Transcript Depression
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 http://www.youtube.com/watch?v=IeZCmqePLzM 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 1.5-3 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 1st 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 http://www.youtube.com/watch?v=ZjFF81ikQJc, min 7:15 Transcranial Magnetic Stimulation (TMS): focus MRI pulse No anesthesia, fewer side effects http://www.youtube.com/watch?v=hMJJ3DpzXdk, 2 min