Review of Depression: Treatment (Nursing)

00:00 So let's look at the treatment modalities available for depression.

00:04 Now, pharmacotherapy, since this is a pharmacology video series, we're gonna focus in on that one but I also want to bring up a couple of the other options that are out there.

00:13 Now, pharmacology is gonna -- we're gonna consider pharmacotherapy a primary therapy.

00:19 What I wanna encourage you in is that first of all, a lot of patients feel a stigma about taking a depression medication.

00:26 So they're hesitant to take it sometimes, they don't want to take something that changes their brain, so there's a lot of misinformation out there about pharmacotherapy associated with depression.

00:38 There are certain times in your life with hormonal changes, situational, there's a number of reasons a patient could be experiencing depression.

00:47 You're getting ready to do a really tough professional job.

00:51 You're gonna face very difficult things.

00:54 There may be periods of time when this is appropriate for you so don't just cross this off, educate yourself about depression medication so you can speak intelligently with your patients about what you've experienced, what you've seen, and what you know.

01:09 Now another side note, every time I teach pharmacology, I know that there's people in the classroom that are dealing with depression and that may have even tried a drug but it wasn't the right one for them so I always remind students treating my depression, your depression, their depression is not the same.

01:29 Every patient can have a little bit unique or different circumstances and pharmacokinetics so if the first one doesn't work, keep going.

01:39 And if you're not having a good result with maybe your family practice doc or your internal medicine, seek out somebody who's a specialist in the brain and depression.

01:50 Keep going 'til you find something that works for you.

01:54 So that's pharmacotherapy and we're gonna break down the specific drugs but I wanna talk about three other things.

02:00 Now this one, I actually am a really big fan of this one too.

02:04 Depression-specific psychotherapy. Cognitive behavioral therapy.

02:09 Now, this is with a trained therapist, someone that this is their specialty, and they can teach you how to retrain your brain essentially.

02:17 There's proven techniques and strategies when you recognize some of the thoughts and feelings that are coming into your mind, how to refrain those into something that's healthier and more beneficial for you.

02:29 So I think these two go together, pharmacotherapy and the cognitive brain therapy or other depression-specific psychotherapy, I think are excellent together.

02:39 Now, the next two I wanna talk about are kind of extreme.

02:43 So these are ones when, hey, the traditional methods haven't worked so these are things that could be considered.

02:51 The first is electroconvulsive therapy.

02:53 So this is when drug and psychotherapy haven't worked.

02:58 This is pretty significant. It's a pretty extreme treatment.

03:02 Patients are usually sedated, they use electricity through the head, but I have known patients that these other therapies did not work for them and they so desperately wanna relieve from some of these symptoms that this is a treatment that they went to.

03:18 Now, it's not like you've seen in the movies. It's different.

03:22 It's a lot more -- diagnosis is a lot more straightforward but still it's a pretty extreme therapy that you would wanna have a long discussion of the pros and cons with a health care provider.

03:33 Now, the last one is vagus nerve stimulation and this is only after like 4 medications haven't worked.

03:39 So we're not gonna go into detail of both of these therapies except I just wanted you to know that they're out there.

03:45 Our focus for the course will be pharmacotherapy or the drugs.

03:50 Now, there's a suicide risk with antidepressants and I wanted to say that right upfront because sometimes we found that patients who are struggling with depression, when they take an antidepressant, it might increase their tendency early in the treatment.

04:04 Now, some theory say maybe that's because the patient now has enough energy to carry out their plan.

04:09 Not exactly sure why it happens, we just know as nurses that we're on watch and we're on alert that early on in the treatment, we want to know that the patients could be at an increased risk for suicide so we always want to watch that and assess for it.

04:25 So it's appropriate for you to ask and say, "How are you feeling?" Or if someone lets you know they're feeling really down, you know the classic questions you've probably already been taught in nursing school, but you ask, "Hey, are you thinking about harming yourself?" And the second question is, "Do you have a plan?" And remember, as nurses, when you're a licensed nurses, you have a responsibility to report anything where you feel a patient is at risk.

04:50 Okay, so let's break that suicide risk with antidepressants down a little bit.

04:55 What are you looking for? Well, for both their mood worsening and maybe some changes in their behavior.

05:01 These are things that we're gonna be on guard for.

05:04 So when you say suicidality, they're having increased thoughts about taking their own life.

05:08 So the kind of precautions we put into place is that we try to give the patient the smallest number of doses, the smallest size dose that we can that's going to be effective.

05:19 Now, as a registered nurse, you won't make that decision but you will collaborate with a health care provider.

05:26 You'll interact with the patient, you'll get assessment information from them.

05:29 You'll sit down and have conversations with them so you can give that information to the health care team.

05:34 Now, dosing of in-patients are obviously gonna be directly observed.

05:38 So if someone was hospitalized for this depression and now we know that they are suicidal or at least have the depression, that dosing is gonna be a lot.

05:46 We're gonna be able to watch them a lot more closely but many patients are in the out-patient setting when starting antidepressants.