Mood Disorders
Mood Disorders
• Depression is the oldest and most frequently
described psychiatric illness.
• Transient symptoms are normal, healthy
responses to everyday disappointments in life.
• Pathological depression occurs when
adaptation is ineffective.
Types of Mood Disorders
• Depressive Disorders
• Bipolar Disorders
• Others
Depressive Disorders
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Major Depressive Disorder
Dysthymic Disorder
Premenstrual Dysphoric Disorder
Bipolar Disorders
Other Mood Disorders
• Mood disorder due to a general medical condition
• Substance-induced mood disorder
Bipolar Disorders
• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder
Depression: Predisposing Factors
• Biological theories
– Genetics:
– Biochemical influences:
Neuroendocrine theories
Physiological influences
– Psychoanalytical theory
• Mourning
• Melancholia
Learning theory
Object loss
Cognitive theory
Depression: Developmental
Implications
Childhood Depression
• Symptoms:
Adolescence
• Symptoms include:
• Senescence
Treatment
• Postpartum Depression Treatment
Assessment
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Transient depression
Mild depression
Moderate depression
Severe depression
Nursing Diagnosis
Outcome
Planning/Implementation
Client/Family Education
Evaluation
Treatment Modalities
Antidepressants
Newer-generation antidepressants
– Selective serotonin reuptake inhibitors (SSRIs)
– Second- and third-generation antidepressants
• Tricyclic antidepressants
• Monoamine oxidase inhibitors (MAOIs)
Contraindications/precautions
• Contraindications/precautions
– Contraindicated in known hypersensitivity (SSRIs,
MAOIs, tricyclics); acute phase of recovery from
myocardial infarction; angle-closure glaucoma
(tricyclics); and concomitant with MAOIs (SSRIs
and tricyclics).
– Caution with elderly or debilitated clients; clients
with hepatic, cardiac, or renal insufficiency;
psychotic clients; clients with benign prostatic
hypertrophy; and those with history of seizures
(tricyclics, MAOIs).
Antidepressants- SSRI
• Generic
Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram
Fluvoxamine
• Brand
Prozac
Paxil
Zoloft
Celexa
Lexapro
Luvox
Serotonin Syndrome
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Delirium
Agitation
Tachycardia
Sweating
Hyperreflexia
Muscle spasms
Shivering
Coarse tremors
More severe cases
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Hyperthermia
Seizures
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Renal failure
Rhabdomyolysis
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Dysrhythmias DIC
Antidepressants
• Generic
Bupropion
Mirtzapine
Venlafaxine
Duloxetine
Amitriptyline
Imipramine
Phenelzine
Selegiline
• Brand
Wellbutrin
Remeron
Effexor
Cymbalta
Elavil
Tofranil
Nardil
Emsam
Monoamine Oxidase Inhibitor
• Nardil
• Parnate
• Marplan
• Selegiline*
*Available in a patch form called EMSAM
Hypertensive Crisis and Tyramine
Bipolar Disorder (Mania)
Assessment
Stage I—Hypomania
Stage II—Acute mania
Stage III—Delirious mania
Bipolar Disorder (Mania)
Childhood and Adolescence
• Lifetime prevalence of pediatric and
adolescent bipolar disorders is estimated at
about 1 percent
• Diagnosis is difficult
• Guidelines for diagnosis and treatment have
been developed by the Child and Adolescent
Bipolar Foundation (CABF)
Nursing Diagnosis
Outcomes
Planning/Implementation
Client/Family Education
Evaluation
Psychopharmacology/Mood Stabilzers
• Generic
Lithum
Valproic acid
Carbamazepine
Oxcarbazepine
Lamotrigine
Topiramate
• Brand
Eskalith, Lithobid
Depakote, Depakene
Tegretol, Equetro
Trileptal
Lamictal
Topamax
Planning/Implementation
• Blood levels are needed
for Lithium (0.41.2mEg/ml)
Depakote (4-12 mEg/ml)
Tegretol (4-12 meg/ml)
• Monitor for side effects of
lithium
– Drowsiness, dizziness,
headache
– Dry mouth; thirst; GI upset;
nausea/vomiting
– Fine hand tremors
– Hypotension; arrhythmias,
pulse irregularities
– Polyuria; dehydration
– Weight gain
--Potential for toxicity
Symbyax is a combination of
Prozac an antidepressant
and Zyprexa an atypical
major tranquilizer.
Monitor for side effects of anticonvulsants
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Nausea and vomiting
Drowsiness; dizziness
Blood dyscrasias
Prolonged bleeding time (with valproic acid)
Risk of severe rash (with lamotrigine)
Decreased efficacy with oral contraceptives (with
topiramate
Planning/Implementation (cont.)
• Educate client and family about the
medication
Outcome Criteria/Evaluation