Depression
1. Introduction
Depression is a common mental illness that affects a person’s mood, thoughts, behavior, and
physical health. It is more than just feeling sad; it lasts for weeks or months and makes it hard to
do daily activities.
Affects all age groups, from teenagers to the elderly.
According to WHO, depression is a leading cause of disability worldwide.
If untreated, it can lead to suicide or worsening physical illness.
2. Definition
Depression is a persistent state of sadness or low mood, accompanied by a loss of interest in
usual activities, reduced energy, and feelings of hopelessness.
3. Types of Depression
Type Explanation
Major Depressive Disorder Severe depression lasting 2+ weeks, affects daily life.
Persistent Depressive Disorder
Mild but long-term depression lasting 2+ years.
(Dysthymia)
Postpartum Depression Depression after childbirth.
Depression triggered by seasonal changes (usually
Seasonal Affective Disorder (SAD)
winter).
Depression occurs in cycles with periods of high energy
Bipolar Depression
(mania).
4. Causes of Depression
A. Biological Factors
Genetics: Family history of depression increases risk.
Brain chemicals: Imbalance of serotonin, dopamine, or norepinephrine.
Hormones: Thyroid problems, pregnancy, menopause can contribute.
B. Psychological Factors
Low self-esteem
Negative thinking
Traumatic childhood experiences
Loss of a loved one
C. Social Factors
Stressful life events (job loss, exams)
Loneliness or social isolation
Family or relationship conflicts
Financial problems
✅ Depression usually develops because of a combination of these factors, not just one.
5. Signs and Symptoms
Emotional Symptoms
Persistent sadness or emptiness
Hopelessness or guilt
Irritability or anger
Loss of interest in hobbies or activities
Physical Symptoms
Fatigue, low energy
Sleeping too much or too little
Change in appetite (weight loss/gain)
Headaches or body pain
Cognitive Symptoms
Trouble concentrating or making decisions
Feeling worthless or hopeless
Thoughts of death or suicide
6. Diagnosis
Clinical Interview: Talk with patient about feelings, thoughts, and behavior.
Mental Status Examination: Check mood, memory, thought process, and judgment.
DSM-5 Criteria: Standard diagnostic tool for depression.
Rule out Medical Causes: Thyroid problems, anemia, or other illnesses.
DSM-5 মানদণ্ড অনুযায়ী মেজর ডিপ্রেসিভ ডিজঅর্ডার (Major Depressive Disorder) নির্ণয় করার নিয়ম
একজন ব্যক্তির অন্তত ৫টি বা তার বেশি লক্ষণ থাকতে হবে, যা একই ২ সপ্তাহের মধ্যে থাকতে হবে এবং আগের থেকে তার
জীবনযাত্রায় পরিবর্তন আনে। কমপক্ষে একটি লক্ষণ হতে হবে:
১) বিষণ্ন মনোভাব (দুঃখ বা শোক), অথবা
২) আগ্রহ বা আনন্দ হারানো।
লক্ষণসমূহ (৫টি বা তার বেশি):
১. বিষণ্ন বা দুঃখের অনুভূতি অধিকাংশ সময়, প্রায় প্রতিদিন।
২. আগ্রহ বা আনন্দ হারানো (যে কাজগুলো আগে পছন্দ করতো সেগুলোতে আর আগ্রহ না থাকা)।
৩. ওজন কমা বা বৃদ্ধি (বা খাওয়ার ইচ্ছা কমে যাওয়া বা বেড়ে যাওয়া)।
৪. ঘুমের সমস্যা (অনিদ্রা বা অতিরিক্ত ঘুম)।
৫. শারীরিক আচরণে পরিবর্তন (অতিমাত্রায় উত্তেজিত বা অত্যন্ত ধীর গতিতে চলাফেরা)।
৬. ক্লান্তি বা শক্তিহীনতা প্রায় প্রতিদিন।
৭. নিজেকে মূল্যহীন বা অতিরিক্ত দোষী মনে হওয়া।
৮. মনোযোগ কমে যাওয়া, চিন্তা করতে বা সিদ্ধান্ত নিতে সমস্যা হওয়া।
৯. মৃত্যুর কথা ভাবা বা আত্মহত্যার চিন্তা/প্রয়াস।
7. Management of Depression
A. Pharmacological (Medicines)
Antidepressants: SSRIs (Fluoxetine, Sertraline), TCAs (Amitriptyline).
Mood stabilizers: Used in bipolar depression.
Monitoring: Watch for side effects like nausea, insomnia, or suicidal thoughts.
B. Psychotherapy (Talk Therapy)
Cognitive Behavioral Therapy (CBT): Change negative thinking.
Interpersonal Therapy: Improve relationships.
Counseling: Emotional support and guidance.
C. Other Treatments
Electroconvulsive Therapy (ECT): Used in severe cases when medicines don’t work.
Lifestyle changes: Regular exercise, proper sleep, healthy diet, and stress management.
8. Nursing Management
1. Care of the Patient in HospitalThe primary goal is to provide a "Safe
Ward" environment to prevent self-harm.
A. Environment & Staffing (Need for Care)
* Safe Environment: The ward must be physically secure and free of hazards.
* Trained Staff: An adequate number of staff specifically trained in psychiatric
crisis must be available.
* Policies: There must be agreed-upon policies for how patients are observed and
reviewed.
B. Admission & Ongoing Management
* Risk Assessment: On admission, the staff must assess the level of risk and agree
on the level of observation (e.g., 1-on-1 or 15-minute checks).
* Object Removal: All objects that could be used for suicide (belts, sharps, certain
clothes) must be removed.
* Communication: Plans must be clearly communicated between staff, especially
during shift changes.
* Visitor Policy: Duration and nature of visits must be regulated.
C. Safe Discharge
* Follow-up: A clear plan for aftercare must be agreed upon before the patient
leaves.
* Medication Safety: Prescribe only adequate but non-dangerous (non-lethal)
amounts of medication.
2. Comprehensive Nursing Management of Depression
For a depressive patient, care involves physical, emotional, and educational
interventions.
A. Physical Care & Vital Needs
* Sleep Hygiene: Maintain strict records of sleep; discourage daytime napping to
promote restful sleep at night.
* Nutrition: Monitor food intake; administer IV fluids if the patient refuses to eat.
* Personal Hygiene: Assist the patient with bathing or warm drinks to promote
relaxation
B. Psychosocial Interventions
* Therapeutic Relationship: Build trust through a one-to-one relationship and a
kind, firm, and warm attitude.
* Activity Level: Provide "non-intellectual" activities (e.g., exercise or cleaning)
to help discharge pent-up tension.
* Decision Making: Postpone major life decisions until the depressive episode has
passed.
* Communication: Focus interactions on the present, reassuring the patient that
their condition is temporary.
3. Health Education & Family Advice
Teaching is a core nursing responsibility to ensure long-term recovery.
A. Patient Education (Regarding Drugs & Disease)
* Expectations: Inform the patient that drugs do not work instantly; it usually
takes at least two weeks to feel better.
* Compliance: Stress the importance of taking medication regularly and never
skipping doses or stopping without a doctor's advice.
* Side Effects: Explain common side effects like dry mouth, constipation, and
giddiness so the patient does not get discouraged.
B. Family Advice
* Disease Awareness: Educate the family that depression is a real illness
requiring active treatment, not just a "mood".
* Support: Encourage the family to provide hope and accept the patient as they
are.
9. Complications of Untreated Depression
Suicide
Substance abuse
Social isolation and relationship problems
Poor physical health (heart disease, diabetes)
Reduced work or school performance
10. Prevention
Early recognition of symptoms
Stress management techniques
Strong family and social support
Regular counseling or therapy sessions
Healthy lifestyle (exercise, sleep, balanced diet)
✅ Tip for Students: Remember the 3 “S” of depression nursing care:
Safety
Support
Supervision
SUTAPA CHAKRABORTY
Nursing Instructor
NNC