1. Chapter 14 Depressive Disorders
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2. Major Depressive Disorder
Persistently depressed mood lasting a minimum of 2 weeks
- Symptom include:
Anhedonia, fatigue, sleep disturbances, changes in appetite, feelings of hopelessness or worthlessness, persistent thoughts of death or suicide, inability to concentrate or make decisions, change in physical activity
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

3. Depressive Disorders Classified
Disruptive mood dysregulation disorder
Dysthymic disorder
Premenstrual dysphoric disorder
Substance abuse depressive disorder
Depressive disorder associated with another medical condition
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4. Epidemiology Leading cause of disability in the United States
Children and adolescents
Older adults
Comorbidity
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5. Etiology Biological factors Genetic Biochemical
Stressful life events
Alterations in hormonal regulation
Inflammatory process
Diathesis-stress model
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6. Etiology (Cont.) Psychological factors Cognitive theory
Learned helplessness
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7. Nursing Process Assessment Assessment tools
Assessment of suicide potential
Key assessment findings
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8. Nursing Process (Cont.)
Areas to assess
Affect
Thought processes
Mood
Feelings
Physical behavior
Communication
Religious beliefs and spirituality
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

9. Nursing Process (Cont.)
Age considerations
Children and adolescents
Older adults
Self assessment
Feeling what the patient is feeling
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10. Question 1
Which question would be a priority when assessing for symptoms of major depression?
“Tell me about any special powers you believe you have.”
“You look really sad. Have you ever thought of harming yourself?”
“Your family says you never stop. How much sleep do you get?”
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11. Question 1 (Cont.)
“Do you ever find that you don’t remember where you’ve been or what you’ve done?”
Answer: B
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12. Nursing Process (Cont.)
Nursing diagnosis
Risk for suicide—safety is always the highest priority
Hopelessness
Ineffective coping
Social isolation
Spiritual distress
Self-care deficit
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

13. Nursing Process (Cont.)
Outcomes identification
Recovery model
Focus on patient’s strengths
Treatment goals mutually developed
Based on patient’s personal needs and values
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

14. Nursing Process (Cont.)
Planning
Geared toward
Patient’s phase of depression
Particular symptoms
Patient’s personal goals
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15. Nursing Process (Cont.)
Implementation
Three phases
Acute phase (6 to 12 weeks)
Continuation phase (4 to 9 months)
Maintenance phase (1 year or more)
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16. Nursing Process (Cont.)
Counseling and communication
Health teaching and health promotion
Promotion of self-care activities
Teamwork and safety
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

17. Psychopharmacology Antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
First-line therapy
Indications
Adverse reactions
Potential toxic effects
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

18. Psychopharmacology (Cont.)
Tricyclic antidepressants (TCAs)
Neurotransmitter effects
Indications
Adverse effects
Toxic effects
Adverse drug interactions
Contraindications
Patient and family teaching
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

19. Psychopharmacology (Cont.)
Monoamine oxidase inhibitors (MAOIs)
Neurotransmitter effects
Indications
Adverse/toxic effects
Interactions
Drugs
Food
Contraindications
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

20. Case Study
Your patient was just diagnosed with a major depressive disorder.
What medication do you anticipate the health care provider will start the patient on?
The selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line therapy for most types of depression.
Examples are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox).
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

21. Case Study (Cont.) What side effects might the patient experience?
May induce agitation, anxiety, sleep disturbance, tremor, sexual dysfunction (primarily anorgasmia), or tension headache.
The effect of the SSRIs on sexual performance may be the most significant undesirable outcome reported by patients.
Autonomic reactions (e.g., dry mouth, sweating, weight change, mild nausea, and loose bowel movements) may also be experienced with the SSRIs.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

22. Other Treatments for Depression
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation
Vagus nerve stimulation
Deep brain stimulation
Light therapy
St. John’s wort
Exercise
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

23. Advanced Practice Interventions
Psychotherapy
Cognitive-behavioral therapy (CBT)
Interpersonal therapy (IPT)
Time-limited focused psychotherapy
Behavior therapy
Group therapy
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24. Nursing Process (Cont.)
Evaluation
Suicide ideation
Intake
Sleep pattern
Personal hygiene and grooming
Self-esteem
Social interaction
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

25. Audience Response Questions
A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding?
Psychomotor retardation
Psychomotor agitation
Vegetative sign
Anhedonia
ANS: A
Invite students to share examples of assessment findings associated with the distracters.
REF: 250, 257
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

26. Audience Response Questions
Which assessment finding in a patient with major depression represents a vegetative sign?
Restlessness
Hypersomnia
Feelings of guilt
Frequent crying
ANS: B
Ask students to identify other vegetative signs associated with depression.
REF: 250, 259
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.