depression and mild depression
What are the side effects of SSRIs
*N/V, weight gain
*insomnia, anxiety, decr. sex drive
*anticholinergic s/e: dry mouth, blurred vision, urinary retention
* serotonin syndrome (rare--client goes into shock)
Describe serotonin syndrome
Extremely high levels of serotonin can have toxic and potentially fatal effects, causing a condition known as serotonin syndrome. In practice, such toxic levels are essentially impossible to reach through an overdose of a single anti-depressant drug, but require a combination of serotonergic agents, such as an SSRI with an MAOI.
What important things to include in SSRI patient teaching
1. can take 1-4 weeks to take full effect
2. side effects (weight gain, sex drive, dry mouth, tremor, lethargy, etc)
3. serotonin syndrome
4. no alcohol & otc drugs
5. don't stop suddenly
Why are SSRIs the best first-line therapy?
less side effects so patients more likely to comply with medication regimen
What are the symptoms of serotonin syndrome?
abdominal pain, diarrhea, sweating, fever, tachycardia, hypertension,delirum, muscle spasms, cardiovascular shock
What are emergency interventions should be taken
1. remove offending agent
2. initiate symptomatic treatment (serotonin receptor blockade, cooling blankets, etc)
What do Tricyclic Antidepressants do?
Tricyclic Antidepressants inhibit the reuptake of norepinephrine and serotonin by the presnaptic neruons in the CNS (increasing the amount of time that they are available to the post synaptic receptors).
Nursing implications/ Teaching about tricyclic antidepressants should include
1. full effects may not be seen for 4 - 8 weeks
2. Low dosage given initially--increased slowly
3. s/e like anticholinergic drugs (dry mouth, blurred vision, tachycardia, constipation, urinary retention, postural hypotension)
3. urinary retention and severe constipation warrant immediate attention
4. Give at night
5. potential toxic side effects are cardiovascular
6. alcohol blocks effect of drug
7. do not double dose of missed doses
8. taper off
Drugs to use with caution when taking TCA
phenothiazines
barbiturates
MAOI
Antabuse
oral contraceptives
anticoagulents
antihypertensives
benzodiazepines
alcohol
nicotine
SSRIs to know
Celexa (Citalopram)
Lexiprol (Escitalopram)
Prozac (Fluoxetine)
Luvox (Flurioxamine)
Paxil (Proxetine)
Zoloft (Setaline)
Vestra (Reboxetine)
Tricyclics to know
Elavil (Amitriptyline)
Tofranil (Imipramine)
Sinequan (Doxepin)
What is Light Therapy?
*first line of defense for treatment of Seasonal Affective Disorder
*though to be effective b/c melatonin secreted shifts biological rhythms
*may also be effective as an adjunct for MDD
Name 4 Tricyclic Antidepressants (TCAs) (S.T.E.P.)
1.Sinequan
2.Tofranil
3.Elavil
4.Pamelor
Name 2 New Atypical Antidepressants
1.Wellbutrin
2.Desyrel
Name 2 MAOI Antidepressants (MAO inhibitors)
1.Nardil
2.Parnate
Name 5 Selective Serotonin Reuptake Inhibitors (SSRIs)
1.Prozac
2.Paxil
3.Celexa
4.Lexapro
5.Zoloft
Common adverse reactions to Monoamine Oxidase Inhibitors (MAOIs)
* Orthostatic Hypotension (most critical side effect)
* sedation, weakness, fatigue
* insomnia
* changes in cardic rhythm
* muscle cramps
* sexual dysfunction
* urinary hesitancy
* weight gain
Describe effects of MAOI toxicity
* life threatening hypertensive crisis
* severe headache, sore neck
* flushing, cold, clammy skin
* tachycardia, nosebleeds, dilated pupils, pyrexia
* nausea / vomiting
* chest pains, stroke, coma,death
Foods that shouldn't be ingested when on MAOIs
FOODS high in tyramine:
1) cheeses
2) processed meats
3) avocados, figs, bananas, soybeans
4) wine, beer, soups
5) chocolate, caffeine, fava beans and ginseng
Antidote for MAOI (tyramine) toxicity
treat the symptoms with antihypertensive drugs and hypothermic blankets
Drugs that interact with MAOIs
*otc drugs for colds, allergies, or congestion
*TCAs
*narcotics
*antihypertensives
*sedatives (alcohol, barbituates, benzos)
*stimulants (cocaine, amphetimines)
*general anesthetics
*amine precursors
Name 4 Newer Atypical (Novel) Antidepressants
1. Wellbutrin: blocks noreinephrine & dopamine reuptake
2. Trazodone: selective but moderate blockage of serotonin (used in conjunction with other drugs)
3. Effexor: blocks reuptake of serotonin, norepinephrine and dopamine
4. Vestra: selective norepinephrine reuptake inhibitor
Describe Wellbutrin
* blocks norepinephrine and dopamine uptake
* may help: ADHD, chronic fatigue syndrome, rapid cycling bipolar 2, sexual side effects from other drugs, selective anxiety disorders, nicotine addiction
++ sexual dysfunction rare, no weight gain
--seizure risk in high risk individuals
Describe Trazodone (Desyrel)
* selective but moderate blockage of serotonin
*may help elderly clients and those with SSRI induced insomnia
++can aid sleep, no anticholinergic effects, low risk of cardiac effects
--postural hypotension, weight gain, memory dysfunction, possible priapism
Describe Effexor
* Serotonine and norepinephrine inhibitor
*may help those with chronic, treatment-resistant depression, bipolar depression, depression with ADHD, anxiety, geriatric depression
++low potential for drug interaction
--possible increase in blood pressure, possible somnolence, dry mouth and dizziness
Describe Vestra
**Selective norepinephrine reuptake inhibitor
* May help lethargy and cognitive difficulties s/t depression
* Impaired social functioning
* Anxiety attacks
++anticataleptic effects (used to counter catatonic states), non sedating
--anticholinergic, decreased libido, potential for drug interactions