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JK is a 37 year old female who has been experiencing significant
anxiety, irritability and depressed mood over the course of the last several
years. She initially sought treatment because her sister had been treated
for similar symptoms and was thriving. JK thought she should also have
a psychiatric evaluation because her own symptoms were so much like those
her sister had prior to treatment. During the assessment, the nurse practitioner
discovered that the patient had had moderate symptoms of depression as
a young adult, but she had not received treatment; in fact, JK had a low
level of depression chronically. Despite this chronic depression, she
was able to work and care for her family (which includes 2 adolescent
children); she even was able to have fun on occasion. JK has been having
increasing conflicts with her husband and has felt like she's not sure
that it's worth continuing to struggle.
GH is a 48 year old male who experienced depressive symptoms
in response to conflicts at work and marital problems. He had been working
long hours for the past several years to clear up the family debts. This
has had significant negative impact on his marriage. His wife has asked
for a divorce and GH has been devastated. He has no history of previous
depression; no family history of depression. He was prescribed a selective
serotonin reuptake inhibitor (SSRI) and had a very good response. He felt
so well after 4 months that he stopped taking the medication. Two months
after stopping the antidepressant his depressive symptoms returned. When
he went back on the SSRI, he did not have as good a response as he experienced
previously.
AB is a 54 year old woman who has experienced depressive
and anxiety symptoms since childhood. She experienced verbal and emotional
abuse in childhood, having a mother who herself had untreated anxiety
and depression. AB has held a variety of jobs in the same large organization
for over 20 years; however, she has taken medical leaves every several
years, due to depression during her entire employment history. Her functional
abilities have been impaired, having missed out on multiple promotions
due to her illness; two failed marriages and a significant lack of enjoyment
in most things. She is often overwhelmed by her feelings of depression
and anxiety. She has been treated for depression with medication and therapy
over much of the course of her life. She was treated for many years with
tricyclic antidepressant medications and therapy. She was often non-adherent
to treatment because she felt that she just needed to work harder at being
happy and not so negative. In recent years she took several different
antidepressants, mainly the selective serotonin reuptake inhibitors, but
continues to feel significantly depressed and is currently on a medical
leave from her job.
CD is a 61 year old female who has been unable to maintain
a job as an editor, despite her graduate education. She is now doing free
lance work; however, she is clearly underemployed. She has suffered from
depression since childhood; her father was also chronically depressed.
CD has been treated for depression since adolescence with only modest
improvement. She is generally motivated to continue to seek treatment
alternatives. CD has been treated aggressively with medications and psychotherapy;
however, her depression has been very treatment resistant. She has had
trials of just about all of the possible antidepressants. Although she
currently feels better than she ever has, she continues to struggle, at
times, with overwhelming feelings of depression.
EF is a 26 year old male who has been unable to maintain
employment since graduating from college 4 years ago due to significant
symptoms of depression. He is now again living with his parents and EF
fears that he will never be able to lead a "normal" life of
marriage, children and successful employment, which has precipitated thoughts
of suicide. He has been in treatment with the same psychiatrist and psychologist
since late adolescence; he is not always forthcoming with either of his
treatment providers; EF often minimizes his symptoms during sessions.
EF had a maternal grandfather who committed suicide due to depression;
no one else in the family suffers from depression. EF has been on the
same selective serotonin reuptake inhibitor for the past several years.
These people have something in common. They all have been
diagnosed with a depressive disorder and they all present a challenge
for the prescribing mental healthcare provider. The advent of antidepressant
medications has been extremely beneficial for millions; people who would
have been disabled by crippling depression are leading productive lives.
However, like all medications, antidepressants may not be beneficial for
all patients; they also potentially can cause serious side effects. An
understanding of depressive disorders and the medications used to treat
them are critical to a nurse's practice.
The World Health Organization has rated depression as the
leading cause of disability in lost years of productive life in market
economies. Depression causes disability at rates greater than cancer,
diabetes, asthma, and HIV/AIDS!
Depression, as well as all of the psychiatric illnesses,
has long been misunderstood and those who suffer from it have long been
stigmatized. Current research confirms that depression is not a matter
of will, or "trying harder", depression is clearly an outcome
of multiple factors including neurochemical, environmental and genetics.
Currently, depression is conceptualized as a chronic illness, and like
all chronic illnesses, it must be managed over time.
Depression is a treatable medical condition that affects
millions of people. The advent of antidepressant medications changed treatment
and recovery. There are many medications available with many more being
produced and marketed. Tricyclic agents (TCAs) were the first medications
used and are still effective. The often disturbing side effects are the
usual reason for discontinuation of therapy. The monamine oxidase inhibitors
(MAOIs) were developed next and are useful for patients with atypical
depression. Serious drug and food interactions occur with this class of
medication and have prohibited their widespread use. In the late 1980s
the introduction of selective serotonin reuptake inhibitors (SSRIs), with
their treatment success rates and low incidence of side effects, saw a
new drug, Prozac, become one of the most widely prescribed medications
in the country. Since the introduction of Prozac, newer drugs in this
class have been introduced and are widely used. Selective norepinephrine/serotonin
reuptake inhibitors, or dual action anti-depressants, are also used in
the primary treatment of depression, and development of additional antidepressants
continues.
This course will provide current information about depression
diagnoses and the pharmacological treatment of depressive disorders. The
choice of an antidepressant medication depends on the symptoms the patient
exhibits and the side effect profile of each drug. Usual drug dosages
are explained as well as strategies when the prescribed medication is
not working. Patient education information is also included. While the
course has most applicability to advance practice nurses, registered nurses
also can benefit from the information provided.
© 2000, 2005 NYSNA, all rights reserved.
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