Depression Information - Causes, Symptoms And Treatment
Also known as unipolar disorder, major depression is a syndrome of persistently sad, dysphoric mood, accompanied by disturbances in sleep and appetite, lethargy, and an inability to experience pleasure (anhedonia). Major depression occurs in up to 17% of
adults, affecting all racial, ethnic, and socioeconomic groups. It affects both sexes, but is more common in women.
About 50% of all depressed patients experience a single episode and recover completely; the rest have at least one recurrence. Major depression can profoundly alter social, family, and occupational functioning. However, suicide is the most serious consequence of major depression; the patient's feelings of worthlessness, guilt,and hopelessness are so overwhelming that she no longer considers life worth living. Nearly twice as many women as men attempt suicide, but men are far more likely to succeed.
What Causes depression?
The multiple causes of depression aren't completely understood. Current research suggests possible genetic, familial, biochemical, physical, psychological, and social causes. Psychological causes (the focus of many nursing interventions) may include feelings of helplessness and vulnerability, anger, hopelessness and pessimism, and low self-esteem. They may be related to abnormal character and behavior patterns and troubled personal relationships. In many patients, the history identifies a specific personal loss or severe stressor that probably interacts with the person's predisposition to provoke major depression.
Depression may be secondary to a specific medical condition, for example:
- metabolic disturbances, such as hypoxia and hypercalcemia
- endocrine disorders, such as diabetes and Cushing's syndrome
- neurologic diseases, such as Parkinson's disease and Alzheimer's disease
- cancer (especially of the pancreas)
- viral and bacterial infections, such as influenza and pneumonia
- cardiovascular disorders such as heart failure
- pulmonary disorders such as chronic obstructive pulmonary disease
- musculoskeletal disorders such as degenerative arthritis
- GI disorders such as irritable bowel syndrome
- genitourinary problems such as incontinence
- collagen vascular diseases such as lupus
Drugs prescribed for medical and psychiatric conditions as well as many commonly abused substances can also cause depression. Examples include antihypertensives, psychotropics, narcotic and nonnarcotic analgesics, antiparkinsonian drugs, numerous cardiovascular medications, oral anti diabetics, antimicrobials, steroids, chemotherapeutic agents, cimetidine, and alcohol.
Symptoms of depression
The primary features of major depression are a predominantly sad mood and a loss of interest or pleasure in daily activities. The patient may complain of feeling "down in the dumps," express doubts about his self-worth or ability to cope, or simply appear unhappy and apathetic. She may also report feeling angry or anxious. Symptoms tend to be more severe than those caused by dysthymic disorder, which is a milder, chronic form of depression. Other common signs include difficulty concentrating or thinking clearly, distractibility, and indecisiveness. All physiologic and psychologic processes are slowed. Anergia and fatigue are common as well as anhedonia and insomnia. Take special note if the patient reveals suicidal thoughts, a preoccupation with death, or previous suicide attempts.
The psychosocial history may reveal life problems or losses that can account for the depression. Alternatively, the patient's medical history may implicate a physical disorder or the use of prescription, non prescription, or illegal drugs that might cause depression.
The patient may report an increase or a decrease in appetite, sleep disturbances (such as insomnia or early awakening), a lack of interest in sexual activity, constipation, or diarrhea. Other signs include agitation (such as hand wringing or restlessness) and reduced psychomotor activity (such as slowed speech).
What are the types of depression?
- Major Depression :-
Major depression is characterized by a combination of symptoms, including sad mood (see symptom list), that interfere with the ability to work, sleep , eat, and enjoy once-pleasurable activities. Disabling episodes of depression can occur once, twice, or several times in a lifetime.
- Dysthymia Disorder :-
Dysthymia is a less severe type of depression. It involves long-term (chronic) symptoms that do not disable, but yet prevent the affected person from functioning at "full steam" or from feeling good. Sometimes, people with dysthymia also experience episodes of major depression. This combination of the two types of depression is referred to as double-depression.
- Unspecified Depression - This category is used to help researchers who are studying other specific types of depression, and do not want their data confounded with marginal diagnoses. It includes people with a serious depression, but not quite severe enough to have a diagnosis of a major depression. It also includes people with chronic, moderate depression, which has not been present long enough for a diagnosis of a Dysthymic disorder. (You get the idea!)
- Adjustment Disorder, with Depression - This category describes depression that occurs in response to a major life stressor or crisis.
- Bipolar Disorder :-
(also sometimes called manic depressive illness) is another depressive condition that involves periods of major depression mixed with periods of mania. Mania is the term for abnormally high mood and extreme bursts of unusual activity or energy.
The diagnosis of depression is supported by psychological tests such as the Beck Depression Inventory, which may help determine the onset, severity, duration, and progression of depressive symptoms. A toxicology screening may suggest drug-induced depression. (For characteristic findings in patients with depression.
Treatment of depression
Depression is difficult to treat, especially in children, adolescents, elderly patients, and those with a history of chronic disease. The primary treatment methods are drug therapy, electroconvulsive therapy (ECT), and psydlOtherapy. Drug therapy for depression includes:
- tricyclic antidepressants (TCAs) such as amitriptyline. TCAs are the most widely used class of antidepressant drugs. They prevent the reuptake of norepinephrine or serotonin (or both) into the presynaptic nerve endings, resulting in increased synaptic concentrations of these neurotransmitters. They also cause a gradual loss in the number of beta-adrenergic receptors.
- monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan). MAO inhibitors block the enzymatic degradation of norepinephrine and serotonin. However, they're commonly prescribed for patients with atypical depression (for example, depression marked by an increased appetite and need for sleep, rather than anorexia and insomnia) and for some patients who fail to respond to TCAs. MAO inhibitors are associated with a high risk of toxicity; patients treated with one of these drugs must be able to comply with the necessary dietary restrictions.
- selective serotonin reuptake inhibitors (SSRls), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). SSRIs are becoming the drugs of choice for treating depression. They're effective and produce fewer adverse effects than TCAs. Even so, they're associated with sleep and GI problems and alterations in sexual desire and function.
- maprotiline, trazodone (Desyrel), and bupropion (Wellbutrin) aren't chemically related to the other antidepressants listed above; however,they're effective in treating depression by blocking the reuptake of norepinephrine, serotonin, and epinephrine, respectively. However, the reason they aren't used as commonly as the other compounds is because of increased adverse effects.
Alternative treatments for depression include:
- electroconvulsive therapy (ECT). When a depressed patient is incapadtated, suiddal, or psychotically depressed or when antidepressants are contraindicated or ineffective, ECT commonly is the treatment of choice for depression. Usually, 6 to 12 treatments are needed, although in many cases improvement is evident after only a few treatments. Even so, ECT has been associated with later short term memory loss, arrhythmias, and seizure activity. Researchers hypothesize that ECT affects the same receptor sites as antidepressants.
- short-term psychotherapy. Many psychiatrists believe that the best results are achieved with a combination of individual. family, or group psychotherapy and medication. After resolution of the acute episode, patients with a history of recurrent depression may be maintained on low doses of antidepressants as a preventive measure.
Special considerations or prevention
Share your observations of the patient's behavior with her. For instance, you might say, "You're sitting all by yourself, looking very sad. Is that how you feel?" Because the patient may think and react sluggishly, speak slowly and allow ample time for her to respond. Avoid feigned cheerfulness. However, don't hesitate to laugh with the patient and point out the value of humor
- Show the patient she's important by listening attentively and respectfully, preventing interruptions, and avoiding judgmental responses.
- Provide a structured routine, including noncompetitive activities, to build the patient's self-confidence and encourage interaction with others. Urge her to join group activities and to sodalize.
- Inform the patient that she can help ease depression by expressing her feelings, participating in pleasurable activities, and improving grooming and hygiene.
- While tending to the patient's psychological needs, don't forget her physical needs. If she's too depressed to take care of herself, help her with personal hygiene. Encourage her to eat. If she's constipated, add high-fiber foods to her diet; offer small, frequent meals; and encourage physical activity and fluid intake.
- Inform the patient that certain antidepressants may take several weeks to produce an effect.
- Teach the patient about depression. Emphasize that effective methods are available to relieve her symptoms. Help her to recognize distorted perceptions that may contribute to her depression. Once the patient learns to recognize depressive thought patterns, she can consciously begin to substitute self-affirming thoughts.
- Instruct the patient about prescribed medications. Stress the need for compliance and review adverse effects. For drugs that produce strong anticholinergic effects, such as amitriptyline (Endep, Emitrip) and amoxapine, suggest sugarless gum or hard candy to relieve dry mouth. Many antidepressants are sedating (for example, amitriptyline and trazodone [Desyrel]); warn the patient to avoid activities that require alertness, including driving and operating mechanical equipment until the central nervous system (CNS) effects of the drug are known.
- Caution the patient taking a TCA to avoid drinking alcoholic beverages or taking other CNS depressants during therapy.