Depression is a common and serious medical illness that negatively impacts mood, thinking, and behavior. It causes feelings of sadness and loss of interest in activities. Depression has various types and can be caused by genetic and environmental factors. Symptoms include changes in sleep, appetite, energy, concentration, and thoughts of death. It is diagnosed when 5 or more symptoms are present for 2 weeks. Treatment involves antidepressant medication, cognitive behavioral therapy, or a combination which can help most people recover.

1. Prepared by:
Aram Mustafa Ali

3. What Is Depression?
Depression (major depressive disorder) is acommon and
serious medical illness that negatively affects how you feel,
the way you think and how you act. Fortunately, it is also
treatable. Depression causes feelings of sadness and/or a
loss of interest in activities once enjoyed. It can lead to a
variety of emotional and physical problems and can
decrease a person’s ability to function at work and at
home.

4. Types of Depression
1.Major depression: as we discussed, is the most common type of depression. Often, people
with major depression experience recurrent episodes throughout their lives.
2.Some people are more sensitive to the lower amount of light in the wintertime. Seasonal
Affective Disorder is a type of depression brought on from a lack of natural sunlight.
3.Bipolar Disorder: is also called Manic Depressive Disorder because it involves alternating
between mania and depressive episodes.
4.Postpartum Depression: occurs after giving birth. Mothers may feel disconnected from their
new baby or fear that they will hurt their child.
5. Premenstrual Dysphoric Disorder: Is Severe depression that shows up during the second
half of the menstrual cycle. It affects the individual’s ability to function normally.

5. Causes of Depression
There is no one cause for depression, as it depends on a unique combination of
an individual’s genetic makeup and environmental conditions. There are many
factors to take into account:
The brain’s physical structure or chemistry
History of depression in the family
History of other disorders (anxiety, post-traumatic stress disorder)
Stressful, traumatic events (abuse, financial issues, death of a loved one)
Hormone changes (menstrual cycles, pregnancy)
Certain medications (sleeping aids, blood pressure medication)

6. Signs and Symptoms of Depression
Though there are multiple types of depression, many of them have similar recognizable symptoms. This list scratches
the surface, but it provides a general idea of what comprises depression:
Persistent feelings of sadness, hopelessness, worthlessness, or emptiness
Irritability, frustration, or restlessness
Loss of interest in activities or hobbies that used to be enjoyable
Difficulty sleeping, sleep disturbances or sleeping too much
Fatigue and lack of energy
Difficulty thinking clearly, remembering, concentrating, or making decisions
Appetite or weight changes
Recurrent thoughts of death or suicide
Physical symptoms such as headaches, stomachaches, or back pain

7. Depression DSM-5 Diagnostic Criteria
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be
experiencing five or more symptoms during the same 2-week period and at least one of the symptoms
should be either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day,
nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite
nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others,
not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide
attempt or a specific plan for committing suicide.

8. Patient Statistics
According to the National Institute of Mental Health (NIMH), major depression is one of the
most common mental disorders in the United States.1
Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows
that in 2017, an estimated 17.3 million adults in the United States reported having at least one
major depressive episode in the previous 12 months. That’s 7.1% of all US adults ages 18 and
older. Adult females have a higher prevalence of experiencing a major depressive episode than
their male counterparts—8.7% compared to 5.3% in adult males. Depression in the adolescent
population (ages 12 to 17) has also increased. An estimated 3.2 million adolescents had at least
one major depressive episode—a number that represents 13.3% of the adolescent population.

10. Treatment for Depression
The good news is that depression is a treatable condition and many people fully recover.
Once depression is diagnosed and treated people usually feel much better. Even people who
are seriously depressed can greatly improve with treatment. Keep in mind, however, that
recovery takes time.
The two most common types of treatment for depression are antidepressant medication
and cognitive behavioral therapy (either group or individual). Antidepressant medications
change the chemical and electrical messages in the brain, while cognitive behavioral
therapy can help improve relationships, manage stress, and increase positive thinking and
pleasant activities.

11. CBT therapy and depression
Fortunately, the downward spiral and cycle of depression can be
reversed with medication and/or cognitive behavior therapy. With these
treatments, persons suffering from depression begin to sleep better, feel
more energetic, socialize more, think more realistically, and generally
feel better. Most of the exercises in this manual are related to cognitive
behavioral therapy. The exercises focus on behaviors that will lead to
feeling better (such as doing more pleasant activities) and on improving
thoughts and feelings (such as reversing negative thinking patterns that
cause feelings of hopelessness).

12. There are two common types of antidepressant
medication.
Serotonin Selective Reuptake Inhibitors
SSRIs treat depression by increasing levels of serotonin in the brain. Serotonin is one of the
chemical messengers (neurotransmitters) that carry signals between brain nerve cells
(neurons).
SSRIs block the reabsorption (reuptake) of serotonin into neurons. This makes more
serotonin available to improve transmission of messages between neurons. SSRIs are called
selective because they mainly affect serotonin, not other neurotransmitters.
(SSRI) include medications such as
Sertraline
Paroxetine
Flouxitine
Escitalopram
Tricyclic antidepressants/heterocyclics like Amitriptyline, Nortriptyline, or Trazodone

13. Treatment for Common Side Effects from Antidepressants
Side Effect Solution
Dry Mouth
Drink plenty of water.
Chew sugarless gum or use sugarless gumdrops to increase
moisture to your mouth.
Constipation
Eat more fiber-rich foods such as prunes, fresh fruits, bran
cereal or whole wheat breads.
Take a stool softener.
Increase fluid intake.
Drowsiness
Get fresh air and take frequent walks.
Wakefulness
Take medications early in the day.
Take a hot bath and have a light snack before bed.
Dizziness
Get up slower.
Drink plenty of fluids.

14. Complication
LOSS OF PRODUCTION
ALCOHOLISM AND DRUG ABUSE
SUICIDE

15. Nursing Intervention
1. Make environment Safe close observation {to protect the Patient from
Suicide}.
2. Establish Trust .
3. Encourage open, Honest, trust, self-esteem.
4. Avoid arguing with the Patient and be silence and active listening.
5. Assistant for problem solving.
6. Encourage group attendance.
7. Help Patient how to take care of himself, eat and take bath.
8. Establish healthy sleep and wake routine
9. Focus on strengths minimize failure
10.Administer prescribed medication

16. Reference
Rantala MJ, Luoto S, Krams I, Karlsson H. Depression subtyping based on evolutionary psychiatry:
proximate mechanisms and ultimate functions. Brain Behav Immun. (2017) 69:603–17.
10.1016/j.bbi.2017.10.012 [PubMed] [CrossRef] [Google Scholar]
G., Loh, H., Renjan, V., Tan, J., & Fung, D. (2017). Child Community Mental Health Services
in Asia Pacific and Singapore’s REACH Model. Brain sciences, 7(10), 126.
O’Connor, Lewandoski, Rodriquez, et al. (2016) Usual Care for Adolescent Depression From
Symptom Identification Through Treatment Initiation. JAMA Pediatr., 170(4):373-380