mental health nursing

1. Depression

2. Learning objectives
 To define depression.
 To be able to identify sign and symptoms of depression.
To be able to understand causes of depression
Describe the management of depression.
To be able to assess depression.

3. Introduction
Sadness/unhappy/disappointment is not merely
depression rather normal human emotions.
It becomes depression when these are abnormal,
excessive and disproportionate leading to impairment.

4. Definition
An alteration in mood that is expressed by feelings of sadness,
despair and pessimism. There is loss of interest in usual activities and
somatic symptoms may be evident. Changes in appetite and sleep
patterns are common.

5. Statistics and incidences
According to WHO-
 Globally 3.8% of the population experience depression, including 5% of adults
(4% among men and 6% among women), 5.7% of adults older than 60 years.
9.3% of youth (18-24 years) in India suffered depression during lockdown (May
2020) which increased by 16.8% by March 2022.

6. Sign and symptoms
Behavioral Avoiding people/psychomotor slowing
agitation/self harm behavior
Motivational Lack of motivation for work/food/sex/other
pleasurable activities
Affective Sadness of mood
Cognitive Inattentiveness, forgetfulness, slowness of
thinking, pessimistic thinking, guilt feeling
Somatic Multiple pain symptoms, dyspepsia etc.

7. Causes
Psychosocial
Biological
Neurotransmitters

8. Medical management
Electroconvulsive therapy (ECT)
Psychotherapy
Transcranial magnetic stimulation

9. Pharmacologic management
Major categories of antidepressants:
Tricyclic antidepressants- Imipramine, Clomipramine, Amitriptyline
Selective serotonin reuptake inhibitors- Fluoxetine, Sertraline, Escitalopram
Atypical antidepressants- Bupropion, venlafaxine, duloxetine
Mono Amine Oxidase Inhibitors- Isocarboxazid, Selegiline, Phenelgine

10. Nursing management
Nursing assessment
Subjective: includes verbalization of inability to cope or ask for help,
sleep disturbances and fatigue, abuse of chemical agents, lack of appetite.
Objective: Include lack of goal-directed behavior or resolution of
behavior, inadequate problem solving, decreased use of social support,
inability to meet role expectations/basic needs, and destructive behavior
towards self.

11. Nursing diagnosis
•Dysfunctional grieving related to real or perceived loss, bereavement
overload
•Hopelessness related to perception of worthlessness and absence of
support system
•Low self esteem related to learned helplessness, feelings of
abandonment and impaired.

12. Nursing Interventions
 Provide for patient’s physical needs.
 Assume active role in initiating communication.
 Educate patients about depression.
 Ask patient whether he thinks about death or suicide.

13. Documentation
Record all observations and conversations with the
patient because these are valuable in evaluating his response to
treatment.

14. References
1)Manisha Gupta,A textbook of therapeutic modalities in psychiatric nursing,
first edition, jaypee brothers medical publishers(P)Ltd, pg no:120-130
2) Deepika C Khakha, Essentials of Mental health nursing, first edition, CBS
publishers & distributors (P). Ltd.pg no:176-182
3)Mary C. Townsend, psychiatric mental health nursing,9th edtion ,jaypee
brothers medical publishers(P)Ltd, pg no: 208-213

15. THANK YOU