need info on depression in crit care units

leslie :-D · Feb 25, 2006

i'd be curious to understand the correlation between depression and recovery time in the ccu. is recovery delayed because of depression?

leslie

suzanne4, RN · Feb 25, 2006

I see it quite often in patients that have prolonged ICU stays. We have had excellent results with Prozac, it can be crushed and placed in feeding tubes and it works.........

Unfortunately, this is one area that many do not treat in some facilities and can really bring a turn around to the patient as well as get them better sooner.

Saifudin · Feb 25, 2006

I am trying to find out more of the effects of depression on patients in critical care units. i am more interested in delirium and there is quite a bit of information regarding adverse effects of delirium on increased weaning times from MV and overall impact on morbidity. The sponsors of the conference want "mood disorder in critical care" which is strange, however, I beleive they are referring to depression and not bipolar disease, etc.

There is information regarding depression occurring up to one year post MI, which is understandable. In fact, emotional impact of illness in general is understandable, particularly in chronic illness, but I am trying to find information on the impact in an acute illness that requires critical care.

Suzanne, how do your patients in critical manifest depressive symptoms and how is it assessed. What is the impact and what improvements do you see with prozac. Do you consult a psych. liason? Do pts. with depressive symptoms try to reject Rx; remove t-tubes, feeding tubes, etc.?

Thanks

Saifudin, RN, CRNP, BS

Dir. of Nsg

Thunderwolf, MSN, RN · Feb 25, 2006

One aspect to keep in mind is the concern of loss and/or perceived loss...relate this as well to changes in self efficacy, self concept, and self worth. Loss in relating, loss in function, and perceived loss of hope. The power of family, friends, and the nursing staff reaching out and being there for the patient can not be overrated.

Saifudin · Feb 26, 2006

Your absolutely right. The psycho-social aspects are as important as the 'biological' aspects. In response to leslie who asked about depression and relationship to recovery times in the CCU; stress (anxiety, depression) effects the sympthetic nervous system, thus catecholimines place a stress on the heart which can be detrimental in the early (and late) AMI periods.

The psycho-social-spiritual parts of the 'bio-psycho-social' model of care is what makes being an NP really enjoyable and rewarding. This was discussed sometime back on another board; but, it really has been the best of 'both worlds', medicine and nursing together. The nursing element lends itself to the nurturing aspects of care that I have so often found lacking in physicians (generally speaking).

Anyway, the conference organizers have now changed my topic to my first choice, delirium in critical care which is much more significant and well researched.

CharlieRN · Feb 27, 2006

Another factor often overlooked is sleepdeprivation in critical care. Critical care bed rest is not the same as restful sleep. It is frequently interupted and thus deprives the patient of REM sleep. REM sleep deprivation has been shown to result in hallucinatory experiences.

Anxiety is also a factor in depression. If you are ill enough to be in critical care you have every right to be anxious. You life is in danger and you have no control over the process of protecting it.

Many medications that are necessary to treat serious illness have depression asa side effect. Cardiac and blood pressure meds particularly seem to have depressive qualities. The depressant character of pain meds is also a factor.

I don't know of any specific studies that attempt to quantify these factors, but med/surg critical care is outside my area of expertiese.

Orca, ADN, ASN, RN · Mar 6, 2006

My sister mentioned an experience she had several years ago while working as a travel nurse. A physician decided to experiment with the use of Prozac with chronic ventilator patients. Of the 13 patients who were started on Prozac, 12 of them were weaned off the vent in less than two weeks. The other patient had a problem with his lower GI tract and was not absorbing the drug.

leslie :-D · Mar 6, 2006

My sister mentioned an experience she had several years ago while working as a travel nurse. A physician decided to experiment with the use of Prozac with chronic ventilator patients. Of the 13 patients who were started on Prozac, 12 of them were weaned off the vent in less than two weeks. The other patient had a problem with his lower GI tract and was not absorbing the drug.

amazing and impressive.

Orca, ADN, ASN, RN · Mar 8, 2006

She told the doctor that he and his collegaues ought to write it up as a scientific paper. I have no idea whether they ever did.