Depression Rebecca Sposato MS, RN

Depression  An episode lasting over two weeks marked by depressed mood or inability to feel enjoyment  Very common mental health disorder  Typical response to negative life event or may have no external trigger at all  Comorbid with many mental and physical diagnoses  Subtypes: Psychotic features, melancholic features, atypical features, catatonic features, postpartum and seasonal affective disorder 

DSM-IV Criteria for depression  5 or more of the following: depressed mood, anhedonia, 5% change in weight w/i month, insomnia/hypersomnia, psychomotor retardation or agitation, fatigue, feeling worthless or guilt, diminished concentration, thoughts of death  Depression is not cyclic with mania  Symptoms impair daily, social or occupational functioning  Symptoms are not the result of medical conditions, substance abuse or bereavement

Major Depression Disorder (MDD)  Characterized by 1 or more episodes of depression  2/3 of cases have full recovery between episodes; partial recovery 1/3 of cases  Past frequency of episodes is best predictor of future recurrences  Manic episodes are absent, symptoms not result of another mental health condition  Lifetime prevalence: May start at any age, present in all demographic groups, 25% women, 12% for men  Presence is times more likely if present in a first degree relative

Dysthymic Disorder  Chronically depressed mood lasting over 2 years, with less than 2 months without symptoms  75% of cases wax and wane with depression w/i 5yrs  Baseline symptoms are not as intense MDD  Have 2 of the following: appetite changes, sleep changes, fatigue, low self-esteem, impaired concentration, feeling hopeless  Lifetime prevalence of 6%  10% remission without treatment

Etiology  Genetic: twin studies, familial patterns  Endocrine: post-partum depression  Diathesis-stress model: interface between biology and social/environmental events  Cognitive: pessimistic thinking and view of self  Behavioral: Learned helplessness, evolved from anxiety  Neuro: low serotonin and norepinephrine levels PET scans show diminished activity

Interventions  Assessment: Mood, affect, thought processes, physical changes, social factors, self-care, suicide ideation  Treatment: in partnership with patient  Acute 2-3months: reduce symptoms and effects on daily life  Continuation 4-9 months: prevent relapse with interventions  Maintenance >1yr: prevent future episodes  Pharmacology: mitigate mental and physical symptoms  SSRI – primary choice, increase amount of serotonin in gap  Suicide risk for 1 st 2 weeks – especially for adolescences  Not recommended for pregnant women  TCA and MOA –I: numerous side effects

Interventions  Psychotherapy: emotion management, coping skills, life management  Vagal Nerve Stimulation  Electric Convulsive Therapy(ECT): induces seizures to increase brain activity for relief of depression symptoms  6-10 treatments done under anesthesia  Faster and more effective symptom relief  Memory impairment, more so with bilateral placement  min 7:15  Transcranial Magnetic Stimulation (TMS): focus MRI pulse  No anesthesia, fewer side effects  2 min