Mental Health Fall '12

1. Depression

2.  Major Depressive d/o
 Potential for pain and suffering in all aspects of life
 Affects ALL ages
 May include: psychosis, catatonic symptoms, and
melancholy
 Dysthymia
 Chronic Depression
 > 1year for children
 > 2 years for adults/ elderly

3.  Premenstrual Dysphoric
 Depressed, anxious , moody
 Still being researched for data
 Also to be considered:
 Seasonal affective disorder
 Postpartum depression

4.  Depression may result from a complex
interaction of causes, as evidences by high
variability of:
 Symptoms
 Response to treatment and course of illness
Common Theories:
-Biological
-Psychosocial influences/ life events
Cognitive
Learned helplessness

5.  Tools
 Beck Depression Inventory
 Hamilton Depression Scale
 Geriatric Depression Scale
 Zung Depression Scale
 SAD Person’s Scale
 National Mental Health Association
 http://www.depression-screening.org

6.  Safety First
 Suicide Potential
 Key Symptoms
 Depressed mood
 Anxiety
 Psychomotor agitation or retardation
 Somatic complaints
 Vegetative signs

7.  Affect (sad, weeping)
 Thought Processes (delusions, poor judgment)
 Feelings (anger, anxiety, hopelessness)
 Guilt (rumination over past failings)
 Physical Behavior (lethargy, poor hygiene, posture )
 Communication (slow speech, slow comprehnsion)

8.  Transient
 “blues” tired, feel like your in a little slump
 Mild
 Normal grief response, may cry, eating changes
 Moderate
 dysthymic., a little hopeless, ?suicidal potential
 Losing interest in self, grooming, social etc
 Severe
 Increased hopelessness, total despair, life functioning
affected, Suicidal? Homicidal?

9.  Unrealistic expectations
 Feelings originating from the client
 Understanding of depression as a systemic
illness with a complex interaction of causes

10.  Risk for suicide
 Hopelessness
 Powerlessness
 Disturbed thought process
 Ineffective coping

11.  Think – Pair- Share
 Find a partner and come up with a one minute
care plan ( ie outcome criteria/ interventions)
 On you mark ..get set…go
 (Prioritize your interventions)!!!

12.  Sheila is a 35 year old IV therapist. She is grossly obese
and has recently been suffering from shortness of breath
on exertion. She has High BP, High Cholesterol and has
noticed that a sore on her foot from a cut has not been
healing. She has not been sleeping in her bed but on the
couch so she can watch movies when she can’t sleep.
She is tired, has a low tolerance for frustration, and feels
constantly behind in all that she does.
 She is divorced and is raising a teenage son. She just
received an invitation to her high school reunion. She

13.  Starts crying and con not stop all day. When her son
gets home from school he calls an ambulance because
his mother keeps talking about ending it all.
 Client hx: she was head cheerleader in high school. She
got married right out of school due to an unexpected
pregnancy.
 What are your priority assessments?
 Diagnosis? Why?
 Outcome Criteria for her that you would expect?

14.  Remain safe
 Reports hope for the future
 Identifies precursors of depression
 Reports improved mood
 Plans strategies to reduce the effects of
precursors of depression
 Did You get these as well???

15.  Communication
 Counseling
 Encourage self care
 Therapeutic Milieu
 Health Teaching
 Medications
 Assess effects of Medications

16.  Psychotherapy
 Cognitive Therapy
 Interpersonal Therapy
 Social Skills Training
 Group Therapy

17.  Classes of antidepressants
 First Line agents
 Selective Serotonin Reuptake inhibitors (SSRIS)
 Heterocyclic antidepressants
 Tricyclic anti depressants (TCA)
 Second line agents (interventions)
 Monoamine oxidase inhibitors (MAOIS)
 Electroconvulsive Therapy (ECT)

18.  Block the reuptake of serotonin; thereby
serotonin neurotransmission is enhanced
 Indications: most widely used (Prozac, Celexa,
Paxil, Zoloft)
 Side Effects: Lower incidence of anticholinergic
side effects than TCA’s
 Adverse effects: agitation, sleep disturbance,
Sexual dysfunction*
 What does that mean? COMPLIANCE!!!

19.  “Novel “ antidepressants (Wellbutrin/trazadone),
 They inhibit the reuptake of norepi/serotonin.
 Neurotransmitters:
 Serotonin –norepinephrine reuptake inhibitors
(SNRI’s) ex. (Effexor/ Cymbalta)
 Selective norepinephrine reuptake inhibitors (NRI’s)
ex. (Vestra)
 Advantages
 Adverse Effects

20.  Inhibit reuptake of norepinephrine and serotonin
by increasing the amount of time that the
neurotransmitters are available at the
postsynaptic receptors
 Examples: Pamelor, Tofranil,
SinequanAdvantages
 Adverse Effects
 Start low….go slow!!!!
 Contraindications (Cardiacs/ hx of seizures/
pregnancy)

21.  Neurotransmitter: increases norepi, tyramine,
dopamine, serotonin in the system
 This naturally raises the mood!
 Advantages: rare sedation, used for atypical
depression and panic d/o, OCD, PTSD
 Nardil, Parnate ( two most common)
 Adverse effects (Cardiac changes)
 Avoid food with tyramine
 Drugs that interact with MAOI ( pg 349)
 Contraindications

22.  Used when a rapid response is needed to
prevent suicidal ideations, extreme agitation,
poor response to a variety of meds.
 Procedure
 Advantages
 Potential adverse reactions
 Article: Read ECT Article on Blackboard
 Also check out pg552 for pharmacology chart

23.  Integrative approaches for depression
 Light Therapy (First line treatment for SAD, seasonal
affective d/o)
 St John’s Wort ( herb)
 Exercise ( naturally increases mood)
 Future of treatment
 Early screening for indicators
 Education for society
 Promotion of supplemental strategies by MD’s