Major Depression - notes PDF

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What is it? A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.With at least four other symptoms of depression such as anhedonia and changes in weight, sleep, energy, concentration, decision making, self-esteem, and goals.

CLINICAL PICTURE An untreated episode of depression can last 6 to 24 months before remitting

TREATMENTS ❖ ❖ ❖ ❖ ❖

MAOI SSRI Tricyclic antidepressants Atypical antidepressants

Serotonin syndrome Assessment ❖ ❖

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NURSING INTERVENTIONS for Depression ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖

Provide for the safety of the client and others. The first priority is to determine whether a client with depression is suicidal. Institute suicide precautions if indicated. Begin a therapeutic relationship by spending non demanding time with the client. Promote completion of activities of daily living by assisting the client only as necessary. Establish adequate nutrition and hydration. Promote sleep and rest. Engage the client in activities. Encourage the client to verbalize and describe emotions. • Work with the client to manage medications and side effects

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Depressed mood Anhedonism (decreased attention to and enjoyment from previously pleasurable activities) Unintentional weight change of 5% or more in a month Change in sleep pattern Agitation or psychomotor retardation Tiredness Worthlessness or guilt inappropriate to the situation (possibly delusional) Difficulty thinking, focusing, or making decisions Hopelessness, helplessness, and/or suicidal ideation

Serotonin syndrome occurs when there is an inadequate washout period between taking MAOIs and SSRIs or when MAOIs are combined with meperidine. Symptoms of serotonin syndrome include: ❖ Change in mental state: confusion and agitation ❖ Neuromuscular excitement: muscle rigidity, weakness, sluggish pupils, shivering, tremors, myoclonic jerks, collapse, and muscle paralysis ❖ Autonomic abnormalities: hyperthermia, tachycardia, tachypnea, hypersalivation, and diaphoresis.

Nclex alert! ❖

If you have a client on antidepressants and they are reporting feeling more energy after about 2-4 weeks monitor closely for suicide. This is when they have the energy to complete the act, or follow through with a plan.

Famous faces case study Eeyore CLIENT FAMILY EDUCATION for Depression ❖ ❖ ❖ ❖ ❖ ❖ ❖

Teach about the illness of depression. Identify early signs of relapse. Discuss the importance of support groups and assist in locating resources. Teach the client and family about the benefits of therapy and follow-up appointments. Encourage participation in support groups. Teach the action, side effects, and special instructions regarding medications. Discuss methods to manage side effects of medication.

Eeyore is a character that displays a relatively accurate example of major depressive disorder. One major issue with the character portrayed is his consistent involvement with a support group. A lack of interest in activities is common with this disorder, causing most persons with depression to not frequently spend time with others. Eeyore exhibits five symptoms of a major depressive episode, and has also experienced these for several years, therefore meeting full criteria. Criteria met include depressed mood most of the day, markedly diminished interest or pleasure in activities, fatigue or loss of energy nearly every day, feelings of worthlessness, and diminished ability to think or concentrate were indicated. Overall, Eeyore exhibits severe clinical major depression without psychotic features. Further diagnosis will be needed to determine catatonic, melancholic, or atypical features as details are limited at this point. Postpartum onset is not a factor....