Depression

Patients with depression have a persistent sense of sadness, more days than not,
often associated with somatic complaints. The medical work-ups for varied
physical complaints will be negative. Patients typically have a loss of interest in
normal activities and alterations in sleep and eating habits. Up to one-third of
patients will seek care from primary care providers. Patients can also present as
unkempt, dirty, withdrawn, and unwilling to engage in conversation. They see
life as a state of hopelessness. The patient’s depression must be treated seriously,
since it can lead to suicide. A patient’s request for help might be his or her last
recourse.

Introduction:

Several different theories exist involving the cause of depression. Genetic factors
may lead to changes in the normal functioning of neurotransmitters. Neurotrans-
mitters are released from one side of a synapse and land on a specific receptor
site on the other side of the synapse. When a balance is maintained between the
amount released and the amount needed to fill the receptor sites, normal function
continues. When there is an imbalance, the neurotransmission is altered. Develop-
mental factors can often be traced back to childhood. Personality disorders may
begin during school age or adolescence. Psychosocial stressors are another factor
linked to the development of depression. Major life changes such as the death of
a family member, unemployment, or moving away from family and friends may
lead to the onset of depression. A sense of sadness or grief is considered a normal
response to this type of loss and should resolve as the person progresses through
the normal stages of grieving. Depression, however, is not a normal response to loss.
A grieving person will have a sustained sense of self-esteem, whereas a person
with depression will have a sense of worthlessness.

PROGNOSIS
Proper treatment can help control the symptoms of depression. Adequate treatment
can cause remission of symptoms. It is not unusual for there to be a recurrence of
symptoms at some point in the future, even with appropriate treatment.


SIGNS AND SYMPTOMS
• Intense feeling of sadness
• Depressed mood
• Anhedonia (loss of interest in usual activities)
• Hopelessness or worthlessness
• Difficulty concentrating
• Indecision
• Changes in sleep (more or less than usual), eating (more or less than usual),
and activity (more or less than usual)
• Social withdrawal and isolation
• Decreased libido
• Thoughts of death
• Physical complaints include headache, malaise, decreased libido, and changes
in sleep, activity, and eating


TREATMENT
• Ask patient about suicidal thoughts.
• Ask patient about suicidal plan.
• Psychotherapy.
• Cognitive-behavioral therapy.
• Support groups.
• Antidepressant medications:
• SSRIs
• venlafaxine
• nefazodone
• bupropion
• mirtazapine
• tricyclics
• monoamine oxidase inhibitors
• Electroconvulsant therapy (ECT) in refractory cases.

NURSING DIAGNOSIS

• Hopelessness
• Risk for suicide
• Dysfunctional grieving
• Impaired social interaction
• Social isolation

NURSING INTERVENTION

• Monitor patient frequently when first admitted.
• One-to-one observation if patient is a suicidal risk.
• Develop a level of sensitivity and trust with the patient.
• Ask patient about suicidal ideation; do they have a plan, have they attempted
to carry out a plan.
• Monitor medication intake.
• Discuss patient response to therapy.
• Monitor vital signs; watch for elevation in blood pressure with some med-
ications.
• Monitor weight; some medications are associated with changes in weight.
• Monitor sleep; ask patient about restful sleep during the night, and difficulty
falling asleep.
• Disturbed self-esteem