00:00
So how do we help them?
How do we help them?
Well, there are therapies
that have been demonstrated
and evidence to be
extremely effective.
00:12
And one of them is cognitive
behavioral therapy.
00:16
Now, it's really
important to remember,
registered nurses
are not therapists,
we do not give cognitive
behavioral therapy.
00:25
In order to give cognitive
behavioral therapy,
a person has to be trained in
cognitive behavioral therapy.
00:33
I always say when you're dealing
with a person who has mental illness,
our words are our scalpels.
00:41
And just as you might work
in emergency or in the OR,
you are not going to be
given a scalpel in the OR
if you don't know how
to do the surgery.
00:53
So what I want to
caution you is that
when you're working with a
person with mental illness,
therapies are like scalpels.
01:02
Our words, the way we deal
with people are very important.
01:07
Understanding how to establish
a nice therapeutic relationship
with our patients can
be extremely helpful.
01:17
To do that safe, make sure that you have
a safe environment where they feel secure
to A. assess what's
going on with them,
to focus just on them
and to evaluate
how they are doing.
01:35
This is the best relationship that you
can put in the room with that person,
bring your true self in.
01:44
When we're thinking about these
different therapies and the treatments,
when you're thinking about
the fact that they may have
things like trans
magnetic stimulation.
01:57
This is not something a
registered nurses going to do.
02:01
What we are going to do is
we are going to monitor them,
we're going to look and see
them, the person,
we're going to make sure
that they are able to get
the medications that they need, that are
prescribed for them by practitioners.
02:17
So that is really important.
02:20
Light therapy is something that
we can advise a patient,
spend more time outside, get more light.
02:29
There are now over the counter
lights that people can use.
02:33
But you have to read
those directions.
02:37
And think about this,
what if you're telling somebody,
"Oh, you can use light therapy."
And they go home and they turn
on the lights, nothing happens.
02:46
And now they are completely
feeling like a failure.
02:50
Because now we have said to them, we've
set them up with hope without reality.
02:56
Light therapy as therapy.
02:59
Yes, if you have somebody who in
the winter is getting depressed,
and it's getting
dark at 4 o'clock,
to be able to have one of those lights that
gives a little bit more light to their life
that might be a
little bit helpful.
03:15
It is not going to eradicate
a major depressive disorder.
03:20
That person needs
much bigger help.
03:24
And that's what we
have to think about.
03:26
They may need to have
psychopharmacology.
03:31
So one of the ways that we do help
our patients is through medication.
03:36
Medications are required in many
cases with major depressive disorder
and they come from
a practitioner.
03:45
There are different types
of pharmacology that we use,
the medications and it
depends on the person.
03:52
We treat the disease that the
person has and the person needs.
03:57
There are a number
of different types.
03:59
For example,
there are the SSRI's.
04:02
And may know Zoloft,
you may know Prozac,
you may know
Citalopram or Celexa.
04:11
These are the medications
that we hear most about.
04:16
There is also Lexapro
again, SSRI's, Paxil,
and also Luvox and Trazodone.
04:25
Trazodone is sometimes used
also to help people sleep.
04:29
But we also have the SNRI's.
04:32
And in that group,
we have Pristiq and we have Cymbalta.
04:36
We have the Fetzima
and we also have Effexor XR.
04:44
So when you're thinking
about the psychopharm,
that medication is
going to be delivered
and given to that patient because
it works for that patient.
04:55
Different medications work
for different patients.
04:58
And we want to really be careful
about what we're giving them.
05:02
This here are the
tricyclic antidepressants.
05:07
And so we want to be
watching these patients
as they're taking
these medications.
05:13
We want to be watching them for
any kind of negative side effects.
05:18
There are also tetracyclic.
05:21
but they are not as commonly used
as the ones who are tricyclic.
05:26
We also have medications that
when the patient is taking them,
the patient has to be very
careful about what they're eating.
05:35
And those are MAOIs.
05:38
With the MAOIs, they do work to get rid
of some of the symptoms of depression.
05:44
But our job with these
patients as we are
offering them these
medications in the hospital
is really to be watching them.
05:53
And to watch them and tell them
about the dietary restrictions
that they need to have.
05:59
Because these
medications when taken,
and if the person has
cheese, for example, or beer,
this person might have a very
bad hypertensive reaction,
critical hypertensive reaction
that may require hospitalization.
06:19
So although MAOIs are medications
that are used and are very effective,
with some patients, there's a lot of
education that goes along with it.
06:29
Now, there are over the
counter medications as well,
many of you may have heard of St.
John's Wort.
06:36
And people swear, some people swear that
it really helps them with their depression.
06:44
It does have some
positive side effects.
06:47
But in any kind of evidence
that we've looked at
that positive effect was really
no bigger than a placebo effect.
06:58
People who got the medication and
then got a placebo or non medication,
they both felt better.
07:05
Part of that was that they were doing
something just to help themselves,
which is really helpful.
07:12
The one problem that we have with St.
John's Wort is,
well, there are two problems.
07:16
One is that it can have
interactions with other medications,
and they can be serious.
07:23
The other is that sometimes
people won't tell you
that they're taking St.
John's Wort.
07:29
And then when you put
them on other medications,
and they have that serious
response, we don't know why.
07:35
So it's really important when you're
talking to your patients to say,
Are you on any
other medications?
How about any over the
counter treatments?
Have you ever taken something like every
day, like a vitamin or anything else?
And then you might hear that
they say that they have,
they've been taking St.
John's Wort.
07:56
What does it interact with?
It interacts with
anti-seizure medications.
08:01
It interacts with
birth control pills.
08:04
It interacts with warfarin
or blood thinners.
08:07
And it also will interact with
any prescription antidepressants
that they might be
then asked to take.
08:16
That's really important.
08:19
SAMe is another over-the-counter,
OTC drug.
08:23
Well, this again,
people feel that it has helped them.
08:28
They feel that they've got
these positive effects.
08:32
But once again,
when we test them scientifically,
those effects are no better
than a placebo effect.
08:39
And once again,
they can cause serious interactions.
08:48
Important for us to
know what people are on.