Depression is a psychological state of mind. It is a major problem faced by most of the people especially the youths. all the reasons why depression is caused what are it's symptoms signs how must the person be treated is explained in this slide

1. Depression

2. INTRODUCTION
 Widespread mental health problem affecting many people.
 It is one of the leading cause of disability across the world.
 It is often associated with variety of medical condition.
 Highest incidence occurs in individuals without close
interpersonal relationships and in person who are divorced
or separated.

4. DEFINITION
Depression is defined as a common mental disorder that
presents with depressed/low mood , loss of interest or pleasure ,
decreased energy , feelings of guilt or low self worth , disturbed
sleep or appetite & poor concentration.(WHO)
More over depression often comes with symptoms of anxiety.
At its worst depression can lead to suicide.

5. Anatomy and Physiology
Thalamus-
speech , behavioural reactions , movement , learning , thinking.
Hippocampus-
processing long term memory and recollection.
Amygdala-
anger, pleasure , sorrow , fear & sexual arousal.
Prefrontal cortex-
making decisions and forming memories.

7. EPIDEMOLOGY
 Common mental disorder.
 1/5th of adults experiences major depressive disorder during their
lifetime.
 More than 300 million people of all ages suffer from depression
 women>men
 4th leading cause of disability. By 2020, depression will Be the 2nd
leading cause of disability.(WHO)
 According to DSM 5 criteria life time prevalance—28.2% for MDD.
 Suicide is the 2nd leading cause of death in 15-29 yr olds.

8. Classification
F 32—Depressive episode
F 32.0—Mild depressive episode
F32.00- without somatic syndrome
F32.01-with somatic syndrome
F 32.1—Moderate depressive episode
F32.10- with out somatic syndrome
F32.11-with somatic syndrome
F 32.2– severe depressive episode without psychotic symptoms
F32.3—severe depression episode with psychotic symptoms
F32.8—Other depressive episode- Atypical depression
F32.9—Depressive episode, unspecified

9. F33.0 Recurrent Depressive Disorder, current mild episode
F33.2 Recurrent Depressive Disorder, current episode moderate
F33.3 Recurrent Depressive Disorder, current episode severe with psychotic
symptoms
F33.4 Recurrent Depressive Disorder, currently in remission
F33.8 Other Recurrent Depressive Disorder
F33.9 Recurrent Depressive Disorder- unspecified

10. ETIOLOGY
BIOLOGICAL THEORIES
 Neurochemical
 Genetic theory
 Endocrine theories
 Circadian rhythm theories
 Change in brain anatomy

11. PSYCHOSOCIAL THEORIES
Psychoanalytic theory
Behavioural theory
Cognitive theory
Sociological theory
Transactional model of stress

12. PSYCHOPATHOLOG
Y
In depression, patient’s sadness deepens to a morbid depression
and the difficulty in concentration becomes retardation of all
thoughts and actions .Depressive patient may show a complete
failure of all insight, deny that they are ill and hold steadfastly
to their ideas of guilt and punishment.

13. STRESS
CRF
INCREASED CYTOKINES
ALTERED HPA AXIS
GLUCOCORTICOIDS RELEASE
RESISTANCE TO GLUCOCORTICOIDS
RECEPTORS
INCREASED SECRETION OF CORTISOL
DECREASED DENDRITIC
BRANCHING(ATROPHY/DEATH OF NEURONS
DEPRESSION

14. CLINICAL FEATURES
 Depressive mood- sadness, loss of interest in
activities
 Depressive cognitions-hopelessness,
helplessness , worthlessness , unreasonable guilt , self
blame
 Suicidal thoughts
 Psychomotor activity-slowness in thinking,
walking & act, restlessness, feeling of uneasiness
 Psychotic features-Delusions & hallucinations,
nihilistic delusions

15. SOMATIC SYMPTOMS
Loss of appetite and weight loss
Early morning awakening at least 2 or more hours before usual
time of waking up
Diurnal variation ,depression being worst during morning
Lack of interest or lack of reactivity to pleasurable stimuli
Psychomotor retardation

18. BOOK PICTURE PATIENT PICTURE
Sadness of mood, loss of pleasure or interest in activities Sadness of mood, loss of pleasure in almost all activities
Hopelessness, helplessness, worthlessness, guilt Hopelessness, worthlessness
Self blame over trivial matters in the past Suicidal thoughts
Suicidal thoughts Thinks, Walks, acts slowly
Thinks, walks, acts slowly
restlessness Loss of appetite
hallucination Loss of weight
Loss of appetite
Loss of weight

19. PSYCHOLOGICAL TESTS-
 BECK DEPRESSION INVENTORY
A 21 question multiple choice self report that measure the severity of depression
symptoms and feeling
 ZUNG SELF—RATING DEPRESSION SCALE
A short survey that measures the level of depression ranging from normal to severely
depressed .The scale consist of 20 item self report questionnaire.
HAMILTON RATING SCALE FOR DEPRESSION
DEXAMETHASONE SUPPRESSION TEST
ICD—10 CRITERIA
SERUM ELECTROLYTES,LFT,RFT
HEMATOLOGICAL INVESTIGATIONS
DIAGNOSIS

23. BOOK PICTURE PATIENT PICTURE
HAMILTON RATING SCALE FOR DEPRESSION HAMILTON RATING SCALE FOR DEPRESSION
BECK’S SUICIDE INTENT SCALE BECK’S SUICIDE INTENT SCALE
BECK’S DEPRESSION INVENTORY ICD—10 CRITERIA
ZUNG SELF RATING DEPRESSION SCALE SERUM ELECTROLYTE,LFT,RFT
ICD—10 CRITERIA HEMATOLOGICAL INVESTIGATION
SERUM ELECTROLYTE,LFT,RFT
HEMATOLOGICAL INVESTIGATION

24. TREATMENT

25. Psychopharmacology

26. INDIVIDUAL PSYCHOTHERAPY
Phase 1
Client is assessed to determine the extent of the illness. Complete
information is given to individual regarding nature of depression
Phase 2
Focus on helping the client resolve complicated grief reactions-----
establishment of new relationships
Phase 3
Clarification of emotional states, improvement of interpersonal
communication, testing of perceptions

27. GROUP THERAPY-
Sharing of feelings in groups.
FAMILY THERAPY
COGNITIVE THERAPY-
The individual is taught to control thought distortions that are
considered to be a factor in the development and maintenance of
depressive disorder.
ELECTROCONVULSIVE THERAPY-
It is induction of generalized grandmal seizure through application
of electric current to the brain .
TRANSCRANIAL MAGNETIC STIMULATION-
Use very short pulses of magnetic energy to stimulate nerve cells in
the brain,
Similar to ECT.

28. COMPLICATION
 Alcohol or drug misuse
 Anxiety , panic disorder , social phobic
 Family conflicts, relationship difficulties
 Social isolation
 Suicidal feelings
 Self mutilation
 Premature death from medical condition

29. NURSING
DIAGNOSIS

30. Altered communication process
related to depressive cognitions as
evidenced by being unable to
interact with others, withdrawn,
expressing fear of failure or
rejection.

31. Observe for nonverbal communication.
Patient may say that she is happy but
looks sad. Point out this discrepancy in
what she is saying and actually feeling.
Introduce the patient to another patient who is quiet and
possibly convalescing from depression.
Use silence appropriately without communicating anxiety
or discomfort in doing so.

32. Altered sleep and rest related to depressed
mood and depressive cognitions as
evidenced by waking up around 3 am and
difficulty falling asleep after that.

33. Plan daytime activities according to patient’s
interest
Ensure a quiet and peaceful environment when
the patient is preparing for sleep
Do not allow patient to sleep for long time during
day……give sedatives as prescribed

34. Self esteem disturbance related to
impaired cognitions as evidenced by
expression of worthlessness, negative
and pessimistic outlook

35. Be accepting of patient and spend time with her, even
though pessimism and negativism may seem
objectionable
Focus on strengths and accomplishments and
minimize failures
Encourage patient to perform his activities without
assistance.

36. Conclusion
Depression is a state of low mood, anhedonia, decreased energy. It is caused
by various biological and psychosocial factors. Diagnosis is done by
various psychological and hematological tests. Treatment includes various
psychopharmacological treatments along with psychotherapy.

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