13420774
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Mapa Mental por Usuario eliminado, actualizado hace más de 1 año
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Creado por Olivia McRitchie
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Depression
- Types:
- Major
depressive
disorder:
- Affects 5-10%
of adults.
- Majority of patients
found in mainstream
society.
- Recognition is a
collaborative effort
- Recognition is a
collaborative effort
- Majority of patients
found in mainstream
society.
- Affects 5-10%
of adults.
- Situational depression
- Result of
circumstances in
person's life.
- Result of
circumstances in
person's life.
- Dysthymic disorder
- Severe depression that
may last several years.
- Person does
not "feel
well".
- May not
function
normally
- May not
function
normally
- Person does
not "feel
well".
- Severe depression that
may last several years.
- Postpartum
depression
- Up to 80% of
women experience
it.
- Caused by
hormonal changes.
- Prevalent enough
that some state
agencies mandate
all new mothers
receive info about
mood shifts
- Caused by
hormonal changes.
- Up to 80% of
women experience
it.
- Seasonal
effective
disorder
- Enhanced release
of melatonin r/t
lower lvls of
natural light.
- May be relieved
w/light therapy
- May be relieved
w/light therapy
- Enhanced release
of melatonin r/t
lower lvls of
natural light.
- Psychotic
depression
- Expression of
intense mood
shifts and unusual
behaviors.
- Depressive signs,
loss of contact with
reality,
hallucinations,
delusions, and
disorganized
speech.
- Depressive signs,
loss of contact with
reality,
hallucinations,
delusions, and
disorganized
speech.
- Expression of
intense mood
shifts and unusual
behaviors.
- Major
depressive
disorder:
- Assessment & treatment
- Corticosteroids, levodopa,
and oral contraceptives can
cause similar symptoms to
depression
- Rule out this
possibility in health
exam
- Rule out this
possibility in health
exam
- Medical and neurologic
disorders can also
cause depressive
symptoms.
- This too
- This too
- Ask about alcohol
& drug use, family
history.
- Therapy:
- Interpersonal:
- Focuses on
pt/ disturbed
relationships
- Focuses on
pt/ disturbed
relationships
- Cognitive-behavioral
therapy:
- Help pt, change
negative styles of
thought &
behavior.
- Help pt, change
negative styles of
thought &
behavior.
- Psychodynamic:
- Focus on
resolving pt.
internal conflict.
- Postponed until
symptoms are
significantly
improved
- Postponed until
symptoms are
significantly
improved
- Focus on
resolving pt.
internal conflict.
- Interpersonal:
- Electroconvulsive therapy
is useful when therapy
fails.
- Over 70% show
improvement
- Over 70% show
improvement
- Transcranial magnetic
stimulation may be an
effective somatic treatment.
- Surgical implant that
does not effect memory,
require general
anesthetic, and is helpful
w/o overt risk of
generalized seizures
- Surgical implant that
does not effect memory,
require general
anesthetic, and is helpful
w/o overt risk of
generalized seizures
- Corticosteroids, levodopa,
and oral contraceptives can
cause similar symptoms to
depression
- Antidepressants
- Depression & anxiety
are caused by similar
neurotransmitter
dysfunction.
- Can also treat some
pain
- Closely monitor for
warning signs of
suicide, especially at
beginning of
treatment.
- Children to young
adults are at greater
risk.
- Also monitor for
anxiety, panic
attacks, agitation,
irritability, insomnia,
impulsivity, hostility,
and mania.
- Children to young
adults are at greater
risk.
- Closely monitor for
warning signs of
suicide, especially at
beginning of
treatment.
- Can also treat some
pain
- Exerts effects
through action on
norepinephrine,
serotonin, and
dopamine.
- Will either block
breakdown of
norepinephrine
or slow reuptake
of serotonin and
norepinephrine
- Will either block
breakdown of
norepinephrine
or slow reuptake
of serotonin and
norepinephrine
- Selective serotonin
repuptake inhibitors
(SSRIs)
- Same efficacy as
MAOIs and TCAs
- Advantage: greater
safety profile, less
sympathomimetic and
anticholinergic effects,
no cardiotoxicity.
- Makes presynaptic
neurons less sensitive to
serotonin, but
postsynaptic more
sensitive
- All drugs have equal efficacy
and similar side effects.
- Most common side effect is
impotence.
- Serotonin syndrome
can result when
combining an SSRi w/
an MAOI, a TCA,
lithium, or any number
of drugs
- Signs include confusion,
anxiety, restlesness,
hypertension, tremors,
sweating, hyperpyrexia, or
ataxia.
- Signs include confusion,
anxiety, restlesness,
hypertension, tremors,
sweating, hyperpyrexia, or
ataxia.
- Serotonin syndrome
can result when
combining an SSRi w/
an MAOI, a TCA,
lithium, or any number
of drugs
- Most common side effect is
impotence.
- All drugs have equal efficacy
and similar side effects.
- Makes presynaptic
neurons less sensitive to
serotonin, but
postsynaptic more
sensitive
- Advantage: greater
safety profile, less
sympathomimetic and
anticholinergic effects,
no cardiotoxicity.
- Serotonin is found in high
concentrations in
hypothalamus, limbic system ,
medulla, and spinal cord
- Functions in cycling btwn REM and
NREM sleep, pain perception &
emotion
- Inadequate amounts cause
depression
- Inadequate amounts cause
depression
- Functions in cycling btwn REM and
NREM sleep, pain perception &
emotion
- Atypical
antidepressants
- Serotonin-norepinephrine
reuptake
inhibitors:
- Includes duloxetine
(Cymbalta) and
venlafaxine
(Effexor)
- In many cases
dopamine is also
affected.
- Duloxetine is also
approved for GAD and
neuropathic pain
- Venlafaxine is also
approved for GAD.
- Venlafaxine is also
approved for GAD.
- Duloxetine is also
approved for GAD and
neuropathic pain
- In many cases
dopamine is also
affected.
- Includes duloxetine
(Cymbalta) and
venlafaxine
(Effexor)
- Bupropion
(Wellbutrin)
- Reuptakes
serotonin and
affects activity of
norepinephrine
and dopamine
- Contraindicated
in pt. w/seizure
disorder
- Contraindicated
in pt. w/seizure
disorder
- Reuptakes
serotonin and
affects activity of
norepinephrine
and dopamine
- Mirtazapine
(Remeron)
- Blocks
presynaptic
serotonin and
norepinephrine
receptors
- Blocks
presynaptic
serotonin and
norepinephrine
receptors
- Nefazodone
- Similar to
mirtazapine
- Causes minimal CV
effects, fewer
anticholinergic
effects, less sedation,
and less sexual
dysfunction, but does
cause hepatotoxicity
- Causes minimal CV
effects, fewer
anticholinergic
effects, less sedation,
and less sexual
dysfunction, but does
cause hepatotoxicity
- Similar to
mirtazapine
- Trazodone
(Oleptro)
- Used to treat
insomnia b/c high
levels are needed
for depression, and
that causes
sedation
- Used to treat
insomnia b/c high
levels are needed
for depression, and
that causes
sedation
- Tricyclic
antidepressnats
- Inhibits presynaptic
reuptake of
norepinephrine and
serotonin
- Safer than MAOIs, but
side effects still include
orthostatic
hypotension, cardiac
dysrhythmia, dry
mouth, constipation,
blurred vision, and
tachycardia.
- Most have a long
half life, increasing
side effect risk.
- Significant
interactions w/ CNS
depressants,
sympathomimetics,
anticolinergics, and
MAOIs.
- Clomipramine
(Anafranil) is used
for OCD
- Doexpin (Sinequan)
is for GAD,
neuropathic pain,
and fibromyalgia
- Some are used off label
for panic disorder and
social anxiety. Can be
used for childhood bed
wetting too.
- Some are used off label
for panic disorder and
social anxiety. Can be
used for childhood bed
wetting too.
- Doexpin (Sinequan)
is for GAD,
neuropathic pain,
and fibromyalgia
- Clomipramine
(Anafranil) is used
for OCD
- Significant
interactions w/ CNS
depressants,
sympathomimetics,
anticolinergics, and
MAOIs.
- Most have a long
half life, increasing
side effect risk.
- Safer than MAOIs, but
side effects still include
orthostatic
hypotension, cardiac
dysrhythmia, dry
mouth, constipation,
blurred vision, and
tachycardia.
- Monoamine
oxidase
inhibitors
- Decreases
effectiveness of
MAO, thus
limiting
breakdown of
norepinephrine,
epinephrine,
dopamine, and
serotonin
- B/c of interactions ,
hepatotoxicity, and
safer meds, these are
reserved for pt.
unresponsive to
conventional
treatment.
- Common side effects
are orthostatic
hypotension,
headache, insomnia,
and diarrhea.
- Hypertensive crisis can
occur w/antidepressants
and sympathomimetic
drugs.
- Serotonin syndrome
can occur when
combined w/SSRIs
- Severe
hypotension when
combined
w/antihypertensives
- Potentiates
hypoglycemic effects of
insulin &oral
antidiabetic drugs
- Potentiates
hypoglycemic effects of
insulin &oral
antidiabetic drugs
- Severe
hypotension when
combined
w/antihypertensives
- Serotonin syndrome
can occur when
combined w/SSRIs
- Hypertensive crisis can
occur w/antidepressants
and sympathomimetic
drugs.
- When taken
w/meperidine,
dextromethorphan, or
TCAs, hyperpyrexia
can occur
- Hypertensive crisis
can occur when
combined w/foods
containing tyramine.
- Tyramine is degraded
by MAO in intestines,
but if MAO is
inhibited, it enters the
bloodstream in high
concentrations and
displaces
norepinephrine within
presynaptic nerve
terminals.
- Results in sudden
release of
norepinephrine.
- Occipital headache,
stiff neck, flushing,
palpations,
diaphoresis, and
nausea are
symptoms.
- Mi and stroke can
happen.
- Calcium
channel
blockers can be
given as an
antidote.
- Calcium
channel
blockers can be
given as an
antidote.
- Mi and stroke can
happen.
- Occipital headache,
stiff neck, flushing,
palpations,
diaphoresis, and
nausea are
symptoms.
- Results in sudden
release of
norepinephrine.
- Tyramine is degraded
by MAO in intestines,
but if MAO is
inhibited, it enters the
bloodstream in high
concentrations and
displaces
norepinephrine within
presynaptic nerve
terminals.
- Hypertensive crisis
can occur when
combined w/foods
containing tyramine.
- Common side effects
are orthostatic
hypotension,
headache, insomnia,
and diarrhea.
- B/c of interactions ,
hepatotoxicity, and
safer meds, these are
reserved for pt.
unresponsive to
conventional
treatment.
- Decreases
effectiveness of
MAO, thus
limiting
breakdown of
norepinephrine,
epinephrine,
dopamine, and
serotonin
- Inhibits presynaptic
reuptake of
norepinephrine and
serotonin
- Serotonin-norepinephrine
reuptake
inhibitors:
- Same efficacy as
MAOIs and TCAs
- Depression & anxiety
are caused by similar
neurotransmitter
dysfunction.
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