The document discusses various types of depression including major depressive disorder, dysthymia, premenstrual dysphoric disorder, and seasonal affective disorder. It covers symptoms, screening tools, treatment options such as antidepressant medications and therapy, and factors that influence depression. Safety concerns like suicide risk are also addressed.

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