Depression

Presentation Objectives

  • Discuss historical origins of the study of depression.
  • Explain epidemiological facts on depression.
  • Describe types of depressive disorders.
  • Discuss predisposing factors to depression.
  • Discuss developmental implications, particularly regarding children.
  • Discuss the nursing process when caring for clients with depressive disorders.
  • Discuss treatment modalities for depressive disorders.
  • Discuss appropriate client and family education.
  • Recommend studying test questions in ATI book and back of textbook.

Introduction

  • Depression is one of the oldest and most frequently diagnosed psychiatric illnesses.
  • Historically, many disorders (e.g., ADHD, bipolar disorder) were misclassified as depression.
  • Transient symptoms like sadness are a normal response; problematic when impacting daily living activities.
  • Pathological Depression: Occurs when adaptation to stressors is ineffective.

Definitions

  • Mood vs. Affect: Mood refers to the emotional state; affect is how these emotions are expressed.
  • Depression: An alteration in mood expressed by feelings of sadness, despair, and pessimism.

Historical Perspectives

  • Ancient cultures attributed mood disorders to supernatural or divine causes.
  • Hippocrates' Theory: Melancholia (depression) caused by excess black bile, thought to affect the brain.

Epidemiology

  • Approximately 6.7% of people aged 18 or older have had one major depressive episode annually.
  • Rates higher in women than men (approximately 2:1).
  • Factors influencing this include hormone fluctuations and traditional caregiving roles of women.
  • Lifetime Prevalence: Higher in individuals aged 45 years or younger.
  • Social Class Relationship: Inverse correlation; lower social classes report higher depressive symptoms.
  • No consistent correlation between race and affective disorders.
  • Marital Status: Single or divorced individuals are more likely to experience depression due to increased loneliness.
  • Seasonal Affective Disorder: Affective disorders more prevalent in fall and winter due to reduced sunlight.

Types of Depressive Disorders

  1. Major Depressive Disorder (MDD)

    • Characterized by a depressed mood and loss of interest in usual activities lasting for at least 2 weeks.
    • No history of manic behavior or attributable to substance use/other medical conditions.

  2. Persistent Depressive Disorder (Dysthymia)

    • Chronic depressive mood for most of the day, more days than not, lasting for at least 2 years.
    • No evidence of psychotic symptoms.

  3. Premenstrual Dysphoric Disorder (PMDD)

    • Severe form of premenstrual syndrome, includes depressed mood, anxiety, mood swings, lack of interest in activities.
    • Symptoms typically begin during the week before menses and improve a few days after onset.

  4. Substance or Medication-Induced Depressive Disorder

    • Directly linked to the physiological effects of a substance or medication.

  5. Depressive Disorder Associated with Another Medical Condition

    • Directly attributable to the physiological effects of a general medical condition.

Predisposing Factors to Depression

Biological Theories

  • Heredity: Family history of depression increases risk (especially in women).
  • Postpartum Depression (PPD): Increased risk in those with previous depression or postpartum experiences.
  • Biochemical Influences: Deficiencies in norepinephrine, serotonin, and dopamine have been linked.

Neuroendocrine Factors

  • Potential issues with the hypothalamic-pituitary-adrenal (HPA) axis, thyroid stimulating hormone release.

Physiological Influences

  • Medication side effects, neurological disorders, electrolyte imbalances, hormonal disorders, nutritional deficiencies, psychological conditions such as inflammation.

Psychological Theories

  • Psychodynamic Theory: Internalization of loss directed at the self.
  • Learning Theory: Theory of learned helplessness; repeated failures lead to despair and withdrawal.
  • Loss Theory: Early significant losses can predispose individuals to lifelong depression.
  • Cognitive Theory: Focus on cognitive distortions leading to negative experiences and beliefs about self/environment/future.

Developmental Implications

Impacts on Children Under Three

  • Lack of communication; symptoms may manifest as feeding problems, tantrums, lack of playfulness.
  • Emotional expressiveness is notably absent; children may not show excitement or recognition.

Ages Three to Five

  • Children may exhibit accidents (potty training), phobias, and excessive self-reproach.

Ages Six to Eight

  • Common symptoms include physical complaints, aggressive behavior, and clinginess.

Ages Nine to Twelve

  • Increased morbid thoughts, excessive worry; often associated with loss and grief.

Adolescents (Ages 13-18)

  • Symptoms may include anger, aggression, social withdrawal, delinquency, sexual acting out, substance abuse.
  • Classic sign of potential suicide includes giving away belongings.
  • Suicide Risk Factors: Perception of abandonment, relationship difficulties.

Treatment Considerations

General Treatment Approaches

  • Supportive psychosocial interventions; possible use of antidepressants (caution in children/adolescents due to increased suicide risk).
  • Importance of family therapy to support client.

Postpartum Depression Treatment

  • Symptoms possibly lasting weeks to months; may include fatigue, irritability, and difficulty caring for the infant.
  • Treatment includes psychosocial therapy and possible antidepressants to prevent psychosis.

Elderly Treatment Considerations

  • Senescence: Refers to the aging process, often linked to bereavement overload and increased suicide rates.
  • Treatment typically involves psychotherapy and careful management of antidepressants (adjusted for decreased clearance).