Depression. First aid for depression

1. Depression  often found in patients in ICUs and sometimes leads to additional complications (for example, the period of transition from artificial ventilation to spontaneous lengthens). Depression can be suspected by the following signs: the patient becomes apathetic, closes in on himself, refuses to cooperate with staff; note a bad mood, tearfulness; sometimes the patient expresses a desire to die or stop treatment (especially for diseases with a favorable prognosis). Particular attention should be paid to factors that can affect the functions of the central nervous system, leading to the development of conditions that simulate true depression (for example, hypoxia, hypotension, sepsis, encephalopathy, focal neurological disorders, as well as drug / alcohol withdrawal). Some diseases, such as Cushing’s disease and pancreatic carcinoma, are often associated with depression.

2. The study of mental status should include an assessment of orientation, memory, hallucinations, as well as the mood of the patient. If contact with the patient worsens, it should be determined whether this indicates the presence of delirium. If it is known that prior to admission to the ICU, the patient received therapy for depression, it should be established whether it is possible to continue this treatment (for example, with antidepressants) without harm to the patient in the ICU.

3. It should be remembered that many medicines have a potential psychotic effect . As a side effect, drug depression is most often found when using beta-blockers, cimetidine, diazepam, drugs, L-methyldopa, antihypertensive drugs, digoxin, and also corticosteroids. Having established drug depression, you should whenever possible stop taking the drug that caused it, which can be replaced by another that does not have a similar effect on the psyche (for example, replace anaprilin with nadolol or cimetidine with ranitidine).

4. As in the case of delirium , a simple change in the situation, aimed at reducing noise levels, ensuring sleep and rest of the patient, can bring some benefit. Often, in order to raise the mood of the patient, a visit to family members is enough. Activation (for example, sit in a chair) helps to convince the patient that the condition is improving. Effective stimulants are radio and television. It is advisable to understand with the patient the causes of his depression and find out how he assesses his illness. In this way, misunderstandings and the fears that arise after them can be eliminated. In some cases, it is possible to identify and eliminate some specific cause (for example, to provide more effective analgesia). It should also be explained to the patient that depression is often found in ICUs and should go away as his condition improves. The staff should make every effort to create the patient’s feeling of the possibility of personal influence on what is happening to him (for example, decide when certain procedures will be performed). Any attempt to eliminate the patient’s sense of helplessness will be helpful.

5. Antidepressants are rarely used in ICUs. Tricyclic antidepressants have a delayed onset of action (from 4 days to 4 weeks), as well as significant side effects (anticholinergic and quinidine-like activity), which limits their use. As a rule, antidepressants are prescribed only if psychosocial support is ineffective and when there is a danger of a significant negative effect of depression on the treatment process. The action of dextroamphetamine, administered at a dose of 2.5-20.0 mg / day, begins immediately; the drug does not have side anticholinergic action, however, it differs in some sympathomimetic activity. Consultation with a psychiatrist will help you choose the appropriate drug, as well as solve other issues of psychosocial support.

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