depression(redirected from Major depressive disorder-recurrent)
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Depression is closely associated with a lack of confidence and self-esteem and with an inability to express strong feelings. Repressed anger is thought to be a powerful contributor to depression. The person feels inadequate to cope with the situations that arise in everyday life and so feels insecure.
Treatment of profound and chronic depression is often very difficult, requiring in most cases intensive psychotherapy to help the patient understand the underlying cause of the depression. antidepressant drugs such as imipramine hydrochloride (Tofranil) and amitriptyline (Elavil) are often used in the treatment of profound depression. They are not true stimulants of the central nervous system, but they do block the reuptake of neurotransmitter substances, which may potentiate the action of norepinephrine and serotonin. monoamine oxidase (MAO) inhibitors are also used. When antidepressants fail, a different technique such as electroconvulsive therapy may be used in conjunction with the psychotherapy.
When patients are depressed, they are likely to isolate themselves and avoid social contact even with those who are trying to help them. Since loss of contact with others contributes to depression, members of the health care team should persist in attempts to talk with these patients, by asking them questions, and actively listening when they attempt to express their feelings. One should be especially careful to avoid being judgmental when the patient does express despair, anger, hostility, or some negative feeling. Above all, it is important not to be condescending or to respond to statements with a meaningless cliché such as “Don't worry,” or “I'm sure everything will turn out okay.” These responses convey a lack of empathy with the patient's suffering and are an unrealistic approach to a problem that is very real.
Physical contact and touching may be misunderstood by depressed patients. Sometimes, it is better just to sit with them and calmly observe them without making them feel uncomfortable. Honest dialogue and expressions of support and concern can often improve their mood and sense of self worth.
Severely depressed patients usually express three basic feelings associated with their mental state. These are a lack of desire for socializing or physical activity, feelings of worthlessness and loss of self esteem, and thoughts of self-injury or destruction. In planning the care of the depressed patient, one must always consider these feelings and strive for some understanding of the reasons for the patient's behavior. Only by gradually gaining their attention and pointing out encouraging signs of progress can they be helped in their early attempts to return to reality and socialize with others.
Physical inactivity will require attention to adequate nutrition, a normal balance of fluid intake and output, proper elimination, and good skin care. Patients will need help in maintaining good personal hygiene. Severely depressed patients may be totally out of touch with reality and completely unresponsive to anyone else's presence. In such instances the health care provider may be able to do little more than demonstrate caring and empathy by remaining with the patient.
Consistency of care is helpful to depressed patients. They know what to expect, and thus are not repeatedly disappointed when their expectations are not met. An example is consistency in scheduling and carrying out treatments and routine care at the same time each day. A supportive family and interested friends should be involved in choosing and planning activities that are helpful.
Constant vigilance must be maintained to prevent the profoundly depressed patient from injuring himself or committing suicide. Self-destructive behavior is a manifestation of the patient's feeling of worthlessness and loss of self esteem. An awareness of the potential dangers in such a situation should help the provider plan and provide a safe and congenial atmosphere, remaining alert to the early signs of a patient's intention to harm or destroy himself. In most cases suicide is most likely to occur when the patient is recovering from severe depression.
cyclosporine ophthalmic emulsion
Restasis, Sandimmun (UK)CNS: tremor, headache, confusion, paresthesia, insomnia, anxiety, depression, lethargy, weakness
Pharmacologic class: Polypeptide antibiotic
Therapeutic class: Immunosuppressant
Pregnancy risk category C
Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm
FDA Box Warning
• Drug should be prescribed only by physicians experienced in managing systemic immunosuppressive therapy for indicated disease. At doses used for solid-organ transplantation, it should be prescribed only by physicians experienced in immunosuppressive therapy and management of organ transplant recipients. Patient should be managed in facility with adequate laboratory and medical resources. Physician responsible for maintenance therapy should have complete information needed for patient follow-up.
• Neoral may increase susceptibility to infection and neoplasia. In kidney, liver, and heart transplant patients, drug may be given with other immunosuppressants.
• Sandimmune should be given with adrenal corticosteroids but not other immunosuppressants. In transplant patients, increased susceptibility to infection and development of lymphoma and other neoplasms may result from increased immunosuppression.
• Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably without physician supervision.
• In patients receiving Sandimmune soft-gelatin capsules and oral solution, monitor at repeated intervals (due to erratic absorption).
Unclear. Thought to act by specific, reversible inhibition of immunocompetent lymphocytes in G0-G1 phase of cell cycle. Preferentially inhibits T lymphocytes; also inhibits lymphokine production. Ophthalmic action is unknown.
Capsules: 25 mg, 100 mg
Injection: 50 mg/ml
Oral solution: 100 mg/ml
Solution (ophthalmic): 0.05% (0.4 ml in 0.9 ml single-use vial)
⊘Indications and dosages
Adults:Neoral only-1.25 mg/kg P.O. b.i.d. for 4 weeks. Based on patient response, may increase by 0.5 mg/kg/day once q 2 weeks, to a maximum dosage of 4 mg/kg/day.
➣ Severe active rheumatoid arthritis
Adults:Neoral only-1.25 mg/kg P.O. b.i.d. May adjust dosage by 0.5 to 0.75 mg/kg/day after 8 weeks and again after 12 weeks, to a maximum dosage of 4 mg/kg/day. If no response occurs after 16 weeks, discontinue therapy. Gengraf only-2.5 mg/kg P.O. daily given in two divided doses; after 8 weeks, may increase to a maximum dosage of 4 mg/kg/day.
➣ To prevent organ rejection in kidney, liver, or heart transplantation
Adults and children:Sandimmune only-Initially, 15 mg/kg P.O. 4 to 12 hours before transplantation, then daily for 1 to 2 weeks postoperatively. Reduce dosage by 5% weekly to a maintenance level of 5 to 10 mg/kg/day. Or 5 to 6 mg/kg I.V. as a continuous infusion 4 to 12 hours before transplantation.
➣ To increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca
Adults: 1 drop in each eye b.i.d. given 12 hours apart
• Aplastic anemia
• Atopic dermatitis
• Hypersensitivity to drug and any ophthalmic components
• Rheumatoid arthritis, psoriasis in patients with abnormal renal function, uncontrolled hypertension, cancer (Gengraf, Neoral)
• Active ocular infections (ophthalmic use)
Use cautiously in:
• hepatic impairment, renal dysfunction, active infection, hypertension
• herpes keratitis (ophthalmic use)
• pregnant or breastfeeding patients
• children younger than age 16 (safety and efficacy not established for ophthalmic use).
• For I.V. infusion, dilute as ordered with dextrose 5% in water or 0.9% normal saline solution. Administer over 2 to 6 hours.
• Mix Neoral solution with orange juice or apple juice to improve its taste.
• Dilute Sandimmune oral solution with milk, chocolate milk, or orange juice. Be aware that grapefruit and grapefruit juice affect drug metabolism.
• In postoperative patients, switch to P.O. dosage as tolerance allows.
• Be aware that Sandimmune and Neoral aren't bioequivalent. Don't use interchangeably.
• Before administering eyedrops, invert unit-dose vial a few times to obtain a uniform, white, opaque emulsion.
• Know that eyedrops can be used concomitantly with artificial tears, allowing a 15-minute interval between products.
CV: hypertension, chest pain, myocardial infarction
EENT: visual disturbances, hearing loss, tinnitus, rhinitis; (with ophthalmic use) ocular burning, conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, itching, stinging, blurring
GI: nausea, vomiting, diarrhea, constipation, abdominal discomfort, gastritis, peptic ulcer, mouth sores, difficulty swallowing, anorexia, upper GI bleeding, pancreatitis
GU: gynecomastia, hematuria, nephrotoxicity, renal dysfunction, glomerular capillary thrombosis Hematologic: anemia, leukopenia, thrombocytopenia
Metabolic: hyperglycemia, hypomagnesemia, hyperuricemia, hyperkalemia, metabolic acidosis
Musculoskeletal: muscle and joint pain
Respiratory: cough, dyspnea, Pneumocystis jiroveci pneumonia, bronchospasm
Skin: acne, hirsutism, brittle fingernails, hair breakage, night sweats
Other: gum hyperplasia, flulike symptoms, edema, fever, weight loss, hiccups, anaphylaxis
The following interactions pertain to oral and I.V. routes only.
Drug-drug.Acyclovir, aminoglycosides, amphotericin B, cimetidine, diclofenac, gentamicin, ketoconazole, melphalan, naproxen, ranitidine, sulindac, sulfamethoxazole, tacrolimus, tobramycin, trimethoprim, vancomycin: increased risk of nephrotoxicity
Allopurinol, amiodarone, bromocriptine, clarithromycin, colchicine, danazol, diltiazem, erythromycin, fluconazole, imipenem and cilastatin, itraconazole, ketoconazole, methylprednisolone, nicardipine, prednisolone, quinupristin/dalfopristin, verapamil: increased cyclosporine blood level
Azathioprine, corticosteroids, cyclophosphamide: increased immunosuppression Carbamazepine, isoniazid, nafcillin, octreotide, orlistat, phenobarbital, phenytoin, rifabutin, rifampin, ticlopidine: decreased cyclosporine blood level
Digoxin: decreased digoxin clearance
Live-virus vaccines: decreased antibody response to vaccine
Lovastatin: decreased lovastatin clearance, increased risk of myopathy and rhabdomyolysis
Potassium-sparing diuretics: increased risk of hyperkalemia
Drug-diagnostic tests.Alanine aminotransferase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, glucose, low-density lipoproteins: increased levels
Hemoglobin, platelets, white blood cells: decreased values
Drug-food.Grapefruit, grapefruit juice: decreased cyclosporine metabolism, increased cyclosporine blood level
High-fat diet: decreased drug absorption (Neoral)
Drug-herbs.Alfalfa sprouts, astragalus, echinacea, licorice: interference with immunosuppressant action St. John's wort: reduced cyclosporine blood level, possibly leading to organ rejection
• Observe patient for first 30 to 60 minutes of infusion. Monitor frequently thereafter.
• Monitor cyclosporine blood level, electrolyte levels, and liver and kidney function test results.
• Assess for signs and symptoms of hyperkalemia in patients receiving concurrent potassium-sparing diuretic.
• Advise patient to dilute Neoral oral solution with orange or apple juice (preferably at room temperature) to improve its flavor.
• Instruct patient to use glass container when taking oral solution. Tell him not to let solution stand before drinking, to stir solution well and then drink all at once, and to rinse glass with same liquid and then drink again to ensure that he takes entire dose.
• Tell patient taking Neoral to avoid high-fat meals, grapefruit, and grapefruit juice.
• Advise patient to dilute Sandimmune oral solution with milk, chocolate milk, or orange juice to improve its flavor.
• Instruct patient to invert vial a few times to obtain a uniform, white, opaque emulsion before using eyedrops and to discard vial immediately after use.
• Inform patient that eyedrops can be used with artificial tears but to allow 15-minute interval between products.
• Caution patient not to wear contact lenses because of decreased tear production; however, if contact lenses are used, advise patient to remove them before administering eyedrops and to reinsert 15 minutes after administration.
• Inform patient that he's at increased risk for infection. Caution him to avoid crowds and exposure to illness.
• Instruct patient not to take potassium supplements, herbal products, or dietary supplements without consulting prescriber.
• Tell patient he'll need to undergo repeated laboratory testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.
depressionDejection, low spirits Psychiatry A spectrum of affective disorders characterized by attenuation of mood, accompanied by psychogenic pain, diminution of self-esteem, retardation of thought processes, psychomotor sluggishness, disturbances of sleep and appetite, and not uncommonly, suicidal ideation; depression can be triggered by stressful life events, associated with medical or mental disorders, or may be idiopathic Clinical Apathy, anorexia, lack of emotion–flat affect, social withdrawal, fatigue Types Major depression, dysthymia, bipolar disorder; depression may run in families. See Anaclitic depression, Bipolar disorder, Clinical depression, DART, Depressive disorders, Double depression, Endogenous depression, Inbreeding depression, Major depression, Masked depression, Postoperative depression, Postpartum depression, Reactive depression.
depressionSadness or unhappiness, usually persistent. This may be a normal reaction to unpleasant events or environment or may be the result of a genuine depressive illness. Pathological depression features a sense of hopelessness, dejection and fear out of all proportion to any external cause. There is persistent low mood, loss of interest or pleasure, low energy, fatigue, disturbed sleep, slowing down of body and mind, poor concentration, confusion, self-reproach, self-accusation and loss of self-esteem. Suicide is an ever-present risk. NICE guidelines for treatment recommend fluoxetine or citalopram. Exercise is valuable.
depressiona mood disorder characterized by feelings of profound sadness. May be classified by severity, by the presence of somatic symptoms and by the presence or absence of psychotic symptoms. Cognitive symptoms include hopelessness, helplessness, guilt, low self-esteem and suicidal thoughts. endogenous depression not resulting from a reaction to a particular negative experience. reactive depression resulting from a reaction to a particular negative experience (such as bereavement, physical illness or loss of employment), also known as exogenous depression. Research has shown that a structured exercise programme can have a mood-enhancing effect similar (and complementary) to that seen with the use of antidepressant medication. See also antidepressants.
n 2. a pitted area on a tooth or other anatomic surface.
Patient discussion about depression
Q. am i depressed i feel sad,lonely,streeted,worthless that nothing matter anymore..i sleep all the time,loss of intrest of everything..
Q. what about depression?
Q. what causes depression?
You may want to start there.