Depression management

NICE, Depression Management of Depression in Primary and Secondary Care CSIP, Choice and Access Programme, 2007 Eero Castren, 2005 H. G. Ruhe, N. S. Mason and Aart H. Schene, 2007. 

NICE, Depression Management of Depression in Primary and Secondary Care . 

NICE, Depression Management of Depression in Primary and Secondary Care. Clinical Practice Guideline No. 23 , National Institute for Clinical Excellence www.nice.org.uk/page.aspxio = 235213 Nitzan, Uriel and Pesach Lichtenberg, Questionnaire Survey on Use of Placebo , British Medical Journal 329 (2004) 944-46 Park, Lee C. and Lino Covi, Nonblind Placebo Trial , Archives of General Psychiatry 12, no. 4 (1965) 336-45... 

Salin-Pascual R. J. (2005). Comparative study between mirtazapine vs. zolpidem in isomnia associated with major depression management. Rev. Mex. Neurosci. 6, 212-17. 

Preskorn S (1994) Targeted pharmacotherapy in depression management comparative pharmacokinetics of fluoxetine, paroxetine and sertraline. Int Clin Psychopharmacol 9(Suppl3) 13-19... 

Malhi GS, Mitchell PB, Salim S. Bipolar depression management options. CNS Drugs. 2003 17 9-25. 

Bipolar affective (manic- depressive) Characterized by episodes of mania. Cyclic mania alone, rare depression alone, occasional mania-depression, usual. About 10-15% of all depressions. May be misdiagnosed as endogenous if hypomanic episodes are missed. Lithium carbonate stabilizes mood. Mania may require antipsychotic drugs as well depression managed with antidepressants. 

National Institute for Health and Clinical Excellence. CG23. Depression management of depression in primary and secondary care—NICE Guidance, December 2005 http //gui-dance.nice. org.uk/CG23. 

Depression—management of depression in primary and secondary care. Clinical Guideline 23. National Institute for Clinical Excellence (UK), December 2004. 

Table 21.1 Depression differential diagnoses Table 21.2 FD depression management Chapter 22 Generalised anxiety disorder (GAD)...

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

MONITORING AND MANAGING RESPIRATORY DEPRESSION These drugs depress the CNS and can cause respiratory depression. The nurse carefully assesses respiratory function (rate, depth, and quality) before administering a sedative, Vs, to 1 hour after administering the drug, and frequently thereafter. Toxic reaction of the barbiturates can cause severe respiratory depression, hypoventilation, and circulatory collapse. 

Antidepressant drugs are used to manage depressive episodes such as major depression or depression accompanied by anxiety. These drugs may be used in conjunction with psychotherapy in severe depression. The SSRIs also are used to treat obsessive-compulsive disorders. The uses of individual antidepressants are given in the Summary Drug Table Antidepressants. Treatment is usually continued for 9 months after recovery from the first major depressive episode. If the patient, at a later date, experiences another major depressive episode, treatment is continued for 5 years, and with a third episode, treatment is continued indefinitely. 

Emotional instability - displaying depressive, aggressive or simply moody behaviour is a taboo for mentors. They must learn how to manage their emotions so as to be capable of providing mentees with the calmness, patience and reflectivity that is required of them. 

Benzodiazepines and other anxiolytics. Although benzodiazepines are widely used in the treatment of acute alcohol withdrawal, most nonmedical personnel involved in the treatment of alcoholism are opposed to the use of medications that can induce any variety of dependence to treat the anxiety, depression, and sleep disturbances that can persist for months following withdrawal. Researchers have debated the pros and cons of the use of benzodiazepines for the management of anxiety or insomnia in alcoholic patients and other substance abuse patients during the postwithdrawal period (Ciraulo and Nace 2000 Posternak and Mueller 2001). 

A meta-analysis of placebo-controlled studies by Levin and Lehman (1991) showed that desipramine produced greater cocaine abstinence than placebo. Although a more recent review did not concur (Lima et al. 2001), secondary analyses of studies with imipramine, desipramine, and bupropion suggested that depressed cocaine abusers are more likely to show significant reductions in cocaine abuse than nondepressed cocaine abusers (Margolin et al. 1995 Nunes et al. 1991 Ziedonis and Kosten 1991). Furthermore, recent work with desipramine supported its efficacy in opioid-dependent patients, particularly in combination with contingency management therapies (Kosten et al. 2004 Oliveto et al. 1999). 

Edgell ET, Hylan TR (1997). Economic outcomes associated with initial treatment choice in depression a retrospective database analysis. Am J Managed Care 5, S51. 

Einarson TR, Arikian S, Sweeney S, Doyle J (1995). A model to evaluate the cost effectiveness of oral therapies in the management of patients with major depressive disorders. Clin Ther 17, 136-53. 

SkaerTL, Sclar DA, Robison LM, et al (1995). Economic valuation of amitriptyline, desipramine, nortriptyline, and sertraline in the management of patients with depression. Curr Ther Res 56, 556—67. 

Out-patient treatment is substantially cheaper than in-patient management and is generally as effective (Lowman, 1991). A French study on patients with generalized anxiety disorder estimated costs per patient over 3 months to he US 423 for hospitalization, 335 for out-patient services and 43 for medications (Souetre et al, 1994). Comorbid conditions (mostly alcoholism and depression) doubled these direct health-care costs. Over three-quarters of all patients were taking anxiolytic medication. 

Drug treatment is a vital part of the management of bipolar disorder, both during episodes of depression or mania and as prophylaxis thereafter. Patients require explanation and education about the illness and about the treatments available, in order to be able to make informed choices and to avail themselves of the appropriate options fot treatment. 

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