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Depression:

PREVALENCE: Females > Males 2: 1. This is really a women’s health problem.

ETIOLOGY:

Social: issues of power, abuse, etc. socialization.

Physiological: Heredity. Decrease is neurotransmitters, particularly serotonin (5 HT) and norepinephrine (NE).

Medications: Beta blockers such as Indural, clonidine, aldomet, thiazides, aldactone, progesterone, oral contraceptives, steriods cimetidine?.

Medical problems: hypothyroidism, anemia, alcohol abuse or other durgs. May coexist with chronic fatigue, somatization disorder, chronic back pain, chronic headaches.

INCIDENCE: Lifetime for all adults 8.3-20%.

SYMPTOMS: (hopeless, helpless and hapless)

Types:

1. Major depression (Mild depression may be treated by the FNP. If response is not positive, refer or consult mental health professional
   1. Melancholic
   2. Seasonal
2. Bipolar . Needs to be followed by mental health professional.
3. Dysthymia. Needs to be followed by mental health professional?

DSM-IV Criteriqa for Major Depressive Episode

1. At least 5 of the following symptoms present nearly every day during the same 2-week period, including one of the first two:

• Depressed mood most of the day.
• Markedly dimisher interest in, or pleasure in all, or almost all, activities most of the day.
• Significant weight loss when not dieting or weight gain, or decrease or increase in appetite.
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Consistent feelings of worthlessness, excessive or inappropriate guilt
• Dimished ability to think or concentrate
• Recurrent suicidal thoughts, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

2. The symptoms do not meed criteria for a mixed episode.

3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4. The symptoms are not due to the direct physiologic effects of a substance or general medical condition

5. The symptoms are not better accounted for by bereavement.

Questions to ask.

Can you describe your mood for me? How long have you felt this way?

What is the feeling of depression like for you?

Have you noticed changes in you level of interest in normal activities?

How would you rate your feelings of depression on a 1-10 scale?

How do you explain your depression?

Have you experiencces any lo9sses or changes in your life?

If you could change one thing about your current situation, what would it be? What do you think would help you feel better? If you have had a problem with depression before, what helped you at that time? Are you experiencing thoughs of harm to yourself? Do you have a plan for suicide? How would you go about it?

DIFFERENTIAL DIAGNOSES:

Seasonal Affective Disorder

Postpartum depression

Premenstrual Tension

Screening Tools

Beck Depression Inventory

Hammond Depression Scale

TREATMENT:

Rule out medical problems.

Explain biologic, social etioloty

Explain basis of treatment

Assess for suicide risk

Treat medical conditions

Referal for psychotherapy

MEDICATIONS: Note: Individual responses to medications are dramatic. Follow your patients closely--weekly at first, they at less frequent intervals, but follow

Do not use MAO inhibitors. Too many side effects and interactions.

Tricyclic antidepressants

Selective serotonin reuptake inhibitors

Atypical antidepressants

COMPLEMENTARY THERAPY: Note: These are brief accounts. Read more about complementary therapies if you are going to prescribe them.

St. Johns Wort: (Hypericum perforatum) Action: possible MAOI, but possibly increases neurotransmittors as well. Takes 4-6 weeks for full effect. Dose: 300 mg TID. Use research grade. Used for mild depression; also used to decrease anxiety and promote sleep. Side effects: GI irritation (take with food), dry mouth, fatigue.

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