Mood Disorders: Depression

Mood

The way a person feels

Affect

An observable response a person has to his or her own feelings

Euthymia

Normal, healthy fluctuations in mood

Major Features: Depression

• Symptoms present most of the day, nearly every day

• Lasts at least 2 weeks

• Impaired functioning

• Anhedonia is common

• Significant distress

• May include suicidal thoughts/behaviors

• Mood disorders are the psychiatric disorders most associated with suicide

Mood Disorders/Depression

• Pervasive alteration in emotions manifested by depression, mania, or both

• Disrupt the individual’s ability to function normally

• Primary mood disorders are major depressive disorder(MDD) and bipolar disorder

Disruptive mood dysregulation

Severe mood changes or temper tantrums seen mostly in children

Cyclothymic disorder

milder form of bipolar disorder that causes frequent, unpredictable shifts between emotional highs (hypomania) and emotional lows (mild or moderate depression)

Depression

• One of the most prevalent mental health disorders

• Occurs in all ages

• More common in women than men

• Major cause of disability worldwide

• Highly treatable when recognized early

Depression affects

• Thoughts

• Feelings

• Behaviors

• Relationships

• Occupation

• Self-esteem

• Social function

• Physical functioning

• Physical health

• Daily functioning

Normal Elation

• Joy

• Enthusiasm

• Increased energy

• Returns to euthymia

Normal Sadness

• Brief periods of sadness

• Reaction to losses or stress

• Temporary decrease in energy

• Does not significantly impair functioning

Depression

• Persistent sadness

• Loss of interest or pleasure

• Impaired functioning

• Changes in sleep, appetite, energy, and concentration

Depression Risk Factors

• Family history

• Chronic illness

• Substance use

• Financial stress

• Unemployment

• Recent loss

• Trauma history

• Female gender

Biological Factors for Depression

• Genetics

• Neurotransmitter imbalance

• Hormonal changes

Psychological Factors for Depression

• Negative thinking patterns

• Low self-esteem

• Learned helplessness

Environmental Factors for Depression

• Trauma

• Loss

• Stressful life events

Etiology: Neurotransmitters and Depression

Neurotransmitters Involved

• ↓ Serotonin

• ↓ Norepinephrine

• ↓ Dopamine

Clinical Manifestations

• Low mood

• Fatigue

• Loss of pleasure

• Poor motivation

“SIGECAPS”

Sleep changes, Interest loss, Guilt, Energy loss, Concentration problems ,Appetite changes, Psychomotor changes ,Suicidal thoughts

Hamilton Rating Scale for Depression (HAM-D)

Tool used to measure the severity of depression and monitor response to treatment over time.

What It Measures

• Depressed mood

• Feelings of guilt

• Suicide risk

• Insomnia

• Anxiety

• Agitation

• Weight loss

• Somatic (physical) symptoms

Hamilton Rating Scale for Depression Purpose

• Assesses the severity of depressive symptoms

• Tracks improvement during treatment

• Commonly used in mental health and research settings

Mood/Depressive Disorders Emotional Symptoms

• Sadness

• Hopelessness

• Worthlessness

• Helplessness

• Excessive guilt

• Crying

Mood/Depressive Disorders Physical Manifestations

• Fatigue

• Sleep disturbances

• Weight changes

• Appetite changes

• Constipation

• Decreased libido

• Many depressed clients first report physical complaints

Mood/Depressive Disorders Cognitive Symptoms/Thought Changes

• Difficulty concentrating

• Indecisiveness

• Negative thinking

• Memory problems

• Responses may be slow and delayed

Mood/Depressive Disorders Behavioral Symptoms/Behaviors

• Social withdrawal

• Decreased self-care

• Staying in bed

• Reduced activity

• Poor eye contact

• Observe behavior, not just verbal reports

Persistent Depressive Disorder (Dysthymia)

• Chronic depressed mood

• Lasts 2 years or longer in adults

• Symptoms less severe than MDD

• Chronic course

• "Long-lasting low-grade depression"

Seasonal Affective Disorder (SAD)

• Occurs during specific seasons

• Most common in winter months

• Related to reduced sunlight exposure

Mood/Depressive Disorders Treatment

• Light therapy

• Antidepressants

• Psychotherapy

Suicide and Depression Major Risk Factors

• Hopelessness

• Prior suicide attempts

• Substance abuse

• Isolation

• Access to lethal means

Suicide Assessment Questions Direct Questions Save Lives!

• Are you thinking about harming yourself?"

• "Do you have a plan?”

• "Do you have the means to carry out the plan?“

• Never avoid asking about suicide!

Psychotherapy for Depression

• Cognitive Behavioral Therapy (CBT)

• Interpersonal Therapy (IPT)

• Group Therapy

Medications for Depression

• SSRIs and SNRIs

• Atypical antidepressants

• Tricyclic antidepressants

Antidepressants Nursing Considerations

Monitor For:

• Nausea

• Anxiety

• Insomnia

• Sexual dysfunction

Patient Teaching:

• Do not stop medication abruptly!

• Most antidepressants need several weeks to work!

• Tricyclics: Cardiac toxicity

• Caution with OTC supplements

• No St John’s Wort!

Monitor for Serotonin Syndrome!

Serotonin Syndrome

• Life threatening

• Hyper mental status (Agitation, confusion, anxiety, restlessness, or delirium)

• Neuromuscular (Tremors, muscle twitching, overactive reflexes, muscle rigidity)

• Autonomic (Heavy sweating, high fever, rapid heart rate, high blood pressure, dilated pupils, and diarrhea)

Electroconvulsive Therapy (ECT)

controlled electric current to trigger a brief, monitored seizure in the brain while a patient is under general anesthesia

Indications

• Severe depression

• Psychotic depression

• Catatonia

• Suicidal crisis

• Medication-resistant depression

Priority Problems for Depressive Disorders

1. Suicide risk

2. Nutrition

3. Hydration

4. Sleep

5. Self-care