Notes on Major Depressive Disorder PDF

 MDD last a minimum of zweeks to be classified as...

 MDD last a minimum of zweeks to be classified as disorder Major depressive in major depressive disorder · Melancholic sub type : Insomnia , loss of appetite , lack of reactiveness to environmental ↓ marked anhedonia · Atypical Sub type : Excessive sleep , 4 appetite , fatigue/weakness extreme , sensitivity to rejection Disruptive Mood Dysregulation disorder Affects children from 618 Outburst temper tantrums , affects : Dysthymic disorder : Persists for at least 2 urs · peds/teens/adults comment : "Always felt this way "... Being depressed is a "normal" way of functioning May have periods of full blown major depre episodes premenstrual dusphoric disorder sumptoms occur one week before women gets her period. · Anger - Anxiety-Suicidal thoughts - Food Craving/Binge eating - Irritability - Panic Attacks - Fatigue/low Energy substance - Induced depressive disorder Due to druglalk consumption , person is most likely to have major depressive episodes. A usually within I month of a pt starting to use meds/alk/substance. I in every 20 ppl suffer from depression infants can display symptoms of depre : If they have childhood depre , they are likely to occur in teen/adulthood w/ higher symptoms/ extent ! depressed just be someone is old doesn't mean they'll be could happen, Not garunted *  Panic Schizo * comorbidity : Depression + other psch disorders Anxiety ED * Martin Seligman : Theory of learned Helplessness All assessment tools · Beck Inventory All end w/ scale · Hamiton depression scale except the Beck Inventory zung Scale * · · Geriatric Scale will depressed experience plesure see Mood , Anhedonia (Unable to , angeria lacke will also see psych agitation , psuch retardation. Disinterest in Sex ! Somatic : Not organic : Due to depression person feels pain-Headache , backache , pain in major organs malaise (weak, discomfort illness ( , , CNA can stay in the room w/ pt to make pt stays alive!. Also give pt enough time to respond when holding a convo Selective Serotonin Reuptake Inhibitors : SSRI's :I teachingeving SSRI's : 1st Line of ! sided S/E thoughts to want to hurt themselves therapy Low tell them to tell a HCP short term : lose weight... Long term : Gain weight (ppLz)he SSRI's low OD risk Fluoxetine (Prozac) Sertraline (Zoloft) Spec F I Citalopram (Celexa) Escitalopram (Lexapro) SSRIS Paroxetine (Paxil) itor wlb Fluvoxamine (Luvox) Mon OD have Note : TCA's have a higher Chance for OD. So give mede I week of a time Serotonin & Norepinephrine Reutake Inhibitors TCA's there is SNRI's In Tricyclic Antidepressants : risks for older Duloxetine (Cymbalta) Venlafaxine (Effexor XR) Amitriptyline (Elavil) Amoxapine only generic DOX/ DOC ↑ adults or pts w/ disease. * ADD A SIE : Dry Desipramine (Norpramin) mouth, blurry vision , Doxepin (Sinequan) PINT Imipramine (Tofranil) tachy Photophobia , consipation , , Dulo V Nortriptyline (Pamelor) (EATNPVSS) Urinary retension a hesitancy on Protriptyline (Vivactil) *drowsiness A Not i Trimipramine (Surmontil) i-s going to take time for A med - to work * Or 1-3 weeks.  No foods ↑ in tyramine Pepperoni Salami Cheese Coffee Choc , Beer MEND : , , , , Strict diet PITS > - BC it can cause HTN crisis Mol's (Monoamin Oxidase Inhibitors ( Phenelzine (Nardil) Isocarboxazid (Marplan) Side Effects: OD too Selegiline (Emsam) transdermal patch CNS stimulation (anxiety, agitation, hypomania Tranylcypromine (Parnate) and mania); orthostatic hypotension; local rash Orthostatic His associated with transdermal preparation AVOID OVER THE COUNTER COLD Hypotension, dizzy light , MEDICINE WHILE ON MAOI headedness Atypical Antidepressant Bupropion (Wellbutrin) pp I who don't like the low libido that SSRI's cause, Inhibiting dopamine reuptake this is an alternative ! to abuse med, be Therapeutic uses: Alternative to SSRIs for for other Cpt may try pressures too clients unable to tolerate the sexual dysfunction side effects; aid it's a psycho stimulant to quit smoking; prevention of seasonal pattern depression But !! person has a Hx of seizures... Do not give BIC. 1% of pts who are on this med may have a seizure * Life threatening emergency Recent head Injury (TBI)Traumatic Brain Injury , , Due to serotonergic agents Onset–within 24 hrs # :adinSerotonin Syndrome Other AA meds ↑ nep Unstable VS Agitation cupro, Due to levels of : Venlafaxine (Effexor) initial MAOI's Sialorrhea (drooling) Ind 2mg Hyperreflexia Duloxetine (Cymbalta) close. & TCAS Desvenlafaxine (Pristiq) Appitite Q2H(every SSRIS , Increased tone of Lower Extremities Hyperactive bowel sounds Mirtazapine (Remeron) > - Stimulant zhrs) Lithium Coma >> Death Herbal products Give if Cyproheptadine 4mg initial dose and Trazodone (Desyrel) untibiotics 2mg Q2H until clinical response seen. - K sleep causes : Helps OTC meda in men ! priaprism agent pt sleep ! long erection caused bu (Mixind ECT (electric therapy) taking antidepressants wh other medy can be x for pt who's med Iv isn't working. Are under anesthesia ! Pt is experiencing a controlled seizure If pt agrees to ECT , another doc will have to re-evaluate ( ECT iS not FORCED. Only provided to voluntary pts !!! to see if hes a good cannadate for this +x. Why other doc who's administer oxygen unrelated ? Bic 1st do gets ? I maybe some * "Commission" for this After 2nd doc clears the +x Now a medical doc will do like ECT +X. m... blood work Head , Neck, a "urlly physical" to verify pt is to get ECT (shocked) Spine I healthy enough Pt is put on NPO EKG , a brain bleed X-ray CT scan abnormality ofNo , Monitor & during ECT. (expected Confused/Feels Likeitby :  Before ECT pt's on certain mede : (this med stops saliva secretions gastric Secretions) To avoid pt out Glycopyrrolate , to dry : own) CHOKING/ASPIRATION > Succinylcholine (can't breathe on their A Prevents Muscle destress Places pt under > Methohexitol/ Brevital - * pretty much anesthesia Make 10-12 to sure total pts gag reflex is back before eating or drinking 7-10x to see results 80% see good results 4 - 6 weeks 5 days a week (30 mins) other depression tx MRI strength magnetic pulses aims device on the cerebral cortex transcranial magnetic Stimulation.' Non-invasive (SAfe for pregnant pts Who can't take antidepre meds) could cause seizures vagus Nerve Stimulation * clamp electrodes (An implant) Pulses 30 seconds, on vagus nerve every every 5 min for 24hrs. voice alteration (change in voice Neck pain, cough paresthesia (tingles) , , & dyspnea (SOB). DBS Deep Brain Stimulation : Electrodes implanted within brain (to activate , underactive Risk: Intracranial regions of brain Hemorrhage leading to depre) light therapy : 1st line to for seasonal affective disorder/MDD, or dysphoric disorder inhibits secretions of melatonin (S/E : Headache & jitteriness Sri* Mild I moderate depression : St. John's Wort + on they CANNOT use. St John's Wort... BC ↑ risk of Serotonin Syndrome Suicide rates are higher in identical twins than fraternal  low Seretonin levels are related to risks of suicide. * clients risk of violence. identifying * Primary High Schoolers Veterans, police officers preventing/educating erisnation : ,. - & - - the (eXER Secondary Management : of suicide crisis - nurse , after pt has attempted suicide. Nurse treating them in * 1 : 1 is the ER stable. a keeping them alive a - a tertiary:Nurseoffers fiendsupport tothoTway who lost some s suicide related. verbal abuse to own kids. alone Self awarness : No bias 1 1 means We CANNOT leave pt : thoughts. leader Autocratic Only RN speaks : Democratic leader : Supports group interaction Laissez-Fair Allows group to do we they :. want.. Risk Factors : hopelessness ! Men 4x to die from suicide likely Women 3x to attempt but notactually die Person who is 45 or older : this is a risk factor for suicide