Depression for the Nurse Practitioner (NP) Licensing Exam
Major Depressive Disorder (MDD)
Diagnostic Criteria:
- Presence of five or more of the following symptoms during a 2-week period, with at least one of the symptoms being either depressed mood or loss of interest or pleasure:
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite.
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day.
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt.
- Diminished ability to think or concentrate, or indecisiveness.
- Recurrent thoughts of death, suicidal ideation without a specific plan, or a suicide attempt.
Management:
- Pharmacological: SSRIs are first-line treatment options. Other options include SNRIs, bupropion, and tricyclic antidepressants. See this tutorial for a review of Antidepressants
- Psychotherapy: Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), and other evidence-based psychotherapies.
- Lifestyle Modifications: Encouraging regular exercise, healthy diet, and adequate sleep.
Persistent Depressive Disorder (Dysthymia)
- Characteristics:
- Depressed mood for most of the day, more days than not, for at least 2 years.
- Presence of two or more of the following symptoms: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness.
- Treatment:
- Long-term psychotherapy and pharmacotherapy similar to MDD, often requiring a combination approach for effective management.
Adjustment Disorder with Depressed Mood
- Features:
- Emotional or behavioral symptoms developing within three months of the onset of a stressor.
- Symptoms are clinically significant, as evidenced by marked distress that is out of proportion to the severity of the stressor.
- Management:
- Short-term psychotherapy and, if necessary, transient use of antidepressants. Focus on stress management strategies and coping mechanisms.
Seasonal Affective Disorder (SAD)
- Clinical Presentation:
- Recurrent major depressive episodes that occur during a specific season (typically fall or winter).
- Treatment:
- Light therapy as the primary treatment. Supplemental SSRIs or other antidepressants may be used depending on the severity and response to light therapy.
Special Considerations
- Suicide Risk Assessment: Integral part of every evaluation. Monitor for worsening depression or emergence of suicidal thoughts, especially during the initial phases of treatment or during dose changes.
- Comorbid Conditions: Often coexists with anxiety disorders, substance use disorders, and chronic medical conditions which may complicate treatment and prognosis.
High-Yield Topics for Nurse Practitioner (NP) Exam
- Differential Diagnosis: Ability to distinguish between different types of depressive disorders and other mental health conditions like bipolar disorder.
- Pharmacokinetics and Pharmacodynamics: Understanding the mechanism of action, side effects, and special considerations of antidepressant medications.
- Patient Education and Advocacy: Educating patients and their families about the nature of the disorder, treatment options, importance of adherence, and prevention of relapse.