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ACNP III - Exam 2 > Depression > Flashcards

Flashcards in Depression Deck (7):
1

What are some risk factors for depression?

  • Neurotransmitter or hormonal imbalance
  • A negative perception of life events (trauma, loss, stress)
  • Medical disorders, chronic conditions, or poor prognosis
  • Medication adverse reactions
  • Loss of significant others
  • Lack of a social support system

2

Who is at highest risk for suicide?

  1. Highest risk: elderly white males with comorbidities lacking social support
  2. Previous suicide attempt
  3. Family history of suicide
  4. Feeling of hopelessness

3

What Mnemonic is used when assessing a patient for suicide risk?

S: sex (males more successful, women attempt suicide more, less successful)

U: past attempt history

I:  family history of suicide

CI: Chronic medical illnesses

D: depression, substance abuse, alcohol abuse

A: age of patient (elderly more successful, teenagers make more attempts)

L: Lethal method available (gun most lethal, followed by hanging and drug overdose)

If any signs are noted in the above assessment follow-up with the below questions should occur:

  • Have you ever thought about death or dying?
  • Have you ever thought that life was not worth living?
  • Have you ever thought about ending your life?
  • Have you ever attempted suicide?
  • Are you currently thinking about ending your life?
  • What are your reasons for wanting to die and your reasons for wanting to live?

4

What are some subjective findings associated with depression?

  • Hopelessness
  • Increased or decreased appetite or weight
  • Decreased libido
  • Guilt
  • Worthlessness
  • Sleep disturbances- insomnia or hypersomnia
  • Fatigue – lack of energy

5

What lab/diagnostic tests should be ordered on a patient suspected of depression?

  • Thyroid function tests
  • Vitamin B12 and folate levels
  • Blood glucose
  • CBC- r/o anemia, infection
  • EKG- prior to starting any tricyclic antidepressants as they may exacerbate preexisting condition
  • Toxicology – drug screen, etoh levels
  • Renal function

 

All these tests are used to rule out medical causes for depression

6

What 3 classes of medications are used for patients in the treatment of depression

  • All anti-depressants equally effective with approximately 2/3 of patients responding to treatment
  • Treatment should be continued for a minimum of 6-8 weeks to be effective.

1. Selective serotonin reuptake inhibitors (SSRIs)

  • Citalopram (Celexa) or Escitalopram (Lexapro). Use cautiously in elderly! and those with liver disease; may cause QT prolongation; get baseline EKG and LFTs prior to initiation of therapy
  • Sertraline (Zoloft)- PREFERRED FOR ELDERLY due to short half life
  • Fluoxetine (Prozac) – long half-life (48 hours)
  • SSRIs are the most commonly prescribed medications due to lower danger of overdose and less adverse effects

2. Selective norepinephrine and serotonin reuptake inhibitors,

  • Mirtazapine or bupropion
  • May be used for those who have not had adequate improvement with SSRIs
  • Venlafaxine (Effexor or Effexor XR) – divided dosing preferred due to sedation effects
  • Duloxetine (Cymbalta) – Use cautiously in elderly! And those with history of glaucoma, liver disease and alcohol abuse

3. Tricyclic antidepressants and MAO inhibitors

  • Are NOT used often due to more adverse side effects and high overdose potential.

7

What is the most common initial presenting symptoms in the depressed older adult?

Weight loss