DEPRESSION
By Chilala A.
Introduction
Depression can impact anyone,
regardless of age, background, or
circumstances, and can have
significant effects on daily life,
relationships, and overall well-being
General objective
At he end of this lecture, students
should be able to express and
understanding of depression
Specific objectives
1. Define depression
2. State the prevalence & the importance of understanding
depression in nursing
3. State the types of depression
4. Outline the Signs and Symptoms
5. State the Causes of depression
6. Explain the diagnosis and management of depression
Definition
Depression is a mood/mental disorder
characterized by persistent feelings of
sadness, hopelessness, and a lack of
interest in activities (anhedonia), which
can affect an individual's thoughts,
feelings, and behaviors lasting at least 2
weeks (APA, 2022).
Prevalence
Approximately 5% of adults globally suffer
from depression, with more women affected
than men.
This translates to around 280 million people
experiencing depression, with 5.7% of adults
over 60 years old being affected (WHO)
Classes
Classified according to its originality
1. Endogenous Depression; Originates from
within the body (internal factors) e.g genetic,
biochemical, or hormonal imbalances. Often runs
in families and may occur without any serios
external trigger. Maybe difficult to treat
e.g Postpartum depression due to hormonal
changes
Classes cont’d
2. Exogenous Depression: Originates from
outside the body (external factors).
Caused by environmental, social, or
psychological stressors & often triggered by a
specific event or situation eg trauma, loss of a
love one, divorce etc. easy to treat than
endogenous depression.
e.g Reactive depression due to the situation @hand
Types of depression
1. Major Depressive Disorder (MDD):
characterized by one or more major depressive
episodes in a person's lifetime. Aka. clinical
depression & usually requires hospitalization
2. Persistent Depressive Disorder: A low,
sad, or empty mood that lasts for most time of
the day. Aka. dysthymia
types cont’d
3. Premenstrual Dysphoric Disorder: A
type of depression that occurs in women
during the premenstrual phase of their
menstrual cycle.
4. Seasonal Affective Disorder:
Depression that occurs during the winter
months when there is less sunlight.
types cont’d
5. Psychotic Depression: A type
of depression that involves
hallucinations or delusions.
6. Postpartum Depression:
occurs in women after childbirth.
types cont’d
7. Reactive depression; occurs in response
to a specific stressful event, situation, or
circumstance. AKA "situational depression“
e.g Loss of a loved one, relationship
problems or breakup, Job loss or work-
related stress and financial difficulties etc
Signs and Symptoms
Emotional Symptoms
Persistent feelings of sadness
emptiness, or hopelessness
Loss of interest in activities once enjoyed
Feelings of guilt, worthlessness, or helplessness
Irritability or restlessness
Anxiety or panic attacks
Signs and Symptoms cont’d
Behavioral Symptoms
Social withdrawal or isolation
Loss of motivation or pleasure
Changes in appetite or sleep patterns
Fatigue or loss of energy
Difficulty concentrating or making decisions
Signs and Symptoms cont’d
Physical Symptoms
Changes in weight or body composition
Slowed speech or movements
Unexplained physical symptoms (e.g., headaches,
digestive issues, pain)
Changes in sleep patterns (insomnia or
hypersomnia)
Loss of interest in sex
Signs and Symptoms cont’d
Cognitive Symptoms
Difficulty concentrating or making decisions
Memory problems or forgetfulness
Negative thinking patterns (e.g., self-blame)
Rumination (repetitive negative thoughts)
Suicidal thoughts or ideation
Signs and Symptoms cont’d
Other Symptoms
Substance abuse or addiction
Self-destructive behaviors
Unexplained physical symptoms
Mood swings or emotional reactivity
Loss of interest in personal care or hygiene
Causes
Biological
Genetics: Family history of depression
Neurotransmitters: Imbalance of serotonin,
dopamine, and norepinephrine
Hormonal changes: Thyroid disorders,
menopause, pregnancy etc
Brain structure: Changes in brain regions like
hippocampus and amygdala
Causes cont’d
Psychological
Trauma: Childhood trauma, abuse, neglect
Stress: Chronic stress, major life changes
Low self-esteem: Negative self-image, self-
criticism
Negative thinking patterns: Rumination,
catastrophizing, all-or-nothing thinking
Causes cont’d
Social Causes
Social isolation: Lack of social support, loneliness
Relationship problems: Conflict, loss, or
separation
Work-related issues: Job loss, bullying, or chronic
stress
Societal pressure: Unrealistic expectations,
discrimination
Causes cont’d
Environmental causes
Childhood adversity: Poverty, neglect, or abuse
Chronic illness: Pain, disability, or terminal illness
Medication side effects: Certain medications can
contribute to depression
Substance abuse: Alcohol or drug addiction
Diagnostic criteria
A period of at least two weeks during
which there is either depressed mood or
loss of interest or pleasure in nearly all
activities, and at least five of the following
symptoms:-
Diagnostic criteria
Depressed mood most of the day
Markedly diminished interest or pleasure in activities
Significant weight loss or gain
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or guilt
Diminished ability to think or concentrate- Recurrent
thoughts of death"
Management
Investigations
History taking
Physical examination
Mental state examination and
Lab exams. R/O any medical condition
eg FBC, LFT, MPS, RPR, DCTetc
Medical management
1. Tricyclic Antidepressants (TCAs)
MoA: work by inhibiting the reuptake of
serotonin (5-HT) and norepinephrine (NE),
increasing their availability in the synaptic
cleft, leading to increased mood, hence
called antidepressant. eg
Amitriptyline 25mg od/bd po, Imipramine 25mg
od/bd po
Medical management cont’d
2. Selective Serotonin Reuptake Inhibitors
(SSRIs)
MoA: selectively inhibit the reuptake of serotonin
(5-HT), increasing its availability in the synaptic
cleft. They have minimal effects on norepinephrine
and other neurotransmitters.
Eg: Fluoxetine 20 mg od/bd po, Sertraline 25mg bd/od
po
Medical management cont’d
3. Serotonin-Norepinephrine Reuptake
Inhibitors (SNRIs)
MoA ; inhibit the reuptake of both serotonin
(5-HT) and norepinephrine (NE), increasing
their availability in the synaptic cleft.
Eg: Venlafaxine 75 mg tab bd/od po etc
Medical management cont’d
4. Monoamine Oxidase Inhibitors (MAOIs)
MoA: Irreversibly inhibit the enzyme
monoamine oxidase (MAO), which breaks
down serotonin, norepinephrine, and
dopamine. This increases the availability of
these neurotransmitters in the synaptic cleft.
Examples: Phenelzine 15 mg tds po.
Medical management cont’d
5. Antispychotics
MoA; block dopamine receptors in the brain.
This blockage reduces the activity of
dopamine, a neurotransmitter that can
contribute to psychotic symptoms.
eg Risperidone 2 mg od/bd po, Haloperidol 5
mg od/bd po
Nursing management
Aims
Promote Safety
Enhance Coping Mechanisms
Improve Mood and Reduce Symptoms
Support Recovery and Relapse Prevention
Therapeutic relationship/rapport
Make a good rapport with the patient and
relatives
Make the patient comfortable to promote trust
Being non-judgmental to promote trust
Give respect to the patient and relatives
Taking the patient as a human being who has
emotions and feelings
Environment
Create a safe environment:
No sharps such as knife, razor blade,
glasses, sticks, match sticks
No slippery floors
Low noise levels
Ensure privacy etc
Observation
Observe the eating pattern
Observe the use of the toilet/ toilet habbits
Observe the pattern of sleep
Observe the side effects ( extra pyramidal
side effect)
Observe the tone of voice
Observation cont’d
Observe the signs of aggression
Observe how the patient if interacting with
others
Vital signs if need be can be done.
Psychological care
Reassure the patient of your presence
Explain about the side effect of the drugs to gain
trust
Tell them that as a team you are working hard to
help them recover
Answer all relevant question from the patient and
relatives to allay anxiety
Explain the routine of the hospital
Rest And Sleep
Involve them in activities during the day so
that if they get tired they may sleep during the
night.
if
possible PRN medication such as diazepam
can be given to make them sleep or rest
Count the minutes or hours the patient is
resting during the day and count them to note
the level of sleeping and activity
Hygiene
Supervise the patient during bathing to ensure
whole body is clean to prevent scabies and rashes
provide things like: soap, tooth brush, teeth paste,
Vaseline or lotion, if possible.
Do nail care to avoid injuries and promote self
esteem
Do oral care to prevent halitosis
Do hair care to prevent lice
Hygiene cont’d
Change linen
Instruct the patient to wash underwear after
bathing
provide sanitary pads for ladies
Help the patient to shave hair and beads
Ladies can bath twice in a day or three during
menstrual periods
Nutrition
Watch the eating pattern as the patients may
not be eating enough food so sit with them
and food should be served from one source to
prevent suspiciousness
Provide nutritious food/ balance diet in bits or
small amounts
Give more fluids to avoid constipation
medication
Administer the prescribed
medication: right dose, route, time,
right patient and right drug
Ensure that the patient has
swallowed by talking to them to
prevent hodding
Elimination
Ensure that the patient takes a lot of fluids
and high fiber foods to prevent constipation.
Orient the patient to the toilet and how to use
the toilet
Check if he is using correctly the toilet
Check input and output patients
Health education or IEC
Importance or drug compliance
Side effects of drugs
Importance of coming for review
Signs and symptoms of relapse
Importance of joining support groups in the community
To avoid taking alcohol with the medication
Storage of drugs at home
Avoiding stigmatizing the patient
Nursing care plan problems identified
1. Risk for Suicide
2. Impaired Mood Regulation
3. Social Isolation
4. Impaired Self-Care or self care deficit
5. Disturbed Sleep Patterns or insomnia
6. Impaired Cognitive Function
Importance of understanding depression in
nursing
1. Early Identification and Intervention:
enables nurses to recognize symptoms early,
allowing for timely interventions and treatment,
2. Empathetic Care: helps nurses provide
compassionate and non-judgmental care,
establishing trust and fostering a supportive
environment for patients.
Importance cont’d
3. Effective Communication: helps nurses
communicate effectively with patients, families,
and healthcare teams, ensuring coordinated
care and support.
4. Suicide Prevention: enables nurses to
identify patients at risk of suicide and take
appropriate measures to prevent it.
Importance cont’d
5. Reducing Stigma: help reduce
stigma around mental illness,
promoting a culture of acceptance and
encouraging patients to seek help
without fear of judgment.
Conclusion
Depression is a treatable condition that
affects many people.
By recognizing the signs and symptoms,
understanding its causes and risk factors,
and seeking help, we can support ourselves
and others in managing and overcoming
depression
References
1. American Psychiatric Association (2013) Diagnostic and
Statistical Manual of Mental Disorders (5th ed.). Arlington, VA:
American Psychiatric Publishing.
2. National Institute of Mental Health (2020) Depression. Available
at: (link unavailable) (Accessed: 10 August 2022).
3. World Health Organization (2019) Depression. Available at: (link
unavailable) (Accessed: 10 August 2022).
4. Beck, A. T., & Alford, B. A. (2009) Depression: Causes and
Treatment. Philadelphia, PA: University of Pennsylvania Press
Thank You For Listening
PEACE
BE
STILL