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Depression

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الكلية كلية التمريض     القسم قسم العلوم الطبية الاساسية     المرحلة 3
أستاذ المادة عمار عباس شعلان الحميري       03/01/2016 06:50:32
Depression

Depression An abnormal emotional state characterized by exaggerated feelings of sadness, melancholy, dejection, worthlessness, emptiness, and hopelessness that impact the patient’s life and may be out of proportion to reality. Signs include withdrawal from social contact, loss of appetite, and insomnia.

Clients starting antidepressant medication therapy for depression need to be advised that symptom relief can take 1 to 3 weeks and possibly 2 to 3 months for full benefits to be achieved. Encourage continued adherence.
Clients with major depression may require hospitalization with close observation and suicide precautions until the antidepressant medications reach their peak effect.
Antidepressant mediations are classified into four main groups
Tricyclic antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Monoamine oxidase inhibitors (MAOIs)
Atypical antidepressants
DOSAGES
Tricyclic Antidepressants (TCAs)
Select Prototype Medication: Amitriptyline (Elavil)
Other Medications
Imipramine (Tofranil)
Doxepin (Sinequan)
Nortriptyline (Aventyl)
Amoxapine (Asendin)
Trimipramine (Surmontil)
Pharmacological Action
These medications block reuptake of norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters.
Therapeutic Uses
Depression
Depressive episodes of bipolar disorders
Other Uses : Chronic pain, Enuresis
Side/Adverse Effects


Contraindications/Precautions
TCAs are Pregnancy Risk Category C.
These medications are contraindicated in clients who have seizure disorders
Use cautiously in clients who have coronary artery disease; diabetes, liver, kidney and respiratory disorders; urinary retention and obstruction; angle-closure glaucoma; benign prostatic hypertrophy; and hyperthyroidism.
Interactions
Selective Serotonin Reuptake Inhibitors (SSRI s)
Select Prototype Medication: Fluoxetine (Prozac)
Other Medications
Citalopram (Celexa)
Escitalopram oxalate (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)
pharmacological action
SSRIs selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin.
Therapeutic Uses
Major depression
Obsessive compulsive disorders (OCD)
Bulimia nervosa
Premenstrual dysphoric disorders
Panic disorders
Posttraumatic disorder (PTSD
Side/Adverse Effects


Contraindications/Precautions
These medications are Pregnancy Risk Category C.
Fluoxetine and paroxetine may increase the risk of birth defects. Other SSRIs should be used. Late in pregnancy, use of SSRIs may increase the risk of withdrawal symptoms or pulmonary hypertension in the newborn.
SSRIs are contraindicated in clients taking MAOIs or TCAs.
Use cautiously in clients with liver and renal dysfunction, cardiac disease, seizure disorders, diabetes, ulcers, and a history of GI bleeding.
Interactions
Monoamine Oxidase Inhibitors (MAOIs)
Select Prototype Medication: phenelzine (Nardil)
Other Medications:
Isocarboxazid (Marplan)
Tranylcypromine (Parnate)
Selegiline (Emsam) – transdermal MAOI
Pharmacological Action
These medications block MAO-A in the brain, thereby increasing the amount of norepinephrine (NE), dopamine, and serotonin available for transmission of impulses. An increased amount of these neurotransmitters at nerve endings intensifies responses and relieves depression.
Therapeutic Uses
Atypical depression
Bulimia nervosa
Obsessive compulsive disorders (OCD)
Side/Adverse Effects
Contraindications/Precautions
MAOIs are Pregnancy Risk Category C.
These medications are contraindicated in clients taking SSRIs and in those with pheochromocytoma, heart failure, cardiovascular and cerebral vascular disease, and severe renal insufficiency.
Use cautiously in clients with diabetes and seizure disorders or those taking TCAs.
Transdermal selegiline is contraindicated for clients taking carbamazepine (Tegretol) or oxcarbazepine (Trileptal), which may increase blood levels of the MAOI.
Interactions

Atypical Antidepressants
Select Prototype Medication: bupropion HCL (Wellbutrin)
Pharmacological Action
This medication acts by inhibiting dopamine uptake.
Therapeutic Uses
Treatment of depression
Alternative to SSRIs for clients unable to tolerate sexual dysfunction side effects of SSRIs
Aid to quit smoking
Prevention of SAD (seasonal affective disorder)
Side/Adverse Effects
Contraindications/Precautions
Bupropion is a Pregnancy Risk Category B.
This medication is contraindicated in clients taking MAOIs.
Use cautiously in clients who have seizure disorders.
Interactions
Nursing Administration
Instruct clients to take these medications as prescribed on a daily basis to establish therapeutic plasma levels.
Assist with medication regimen adherence by informing clients that therapeutic effects may not be experienced for 1 to 3 weeks. Full therapeutic effects may take 2 to 3 months.
Instruct clients to continue therapy after improvement in symptoms. Sudden discontinuation of medication can result in relapse.
Advise the client that therapy usually continues for 6 months after resolution of symptoms and may continue for a year or longer.
Nursing Administration
Suicide prevention can be facilitated by prescribing only a week’s worth of medication for an acutely ill client, and then only prescribing 1 month’s worth of medication at a time, especially with TCAs.

For SSRIs:
Advise clients to take medication in the morning to minimize sleep disturbances
Advise clients to take medications with food to minimize GI disturbances.
Obtain baseline sodium levels for older adult clients taking diuretics and monitor periodically.

For MAOIs:
Give clients a list of tyramine-rich food so hypertensive crises can be avoided.
Advise the client to avoid taking any other prescription or nonprescription medications unless approved by the provider.

For bupropion HCL:
Advise clients with SAD to take medication beginning in the autumn each year and gradually taper dose and discontinue by spring.
Nursing Evaluation of Medication Effectiveness
Verbalizing improvement in mood
Ability to perform ADLs
Improved sleeping and eating habits
Increased interaction with peers


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .
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