Mood Disorders: Depression Chapter 12

Defined as a depressed mood or loss of interest that lasts at least 2 weeks & is accompanied by symptoms such as weight loss & difficulty concentrating Prevalence & Comorbidity  4 th leading cause of disability in US  Projected to be 2 nd leading cause disability by 2020  Frequently accompanies other psychiatric disorders  Mixed anxiety-depression most common psychiatric presentation  Pts with medical disorder at high risk for depression  Occurs in children, adolescents, adults and older adults Cultural Considerations  Rate is lowest in Asians as compared to Caucasians, African Americans & Hispanics Depression

Heterogeneous, systematic illness involving an array of different neurotransmitters, neurohormones, & neuronal pathways Biological: Genetic link  Biochemical: Neurotransmitter abnormalities can probably cause depression Serotonin: regulator if sleep, appetite & libido Norepinephrine: decreased levels can result in anergia (lack energy) anhedonia (inability to find meaning or pleasure) decreased concentration & decreased libido  Neuroendocrine: evidence of increased cortisol secretion  Image Findings: CAT & MRI show ventricular enlargement, cortical atrophy, & sulcal widening Theory

Cognitive Theory  Developed by Aaron T. Beck  Applied CBT to depression  Proposed that people acquire psychological predisposition to depression through early life exp  Becks Cognitive Triad A negative self-depreciating view of self A pessimistic view of world A belief that negative reinforcement will continue Learned Helplessness  Seligman (1973) stated that although anxiety is initial response to stress, anxiety is replaced by depression if person feels no control over outcome Theory

Major Depressive Disorder  Defined as 1 or more major depressive episodes and no history of manic or hypomanic episodes  Subtypes Psychotic features Catatonic features Melancholic features Postpartum onset Seasonal features Atypical features Depressiove disorders

Dysthymia Disorder  Chronic depressive syndrome usually present for most day, more days than not, for at least 2 yrs  Early and insidious onset  Depressive mood disturbance cannot be distinguished from person’s usual pattern of functioning  Age of onset is usually early childhood and teenage years to early adulthood Depressive disorders

Assessment  Undiagnosed & untreated depression often associated with more severe presentation of depression, greater suicidality, somatic problems, & severe anxiety Assessment Tools  Beck Depression Scale, Hamilton Depression Scale, Geriatric Depression Scale Assessment of Suicide Potential Areas to Assess  Mood, physical changes, cognition Assessment Guidelines Diagnosis: risk for suicide Outcomes Identification: Goal for safety Planning Application of the nursing process

Implementation  Communication Guideline  Health Teaching and Promotion  Milieu Therapy  Psychotherapy: CBT and Behavioral therapy  Group: widespread modality for treatment  Pharmacological/Biological/Integrative: ECT, Antidepressant drugs (SSRI’s, TCA, Atypical, MAOs) Application of nursing process

 Somatic Treatments Electroconvulsive therapy (ECT) Vagus Nerve Stimulation  Integrative Therapies Light Therapy St. John’s Wort Exercise Future Treatment  Transcranial Magnetic Stimulation  Brain Imaging  Evaluation Short term indicators and outcome criteria are frequently evaluated Application of the nursing process