GULSHAN COLLEGE OF NURSING, SWM

SUBJECT- MENTAL HEALTH NURSING

UNIT- MOOD DISORDER

DEPRESSIVE EPISODE

INTRODUCTION-

 Depression is a mood disorder that causes a persistent feeling of sadness and loss of
interest. also called major depressive disorder or clinical depression, it affects how
you feel, think and behave and can lead to a variety of emotional and physical problems.
 Depression is a wide-spread mental health Problem affecting many people.
 The life time risk of depression in males is 8-12% and in female it is 20-26%.
 Depression occurs twice as frequently in woman as in men.
 Onset is usually after 25-30 years & peak between 40-60
 The highest incidence of depressive symptoms has been indicated in individuals without
close interpersonal relationship and in persons who are divorced or separated.

DEFINITION-

“ Depression is a common mental disorder that presents with depressed mood, loss of
interest or pleasure, feelings of guilts or low self worth, disturbed sleep or appetite, low energy
& poor concentration.”

CLASSIFICATION-

F32 - Depressive episode

F32.0 - Mild depressive episode.
F32.1 - Moderate depressive episode.
F32.2 - Severe depressive episode without psychotic symptoms.
F32.3 - Severe depressive episode with psychotic symptoms.
F32.8 - Other depressive episodes-Atypical depression.
F32.9 - Unspecified depressive episode.
F33 - Recurrent depressive disorder.

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ETIOLOGY-
1. Neurochemical factor-
- Research finding suggest that depression results when levels of norepinephrine and serotonin
are decreased and dysregulation of acetylcholine and GABA.
2. Genetic factor-
- Major depressive disorders occur more often in first degree relatives than they do in the general
population.
- Studies of identical twins show that when one twin is diagnosed with major depression, the
other twin has a greater than 70 percent chance of developing it.
3. Psychological causes-
- Loss of person.
- Loss of love.
- failure in occupation.
- Failure in exam.
- Failure in business.
- Disappointment.
- Through the divorce.
4. Physical illness-
- In some people , a chronic illness causes depression which last for a long time and usually
cannot be cured completely. Such as- diabetes, heart disease, AIDS etc.
5. Sociological causes-
- Stressful life events such as death, marriage, financial loss before the onset of the disease.
- social isolation due to other mental illnesses or being cast out of a family or social group can
contribute to the risk of developing depression.
6. Cognitive factor- Depression due to negative cognition which includes-
- Negative expectation of the environment.
- Negative expectation of the self.
- Negative expectation of the future.

CLINICAL FEATURES :
1. Depressed Mood – Sadness of mood or loss of interest and loss of pleasure in almost all activities.
2. Depressive cognitions - Hopelessness, helplessness, Worthlessness, unreasonable guilt, self blame.
3. Suicidal thought – Ideas of hopelessness are often accompanied by the thought that life is no
longer worth living and that death has come as welcome release. These thought plan for suicide.

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4. Psychomotor activity –
- Psychomotor retardation is frequent.
- The retarded patient thinks, walks and acts slowly.
- Slowing of thought is reflected in the patient’s speech, Questions are often answered after a
long delay.
- Restlessness, anxiety, feeling of uneasiness.
- Avoid social responsibility, Frustration in day to day activity.
5. Psychotic Features –
- Hallucination.
- Delusions of guilt, delusions of control, delusions of poverty.
6. Somatic symptoms –
- Significant decrease in appetite or weight.
- Early morning awakening, at least 2 or more hours before the usual time of waking up.
- Lack of interest and lack of reactivity to pleasurable stimuli.
- Psychomotor agitation or retardation.- A state of Restlessness & anxiety that result in repetitive
& Unintentionally Movement.
7. Other Features –
- Difficulties in thinking & Concentration.
- Poor memory.
- Menstrual or sexual disturbances.
- Physical symptoms such as- Fatigue, discomfort, sleep disturbance, constipation etc.
- Apathy, Sadness, hopelessness, Helplessness, worthlessness, guilt, anger.

TREATMENT MODALITIES :
1. Psychopharmacology-
I) Selective Serotonin Reuptake Inhibitors (SSRIs)- SSRIs acts by increasing level of serotonin in
the brain. SSRIs blocks the reabsorption of serotonin in the brain, making more serotonin
available at the receptor site.
- Fluoxetine - 10-80 mg/day
- Sertraline - 50-200 mg/day
II) Tricyclic Antidepressants (TCAs) – Blocking the reuptake of Norepinephrine & Serotonin at the
nerve terminals, Thus Increasing the norepinephrine & Serotonin level.
- Imipramine - 75-300 mg/day
- Amitriptyline - 75-300 mg/day
III) Monoamine oxidase inhibitors (MAOIs) – It responsible for the degradation of Norepinephrine
& Serotonin Neurotransmitter after reuptake. The final effect is the same. Function increase in

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 the norepinephrine & Serotonin level.
- Isocarboxazid -10-30 mg/day
- Phenelzine - 45-60 mg/day
- Selegiline - 5-10 mg /day
IV) Atypical Antidepressant – Atypical antidepressant work by altering the level of
neurotransmitters in the brain. Different atypical antidepressant work in different ways.
Such as-
- Bupropion -100-300 mg/day - inhibit the reuptake off norepinephrine and dopamine.

2. Physical Therapies-
I) Electroconvulsive therapy (ECT) –Severe depression with suicidal risk is the most important
indication for ECT.
II) Light therapy - Sometime called phototherapy involves exposing the patient to an artificial
light source during winter months to relieve seasonal depression.
III) Repetitive Transcranial Magnetic Stimulation (TMS) & Vagus Nerve Stimulation (VNS)-
A Non-invasive treatment that uses magnetic field to stimulate nerve cell in the brain to
improve the symptoms of major depression.

3. Psychosocial Treatment –
I) Psychotherapy- Helping patient gain insight into the cause of their depression.
II) Cognitive therapy – It aims at correcting the depressive negative cognitions like hopelessness,
worthlessness, helplessness and replacing them with new cognitive and behavioral responses.
III) Supportive Psychotherapy – Various techniques to support the patient such as- Reassurance,
Ventilation, Occupational therapy, Relaxation etc.
IV) Group therapy – It is useful for mild cases of depression. In group therapy negative feelings,
such as – Anxiety, Anger, Guilt, are recognized and emotional growth is improved through
expression of their feelings.
V) Family therapy – It is used to intrafamilial and intrapersonal difficulties and to reduce or modify
stressors, which may help in faster and more complete recovery.
VI) Behavioral therapy – It includes social skills training, problem solving techniques, assertiveness
training, self control therapy, activity scheduling and decision making techniques.

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NURSING MANAGEMENT-

1. Nursing Assessment-

S.N. SUBJECTIVE SIGN OBJECTIVE SIGN

1. Anhedonia Alterations of activity
2. Worthlessness Poor personal hygiene
3. Hopelessness, Helplessness Loud, pressure speech
4. Suicidal ideas Apathy
5. Impairment of cognition Altered social interactions
6. Delusions & Hallucinations
7. Somatic symptoms

2. Nursing Diagnosis-

i) High risk of self directed violence related to depressed mood, feeling of worthlessness & anger.

Objective : Patient will not harm self.

Nursing Intervention :

 Create a safe environment for the patient. Remove all harmful objects Such as glass items,
sharp objects Straps, belts etc.
 Do not leave the patient alone, Place the patient near the nursing station.
 Close observation is especially required.
 Do not allow the patient to put the bolt on his side of the door of bathroom or toilet.
 Encourage the patient to express his feelings including anger.

ii) Dysfunctional grieving related to real or perceived loss.

Objective : Patient will be able to verbalize normal behaviors associated with grieving.

Nursing Intervention :

 Assess stage of fixation in grief process.

 Be accepting of patient and spend time with him. Show empathy, care and unconditional
positive regards.
 Explore feelings of anger and help patient direct them towards the intended object or
person.
 Provide simple activities which can be easily and quickly accomplished.

iii) Altered nutrition, less than body requirement related to depressed mood, lack of appetite or
lack of interest in food.

Objective : Patient’s nutritional status will improve..

Nursing Intervention :

 Closely monitor the patient’s food and fluid intake.

 Record patient’s Weight regularly.

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  Find out the like & dislike of the person before he was sick and serve the best preferred
food.
 Serve small amount of a light or liquid diet frequently that is nourishing.
 Encourage more fluid intake & green leafy vegetables.

iv) Self-esteem disturbance related to learned helplessness, impaired cognition, negative view of
self.

Objective : Patient will be able to verbalize positive aspects about self and attempt new activities
without fear of failure.

Nursing Intervention :

 Be accepting of patient and spend time with him.

 Focus on strengths and minimize failures.
 Provide him with simple and easily achievable activity. Encourage the patient to perform his
activities without assistance.
 Teach assertiveness and coping skills.

v) Altered Communication process related to depressive cognition.

Objective : Patient will communicate or interact with staff or other patients in the unit.

Nursing Intervention :

 Observe for nonverbal communication.

 Use short sentences.
 Introduce the patient to another patient.
 Ask the patient what's on their mind or what they'd like to talk about.

vi) Altered sleep and rest, related to depressed mood & depressive cognitions.

Objective : Patient will sleep adequately during the night.

Nursing Intervention :

 Plan daytime activity according to the patient’s interest.

 Ensure a quit & peaceful environment when the patient is preparing for sleep.
 Provide comfort measures.
 Talk to the patient for a brief at bedtime but do not enter into lengthy conversations.
 Give prescribed sedatives if necessary.

****THANKS****