Major Depressive Disorders: Treatment and Psychopharmacology (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    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.

    01:34 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.

    02:00 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.

    02:45 And now they are completely feeling like a failure.

    02:49 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.

    03:44 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.

    04:31 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 when we think about tricyclic that means there are 3 different kinds of medications that are in that same medication.

    05:16 And so we want to be watching these patients as they're taking these medications.

    05:21 We want to be watching them for any kind of negative side effects.

    05:27 Because again, tricyclics have 3 different medications in them.

    05:33 There are also tetracyclic.

    05:36 And those have 4 different medications in them, but they are not as commonly used as the ones who are tricyclic.

    05:44 We also have medications that when the patient is taking them, the patient has to be very careful about what they're eating.

    05:53 And those are MAOIs.

    05:56 With the MAOIs, they do work to get rid of some of the symptoms of depression.

    06:03 But our job with these patients as we are offering them these medications in the hospital is really to be watching them.

    06:11 And to watch them and tell them about the dietary restrictions that they need to have.

    06:17 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.

    06:37 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.

    06:47 Now, there are over the counter medications as well, many of you may have heard of St. John's Wort.

    06:54 And people swear, some people swear that it really helps them with their depression.

    07:02 It does have some positive side effects.

    07:05 But in any kind of evidence that we've looked at that positive effect was really no bigger than a placebo effect.

    07:16 People who got the medication and then got a placebo or non medication, they both felt better.

    07:23 Part of that was that they were doing something just to help themselves, which is really helpful.

    07:30 The one problem that we have with St. John's Wort is, well, there are two problems.

    07:34 One is that it can have interactions with other medications, and they can be serious.

    07:41 The other is that sometimes people won't tell you that they're taking St. John's Wort.

    07:47 And then when you put them on other medications, and they have that serious response, we don't know why.

    07:53 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.

    08:14 What does it interact with? It interacts with anti-seizure medications.

    08:19 It interacts with birth control pills.

    08:22 It interacts with warfarin or blood thinners.

    08:26 And it also will interact with any prescription antidepressants that they might be then asked to take.

    08:34 That's really important.

    08:37 SAMe is another over-the-counter, OTC drug that people feel.

    08:42 I don't need to go to a doctor, I'm just going to take some SAMe.

    08:46 I saw something on television, I'm going to take it.

    08:49 Well, this again, people feel that it has helped them.

    08:54 They feel that they've got these positive effects.

    08:58 But once again, when we test them scientifically, those effects are no better than a placebo effect.

    09:05 And once again, they can cause serious interactions.

    09:14 Important for us to know what people are on.

    About the Lecture

    The lecture Major Depressive Disorders: Treatment and Psychopharmacology (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Mood Disorders: Major Depressive and Bipolar Disorders (Nursing).

    Included Quiz Questions

    1. “Light therapy is extremely effective at stopping most depressive symptoms.”
    2. “Antidepressants are the only treatment for MDD.”
    3. “Cognitive behavioral therapy has shown to be an effective treatment for depression.”
    4. “Transcranial magnetic stimulation can be used to help people experiencing MDD.”
    1. SNRIs
    2. SSRIs
    3. Tricyclic antidepressants
    4. ACE-inhibitors
    5. HZT
    1. Sertraline (Zoloft)
    2. Fluoxetine (Prozac)
    3. Escitalopram (Lexapro)
    4. Venlafaxine (Effexor XR)
    5. Duloxetine (Cymbalta)
    1. Aged cheese
    2. Salami
    3. Beer
    4. Ground turkey
    5. Nuts and seeds
    1. “I’ve started taking St. John’s Wart with my sertraline every morning to maximize its effects.”
    2. “I’ve heard that taking SAMe is much more effective than taking an SSRI.”
    3. “I’ve started taking a walk every morning after I take my fluoxetine.”
    4. “I’ve stopped drinking beer since being prescribed an MAOI.”

    Author of lecture Major Depressive Disorders: Treatment and Psychopharmacology (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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