Depression

Depression

What causes Depression? • Family History – Having a family members who has depression may increase a person’s risk – Imbalances of certain chemicals in the brain may lead to depression

• Major Life Changes – Positive or negative events can trigger depression. Examples include the death of a loved one or a promotion. – Major Illnesses such as heart attack, stroke or cancer may trigger depression.

– Certain medications used alone or in combination can cause side effects much like the symptoms of depression. – Use of Alcohol or other Drugs can lead to or worsen depression. – Depression can also occur for no apparent reason!

Symptoms of Depression • Vary from person to person • 2 key signs are loss of interest in things you like to do and sadness or irritability

Additional Signs include: • Changes in feelings which may include: – Feeling empty – Inability to enjoy anything – Hopelessness – Loss of sexual desire – Loss of warm feelings for family or friends – Feelings of self blame or guilt – Loss of self esteem – Inexplicable crying spells, sadness or irritability

Changes in behavior and attitude • These may include: – General slowing down – Neglect of responsibilities and appearance – Poor memory – Inability to concentrate – Suicidal thoughts, feelings or behaviors – Difficulty making decisions

Physical Complaints • These may include: – Sleep disturbances such as early morning waking, sleeping too much or insomnia – Lack of energy – Loss of appetite – Weight loss or gain – Unexplained headaches or backaches – Stomachaches, indigestion or changes in bowl habits

Different Types of Depression 1- Major Depression: A Major Problem you may feel and see symptoms of extreme sadness, hopelessness, lack of energy, irritability, trouble concentrating, changes in sleep or eating habits, feelings of guilt, physical pain, and thoughts of death or suicide

2- Dysthymia is a type of depression that causes a low mood over a long period of time perhaps for a year or more,.” Symptoms include sadness, trouble concentrating, fatigue, and changes in sleep habits and appetite.

3- Postpartum Depression: is characterized by feelings of extreme sadness, fatigue, loneliness, hopelessness, suicidal thoughts, fears about hurting the baby, and feelings of disconnect from the child. It can occur anywhere from weeks to months after childbirth

4- Atypical Depression: A Misunderstood Form of Depression This type of depression is less well understood than major depression Unlike major depression, a common sign of atypical depression is a sense of heaviness in the arms and legs like a form of paralysis.

5- Seasonal Affective Disorder: Extreme Winter Weariness you could be one of 4 to 6 percent of people in the United States estimated to have seasonal affective disorder, or SAD. Though many people find themselves in winter funks, SAD is characterized by symptoms of anxiety, increased irritability, daytime fatigue, and weight gain. This form of depression typically occurs in winter climates, likely due to the lessening of natural sunlight. "We don't really know why some people are more sensitive to this reduction in light

6- Psychotic Depression: Losing Touch With Reality Psychosis — a mental state characterize by false beliefs, known as delusions, or false sights or sounds, known as hallucinations — doesn’t typically get associated with depression. But about 10 to 15 percent of people with depression have episodes so severe that they see or hear things that are not really there. "People with this psychotic depression may become catatonic, not speak, or not leave their bed,“

7- Bipolar Disorder: From High to Low (and Back to High

Again) If your periods of extreme lows are followed by periods of extreme highs, you could have bipolar disorder(which is also sometimes called manic depressive disorder, as symptoms can alternate between depression and mania).

8- Premenstrual Dysphoric Disorder: When Depression Strikes Once a Month Premenstrual dysphoric disorder, or PMDD, is a type of depression that affects women during the second half of their menstrual cycles. Symptoms include depression, anxiety, and mood swings. Unlike premenstrual syndrome (PMS) 9- Situational Depression: When Life Gets You Down Also called adjustment disorder ,situational depression is triggered by a stressful or lifechanging event, such as job loss, the death of a loved one, trauma — even a bad breakup.

Nursing Care Plan for Depression

Scenario

A 50 year old female in admitted to your floor with suicide attempt. The patient was found trying to jump off her 50 foot balcony outside her apartment. The patient’s neighbor was able to prevent her from doing this and EMS was called immediately. According to the patient’s history, the patient lost her husband, two sons, and dog in a car accident 6 months ago while they were coming back from a hunting trip. The patient was apparently unable to go with her family on this hunting trip because she was sick with the flu. On assessment, the patient reports inability to sleep at night and constant episodes of crying spells. She states that her whole family is gone and that she is not able to cope with this tragedy. She states she has also lost her job because she couldn’t “drag” herself out of bed. She report feelings of social isolation, inability to deal with stress and think clearly. She reports that she wants to get out of this dark place of her life and have things go back to the way they were but feels like this will never happen without help. The patient agrees with you to a verbal contract of safety and that she will not try to hurt herself again. She states that it was her first suicide attempt ever.

Nursing Diagnosis: Ineffective individual coping related to situational crisis as evidence by verbalization of inability to cope, reported life stress, and alteration in social participation. Goal to prevent crisis or suicide Subjective Data On assessment, the patient reports inability to sleep at night and constant episodes of crying spells. She states that her whole family is gone and that she is not able to cope with this tragedy. She states she has also lost her job because she couldn’t “drag” herself out of bed. She report feelings of social isolation, inability to deal with stress and think clearly. She reports that she wants to get out of this dark place of her life and have things go back to the way they were but feels like this will never happen without help. She states that it was her first suicide attempt ever. Objective Data A 50 year old female in admitted to your floor with suicide attempt. The patient was found trying to jump off her 50 foot balcony outside her apartment. The patient’s neighbor was able to prevent her from doing this and EMS was called immediately. According to the patient’s history, the patient lost her husband, two sons, and dog in a car accident 6 months ago while they were coming back from a hunting trip. The patient agrees with you to a verbal contract of safety and that she will not try to hurt herself again.

Nursing Outcomes

Pt will remain safe without any self harm during hospitalization.-By discharge the patient will report an increase in sense of control over her current situation. -Pt will verbalize 2 people she can talk to when she needs emotional assistance. -The patient will report decrease crying spells and ability to sleep better at night. -The patient will verbalize 3 coping techinques to help her get her life back on track . Interventions: Nursing  nurses will assess every shift the patient’s mental status regarding suicidal The thoughts. -The nurse will give the patient opportunities to make decisions about her hospitalization and treatment plan. -The nurse will discuss with the patient about how set-up a network of people she can talk to during emotional times. -The nurse will encourage the patient to verbalize feelings, perceptions, and fears of her current situation. -The nurse will discuss with the patient 3 coping techniques she can use to help her feel more control over her current situation.

The therapy for patients with depression

( antiderpressed drug) possibly electroconvulsive therapy communication with patients with depression

Professional treatment is necessary for all these types of depression.

Treatment for Depression • Medication – Antidepressants can help ease the symptoms of depression and return a person to normal functioning. Antidepressants are not habit forming.

Psychotherapy • This can help many depressed people understand themselves and cope with their problems. For example: – Interpersonal therapy works to change relationships that affect depression – Cognitive-behavioral therapy helps people change negative thinking and behavior patterns

If you or someone you know has symptoms of depression…

Take Action!

• See a doctor for a complete check up. • Go to the counseling center and talk to a counselor. • Talk things over with a friend, family member or a residential life staff member.

• • • •

Don’t expect too much of yourself Take a break Get some exercise Avoid extra stress and big changes

Things to do • Reduce or eliminate the use of alcohol or drugs • Exercise or engage in some form of physical activity • Eat a proper, well-balanced diet

• Obtain an adequate amount of sleep • Seek emotional support from family and friends • Focus on positive aspects of your life • Pace yourself, modify your schedule, and set realistic goals

Things to Avoid • Don’t make long-term commitments or important decisions unless necessary • Don’t assume things are hopeless • Don’t engage in “emotional reasoning” (i.e.: because I feel awful, my life is terrible) • Don’t assume responsibility for events which are outside of your control • Don’t avoid treatment as a way of coping

Intervening with a depressed friend • • • • •

Be empathetic and understanding Don’t try to “cheer up” a depressed person Avoid critical or shaming statements Challenge expressions of hopelessness Empathize with feelings of sadness, grief, anger and frustration

Helping a depressed friend… • Don’t argue about how bad things are • Don’t insist that depression or sadness are the wrong feelings to be experiencing • Don’t become angry even though your efforts may be resisted or rejected

Helping a depressed friend… • Advocate for their recovery from depression • Emphasize that depression is treatable • Seek consultation • Encourage them to seek help, go with them to the counseling center • Be supportive of counselor or doctor suggestions