What conditions are important to rule out when diagnosing depression? (4)
- Hypothyroidism
- Anemia / vitamin deficiency
- Parkinson’s
- Huntington’s
Mild depressive disorder is known as ______
Dysthymia
Cycling between hypomania and mild depressive symptoms (not as severe as bipolar I / bipolar II) is known as ______
Cyclothymia
When is cyclothymia diagnosed?
After 2 years of symptoms
When is persistent depressive disorder diagnosed?
After 2 years of symptoms
Describe the SIGECAPS mnemonic used for depression (8)
- Suicidality
- Interest - decreased
- Guilt
- Energy - decreased
- Concentration - decreased
- Appetite - increased / decreased
- Psychomotor retardation
- Sleep - increased / decreased
Describe the DSM-5 criteria for major depressive disorder (3)
- 5 or more symptoms during the same 2 week period
- MUST have depressed mood / anhedonia
- NO manic / hypomanic episodes
Describe ECT
Brief seizures induced by electrical currents attached to the forehead
Describe nursing interventions prior to ECT (2)
- Discontinue benzodiazepines - goal is to induce seizure
- NPO 6 - 8 hours prior
Describe the process of ECT induction (3)
- Administer general anesthetic
- Administer muscle paralytic
- Induce seizures (hyperoxygenate)
Describe monitoring of seizure activity during ECT (3)
- BP cuff placed around lower leg prior to administering muscle paralytic
- Paralytic will not reach area below the cuff
- Seizure activity observed in great toe
During ECT, seizure activity lasting ______ is considered effective
45 - 60 seconds
______ is expected following ECT
Short-term memory loss / confusion
What drugs are used to treat depression? (4)
- MAOIs
- TCAs
- SSRIs
- SNRIs
What side effects are common among all classes of antidepressants? (4)
- Nausea
- Constipation
- Insomnia
- Sexual dysfunction
Name some examples of MAOIs (3)
- Phenelzine
- Isocarboxazid
- Tranylcypromine
What side effects are specific to MAOIs? (2)
- Weight gain
- Daytime sedation
Describe patient education for MAOIs (2)
- DO NOT eat food containing tyramine - hypertensive crisis
- DO NOT combine with alcohol - CNS depression
What foods contain tyramine / should be avoided while taking MAOIs? (6)
- Cheese
- Cured / processed meats
- Sauces
- Wine
- Overripe fruit
- Pickled foods
What are the manifestations of a hypertensive crisis due to consumption of tyramine while taking MAOIs? (4)
- Hypertension
- Tachycardia
- Sweating
- Tremors
What medications CANNOT be taken in combination with MAOIs? (5)
- TCAs
- Barbiturates
- Antihistamines
- Antihypertensives
- OTC cold medications
Name some examples of TCAs (4)
- Amitriptyline
- Nortriptyline
- Imipramine
- Doxepin
What side effects are specific to TCAs? (2)
- Anticholinergic effects
- Orthostatic hypotension
How long does it take to see therapeutic effects from TCAs?
2 - 4 weeks
