Depression
Mood disorders
 Unipolar

Depressive Disorders
○
Major Depressive Disorder

Single or Recurrent
○
Dysthymic Disorder
○
Depressive Disorder NOS
 Bipolar

Manic-depressive disorders
○
Bipolar I
○
Bipolar II
○
Cyclothymic Disorder
○
Bipolar Disorder NOS
Major Depressive Disorder—
DSM-IV Diagnosis
 One or more episodes
 Depressed mood OR Anhedonia
4 of 7 additional symptoms
 Disruption in sleep
 Appetite (or weight)
 Concentration
 Energy
 Psychomotor agitation OR retardation
 Excessive guilt or feelings of worthlessness
 Suicidal ideation
Epidemiology
 Mean age of onset—40 years old
 Within 1 year—7% (11 million) of Americans will experience a mood disorder
 40% comorbid with other psychiatric illnesses/substance-related disorders
 Associated with medical conditions
 25% of pts have chronic, recurrent depression
 1 episode puts you at risk for another
Risk Factors
 Prior episode of depression/suicide attempt
 Family history of depressive disorder/suicide
 Lack of social support
 Lack of coping abilities
 Presence of life and environmental stressors
 Current substance use and/or abuse
 Medical comorbidity
 History sexual abuse
Etiology
 Genetics

Common among first-degree biologic relatives
 Neurobiologic Hypotheses
 Neuroendocrine & Neuropeptide Hypotheses
 Cognitive Theory
Assessment
 Key element is change in behavior
 Most common behavior is depressed mood
 Screening Tools

Beck Depression Inventory

Geriatric Depression Scale
 Mood

Depressed

Anxiety
 Physical Changes

Anergia

Psychomotor retardation
 Cognition

Slow to process
ALWAYS assess for Suicidal Ideations!!!!!!!!!!
Nursing Diagnoses?
Goals
 Short term:

Eliminate symptoms
 Long term:

Lifting of the depressed mood

Continuation-prevent relapse
Interventions
 Evidence-based practice recommends antidepressants plus therapies
 Environmental: safety
 Nurse-Pt relationship
 Socialization
 Cognitive Interventions
 Help increase sense of control, self-esteem and modify dysfunctional thinking
 “self-fulfilling prophecy”-victim thinking
 Explore feelings, define problem, modify thinking
 Negative thinking
 Behavioral Interventions
 Find an activity the pt can be successful at
 Praise genuine effort
 Physical exercise
ECT
 Grand mal seizure artificially induced. Pt is sedated, treatments usually 6-12, 2-3x/week, response
rate of 80%, usually tried after pharmacotherapy fails, safe for pregnancy.
 Adverse Effects-headaches, memory difficulties, muscle soreness.
Interventions—Pharmacologic
 Antidepressants

SSRIs

TCAs

MAOIs

others
Antidepressants
 SSRI’s

Second-generation drugs

Newer, more expensive

Much less side effects

Safer in overdose

Side effects: GI, sexual dysfunction, weight gain (some)

Serotonin Syndrome
 Tricyclic antidepressants

First-generation drugs

Efficacy established

Less expensive

Side effects: antihistaminic, anticholinergic, orthostasis, cardiac

Take at bedtime to minimize side effects

SE should subside after a few weeks

Lethal in overdose!
 Monoamine Oxidase Inhibitors (MAOIs)

First-generation drugs

not used much d/t side effects

May precipitate hypertensive crisis

Food Cautions
 Others

Serzone, Effexor, Wellbutrin, Trazodone

Trazodone-mostly for insomnia

Wellbutrin-marketed as Zyban for smoking cessation, potential for seizures

Different side effect profiles, still less than TCA’s
Complementary and Alternative Therapies
 For Depression:

St. John’s Wort

Melatonin

Omega 3 fatty acids

Acupuncture

Massage

Exercise

Meditation

Yoga

Phototherapy
Other Types of Depression
 Major Depression

Postpartum depression

Seasonal Affective Disorder (SAD)
Dysthymic Disorder—
DSM-IV Diagnosis
 Depressed mood for most days for at least 2 years
 2 or more of following symptoms

Poor appetite or overeating

Insomnia or oversleeping

Low energy or fatigue

Low self-esteem

Poor concentration or difficulty making decisions

Feelings of hopelessness
Suicide
 Epidemiology

1 person every 17 minutes commits suicide in United States

80 suicides a day in United States

1000 suicides a day worldwide
Risk Factors
 Gender
 Age
 Psychiatric Dx-Mood D/O, Substance Abuse, Schizophrenia, Anxiety D/O
 ETOH associated with 25-50%
 Lack of social support
 Family hx of suicide
 Loss
Assessment
 “Have you thought about killing yourself?”
 “Do you have a plan?”
 Are the means to carry out this plan available to the pt?
 Assess plan for lethality
 Contract for safety
 Elopement risk
 Attempt history
Goal
 Pt will not harm self.
Interventions
 Safety: 1:1, close observation, 15 minute checks
 Remove objects such as belts and shoelaces, mirrors, etc.
 Contracting
 Monitor medications
Resources
 www.depression-screening.org

Confidential screening tool
 www.nami.org

National Alliance for the Mentally Ill
 www.med.nyu.edu/psych/screens/depres.html

Short assessment