Question

When taking care of a depressed client, they should always be evaluated for a risk for suicide.

You are spending time with Mr. Plotsky, who is being given a workup for depression.  He avoids eye contact, he slouches in his seat, and his expression appears blank, but sad.  Mr. Plotsky has suffered from numerous bouts of major depression in the past and says to you, “This will be my last depression.  I will never go through this again.”

1. What is the difference between chronic depression and major depressive disorder?
2. If safety is the first concern, what are the appropriate questions to ask Mr. Plotsky at this time?
3. Mr. Plotsky tells you that he has tried every medication there is, but that none have worked. He asks you about the herb St. John's Wort. What is information he should have about its effectiveness for severe depression and any interactions with other antidepressants?
4. What are some communication guidelines that can be used for Mr. Plotsky?

Answer 1

1. What is the difference between chronic depression and major depressive disorder?

   Chronic depression is less severe and has fewer symptoms than major depression.

2. If safety is the first concern, what are the appropriate questions to ask Mr. Plotsky at this time?

We can ask questions like;

• “You seem really depressed lately – how are you handling that? ”
• “Do you think about hurting yourself?”
• “What do you think about your future?”
• “Are you feeling hopeless?”
• “Have you thought about doing something about that?”

3) Mr. Plotsky tells you that he has tried every medication there is, but that none have worked. He asks you about the herb St. John's Wort. What is information he should have about its effectiveness for severe depression and any interactions with other antidepressants?

St. John's wort is most commonly used for depression and symptoms that sometimes go along with mood such as nervousness, tiredness, poor appetite, and trouble sleeping. There is some strong scientific evidence that it is effective for mild to moderate depression. If St. John's wort is taken with other antidepressants, it might increase the risk of the accumulation of high levels of serotonin in your body and this can cause mild to severe side effects. We should avoid taking St. John's wort if taking a mono amine oxidase inhibitor.

4) What are some communication guidelines that can be used for Mr. Plotsky?

Since Mr. Plotsky is going through depression, we can keep in mind to follow these steps;

• Call 911 or your local emergency number.
• Stay with the him until help arrives.
• Remove any guns, knives, medications, or other things that may cause harm.
• Listen to all he has to say, but don’t argue, threaten, or yell.