Page 17 Complete Your CE Test Online - Click Here to be more serious than SSRIs. Tricyclics can affect cardiac status in people who have heart conditions. They can also cause dizziness, drowsiness, dry mouth, and weight gain. Examples of tricyclics include imipramine and nortriptyline (Comerford, 2018; Durkin, 2013; National Institute of Mental Health, 2016: Videbeck, 2017). ● ● MAOIs (monoamine oxidase inhibitors) are the oldest class of antidepressants but are used infrequently because of potentially fatal side effects and possibly dangerous interactions with other drugs (including prescription and over-the-counter [OTC]) and certain foods. The most serious side effect is hypertensive crisis, a life-threatening event that occurs when someone who is taking an MAOI eats foods such as cheese and red wine that contain tyramine and/or medications such as certain types of oral contraceptives, prescription pain relievers, cold and allergy medications, and herbal supplements. MAOIs can also adversely interact with SSRIs to cause serotonin syndrome, which can lead to confusion, hallucinations, diaphoresis, seizures, muscle stiffness, and adverse changes in blood pressure or heart rhythm. MAOIs and SSRIs should never be taken together (Comerford, 2018; Durkin, 2013; National Institute of Mental Health, 2016: Videbeck, 2017). Nursing consideration: The Food and Drug Administration (FDA) has issued a black box warning label on all antidepressants to alert prescribers and consumers to the potential for increased risk of suicidal ideation in children, adolescents, and young adults taking these medications. Clients and families must be aware of this warning and taught how to respond to an increase in suicidal ideation (Comerford, 2018; Durkin, 2013; National Institute of Mental Health, 2016: Videbeck, 2017). Psychotherapy. Psychotherapy and medications, used concurrently, are considered to be the most effective treatment for depressive disorders. Some types of psychotherapy include (Durkin, 2013; Videbeck, 2017): ● ● Cognitive Behavioral Therapy (CBT): CBT focuses on how a person thinks about him/herself, others, and the future. It also helps people focus on how they interpret their experiences. In the case of veterans returning home, CBT can help veterans focus on how they interpret traumatic events. Qualified therapists help veterans recognize how their beliefs, feelings, interpretations, and behaviors may contribute to their depression, and how to change them so they can interact with their environments in positive and realistic ways. ● ● Interpersonal Therapy (IPT): IPT focuses on problems in interpersonal relationships. This form of therapy helps veterans understand and work through troubled relationships that may contribute to their depression and to work on improving interpersonal relationships. ● ● Behavioral Therapy: This therapy focuses on increasing the frequency of positive interactions with the clients’ environments and decreasing negative interactions. Therapists can also help clients work on improving social skills. Electroconvulsive Therapy (ECT). ECT is used by psychiatrists to treat clients who do not respond to medication and/or psychotherapy. Formerly known as shock therapy, ECT once had very negative connotations, and experts still remain divided about its effectiveness. In recent years, however, the administration of ECT has improved significantly and can provide relief for clients with severe depression who have not been helped by other types of treatments. Clients who are actively suicidal may also be given ECT if there is concern for their safety while waiting for the effects of antidepressant medications to be felt (Videbeck, 2017). Electrodes are applied to the head of the client to deliver an electrical impulse to the brain, which causes a seizure. It is believed that the shock delivered via ECT stimulates the brain to correct the chemical imbalance of depression (National Institute of Mental Health, 2016; Videbeck, 2017). Clients are to eat nothing by mouth after midnight before the procedure, remove fingernail polish, and void immediately prior to the procedure. An intravenous line is inserted, and the client is given a short-acting anesthetic so that he/she is not awake during the procedure itself. Then, a muscle relaxant is administered to reduce the outward signs of seizure. Electrodes are applied to the head so that brain activity is monitored as the electrical stimulation is delivered. After the ECT treatment, the client is very tired, usually has a headache, and is slightly confused or briefly disoriented (Videbeck, 2017). Clients usually receive a series of six to 15 treatments usually scheduled three times a week. In addition to ECT, most clients take antidepressants as well (National Institute of Mental Health, 2016). Nursing consideration: Some people, including some healthcare professionals, may have negative opinions about ECT. It is important that nurses know the current therapeutic uses for ECT and how to teach clients and families about its use as a treatment. Additional Nursing Interventions. ● ● Maintain an objective, supportive environment. ● ● Teach the veteran and his/her family about the signs and symptoms of depression as well as to be on the alert for suicidal ideation. Take all mention of suicide seriously! ● ● Teach clients and families about any medications being taken. Explain that the veteran’s health care provider must be aware of all medications he/she is taking including prescription, OTC drugs, vitamins, minerals, supplements, and any herbal preparations. Note if the client is drinking alcohol and, if so, how often and how much. It should also be determined if any illegal and/or recreational drugs are being used. Summary Veterans are at significant risk for PTSD and depression, as well as for suicidal ideation and suicide attempts. Veterans of all ages are at risk. It is important that nurses and other health care professionals tell veterans and their loved ones that, even if many years have passed since experiencing traumatic events, treatment can still be effective and help significantly improve quality of life. Veterans have expressed a number of reasons why they do not seek help for their mental health problems. These include believing that nothing can help them, guilt, and feeling that seeking assistance for mental health issues is a sign of weakness. Nurses should do their best to encourage veterans to seek help and point out that treatment can and does work. Arguably the most important issue facing nurses when facilitating mental illness treatment is recognizing, and helping veterans and their families to recognize, the signs and symptoms of mental health problems. Recent publicity about veterans and PTSD, depression, and suicide has helped bring attention to these devastating problems. But it is not enough to just call attention to the problem—the health care community must act to assess and intervene to help veterans deal with the signs and symptoms of mental health disorders and to obtain necessary, even life-saving treatment.