Nursing & Depression

abrenrn · Oct 9, 2002

I have read through this thread with great interest. First things first though:

Seize the day, try to seize the physician. Why are you having to research this topic? Is he paying you for this? Is he board certified? If so, he is expected to meet certain standards including some famialiarity with accepted off-label uses of medications. The use of stimulants as an adunct for treatment resistant depression has been in the literature for at least four or five years. Why does he not know this? Why doesn't he at least try to discuss this with the physician who treated you before? Have you ever asked a patient to research some nursing intervention for you before you will consider it? This is substandard medical care.

Youda - regarding FMLA - Do your employers know they are breaking the law? If it is a big organization, have you spoken to human resources? All you need for FMLA is the form filled out by a licensed physician (I'm not sure if NPs can sign) and they are legally required to honor it. If you haven't spoken to human resources, do so. If they know what they are doing, there next step will be damage control - and I doubt you will be the one to take the brunt.

Mario - if your so damned curious about what antidepressants do, how they feel, take some and stop asking. If you are so curious about how medications feel, you may want to try lanoxin, insulin, inderal, whatever. Generally if you don't need something you don't take it, if you do need it, you take it.

My take on depression and other "psychiatric disorders" - they are no different from "physical disorders" but instead of affecting the pancreas, say, they affect mood, behavior or thought processes. As far as I can see, most chronic illnesses result from a genetic predisposition to certain environmental insults. The susceptibility varies from none (some people can eat all the sugar and carbs they want and never get type 2 diabetes) to severe. Once you never saw children with this, now it's almost epidemic. The predisposition was always there, now they eat the diet that shows it. Some people will get it despite an almost perfect diet. It is a continuum of sorts.

My guess is depression is the same thing. A genetic predisposition/ susceptibility to depression that occurs in the face of various environmental factors. Some may get depressed in the best environment, others will never get depressed. It's a continuum.

DEEP THOUGHT Is it possible to be enabler without a user somewhere nearby? Might the enabler in other circumstances be seen as just a nice person? I'd love to hear responses to this. It seems like it might relate to nursing

abrenrn · Oct 9, 2002

I saw your comments, Youda (I love reading your posts, btw). Thought I could share some things I learned as an NP re non-FDA use of meds, aka "off-label".

It is perfectly acceptable to use a med for a purpose not approved by the FDA as long as that use is supported in the literature. Who uses what, where, without getting in trouble for something that goes wrong usually depends on how extensive the literature is. Examples:

In an internal med/ ID practice with lot of HIV patients, I felt comfortable prescribing Elavil or other TCAs at low doses for certain chronic pain. It is widely accepted. It is off-label because and will remain so - getting FDA approval is expensive and since these drugs are all generic, no one will assume the cost. I was also prescribing neurontin for this.

I did not feel comfortable prescribing neurontin for bipolar disorder, say, though I've heard of it. Basically, I wouldn't even try to treat bipolar in a primary care environment. Once I used Depakote to try to stabilize someone who was hypomanic before he got in with the psychiatrist. Depakote is also off-label, probably has fewer side effects than neurontin but has been in the literature longer with more info re dosing and so forth. Lithium is has too many toxicities, I would not prescribe it (in my setting). If anything went wrong, my selection was defensible for my setting and level of practice.

Several drugs have off-label indications for treatment resistant depression - the stimulants, synthroid, and Provigil are all there. That means a psychiatrist has good documentation to justify prescribing those meds. I would not, in primary care, because treatment resistant was out of my ball park. If I could not manage a patient with an SSRI, I usually referred.

Of course, I have personal reasons for having researced treatment resistant depression.

sphinx, BSN, RN · Oct 9, 2002

I am so sick and tired, so depressed, I just want to up and quit my job. I can't take the long hours, doing paperwork past the time my kids are in bed. Then I am so tired, but hate to go to bed, because the it's like all I did in the day was work, eat dinner, and go to bed. Today I didn't even eat until 5pm, and only had a class of citrucel and tea in the am before heading off in the morning. Every night when I take my pm meds, I am so tempted to just swallow a ton more. I don't know how I am making it through each day. My psychiatrist thinks my job stress is a big contributor, and wants to wqait it out to see if I get the new job, before he makes any more changes....but it's been over w eek, and I just have a bad, bad feeling. My head hurts, stomach hurts (next week have CCK HIDA scan and EGD I forgot to ask for time off yet) and shoulder aches.

Pardon my whining folks. I need to somewhere...my hubby has been depressed too, and I feel like I am a burden.

sjoe · Oct 9, 2002

(Sounds like we are hearing from a home health care nurse.)

Time to take a break! A long one! IMHO.

Youda · Oct 9, 2002

Originally posted by abrenrn
Youda - regarding FMLA - Do your employers know they are breaking the law? If it is a big organization, have you spoken to human resources? All you need for FMLA is the form filled out by a licensed physician (I'm not sure if NPs can sign) and they are legally required to honor it. If you haven't spoken to human resources, do so. If they know what they are doing, there next step will be damage control - and I doubt you will be the one to take the brunt.

If they didn't know before, they figured it out last week after I called the Department of Labor to file a complaint for violations of the FMLA! :chuckle Now they are claiming that they denied the claim because my Doc filled out the form and said I definitely had a serious illness, but not one that required me being off work. Sorry, but I think that's kinda like an oxymoron. If you have a serious illness, doesn't that automatically mean you're off work? Oh well. I talked to my Doc today. He said he'd fill it out again. When their "form" used words like "will have" and "will need" he thought he was indicating my working ability after I returned from FMLA, not my ability to work DURING FMLA. Bottom line is that they're just jerking me around. I've gotten long past caring about it or worrying about it, though. I'll file the complaint and get another job. Or be a bag lady. All I know for sure is that NO JOB WILL EVER DO THIS TO ME AGAIN!!! and I will NEVER allow a job to get me so burned-out and depressed like this again. It isn't worth it. And once you get on the up side of depression, you'll understand why I say that. It isn't worth it.

SPHINX! Get the hell out of there!

Youda · Oct 9, 2002

Originally posted by abrenrn
I saw your comments, Youda (I love reading your posts, btw). Thought I could share some things I learned as an NP re non-FDA use of meds, aka "off-label".

Thank you.:blushkiss I figured I just annoyed everyone!

And, thank you for your information about off-label use of meds. I never thought of it before. But, it is done all the time!

I can understand why a doc would be hesitant about this particular med for depression, though. The product information from Stine laboratories specifically says the med is contraindicated with depression d/t too many adverse side effects (psychosis, for one) during clinical trials. But, it is being used "off label" for treatment resistent depression anyway, from what I read this evening.

I love allnurses. Everyday, I learn something new.

florry · Oct 9, 2002

Originally posted by teeituptom
Howdy yall
from deep in the heat of texas

I dont understand why so many people are on drugs for so called or alledged depression.. I think its way overplayed in the news, the medias and everything else.
Basic things I do when Im a little down

1> I play golf

2> I exercise

3> I eat and sleep well

4> I get laid, excuse the language

5> I go dancing

6> I go to a movie

7> I go to a comedy club

8. Remember little problems are actually no problems, and all problems are little problems.

Hello!
If this is not irony, I think its a little bit devaulating...I do all of theese things you say, and even more! But I am still depressed and have angciety! Not all the time, but often!

But our proffession is so hard, that
the day a am loosing my woundness I hope my superviser or a good friend would telling me stop doing my nursing....
Maybe I am doing too much......

doo wah ditty

Pretzlgl · Oct 9, 2002

Considering that more than 4000 people have viewed this post, I would say that "yes", nursing as a profession brings more depression along with it.

sphinx, BSN, RN · Oct 9, 2002

Hello...

sjoe...yes, I am in homecare....a love/hate relationship. More hate these days than not. The past several months things have gotten worse and worse. I did recently get a "break", but I happened to be recovering from surgery, so it was no vacation, haha!

youda.....I am indeed working on "getting the hell out"......had 2 interviews that I thought went good.....of course as each day passes I lose more and more hope. I'd just quit, but we need the income, really. I'm limited in where I can look for jobs, since several years ago, my depression was so bad called in so so much that I was fired. That institution would not rehire me, and of course, they own more than half the health care industry around here, including another hospital, some offices,etc! My last job was wonderful, but the hospital closed. And to be honest, I don't do well with the shift rotating....which makes me wonder how cut out I am for this profession. I've always been depressed, as far back as I can recall, but things have gotten so much worse since I started nursing........*sigh*

Well, I have a long day.....7 (maybe 8) patients to see, don't know if there'll be help, my son has therapy at 4, and his open house is at 7 (leaving me doing paperwork till at least 11, gauranteed). Plus, our new software is not perfect, have been having some probs, and as soon as my son's bus gets him, I have to go into the office and have it looked at.

montroyal · Oct 9, 2002

Originally posted by Youda
I am so sorry to hear about your wife! How terrible for you and your family. You've made an assumption in your thinking, that Ativan impaired the woman's driving, and without the Ativan, the accident may not have happened. You may very well be correct, but more information is needed to make that conclusion. For example, did the woman have other health problems such as diabetes, seizure disorders, etc. What was the dose of the Ativan, and the last time that she had taken it?

Also, please understand that Ativan is not used to treat depression. It is sometimes used when depression also has anxiety, sorta like two different illnesses together. However, Ativan is prescribed for other things than anxiety. We'd need to know why it was prescribed, and the woman's diagnosis.

I know it is hard to understand this, but, antidepressants do not affect a person's reaction time as much as DEPRESSION affects a person's reaction time. An antidepressant will often improve a person's alertness and ability to react quickly in an emergency.

No, no negative posts from me about your wife's terrible accidents. I understand that you just don't have all the information needed. And, quite frankly, I see more than one victim in your situation beyond your family. May the good Lord be with you and help your wife heal.

I apologize if I did not make myself clear. I was not assuming that the ativan caused the accident. I was stating that it is illegal to have a drivers liscence while on ativan. I live in North Carolina and the law states if you are a habitual (daily) user of a narcotic, even if it is a Rx, you are not eligible for a drivers liscence. If you take any mood altering medication, you must report this to the DMV and they often times require a note from the treating MD stating the medication does not empair your driving ability. This also goes for HTN,DM and several other medications. What this incident has made me painfully aware of, is the number of people driving today who should not be or have failed to follow the law. I applaud anyone who seeks treatment and gets treatment for their disease. I just am concerned by the people who don't recognized the potential danger to themselves and others.

micro, RN · Oct 9, 2002

Montroyal,

Good to hear from you. How are you and how is your wife doing.

Micro

sanakruz, ADN · Oct 9, 2002

There is a built in martrydom in this profession. And it's got to go!!In order to rid ourselves of this we are going to need radical changes in our health care delivery system. Not going to be easy or fast. For the shortterm, you may need to leave the bedside. ( you have my permission...) Your health should become your priority.You (anyone) can not give give give without "filling back up" All the points you make are correct. i personally dont like the sound of disability-can you take a leave of absence?

Nursing & Depression

Nurses and Depression/Anxiety