3. DEFINITION
• Depression is a widespread mental health problem
affecting many people.
• Depression is a common mental disorder that
presents with
• depressed mood,
• loss of interest or pleasure,
• feelings of guilt or low self-worth,
• disturbed sleep or appetite,
• low energy, and
• poor concentration.
4. PREVALENECE
occurs in persons of all genders, ages, and
backgrounds.
higher in women than in men by almost 2 to 1.
Average age of onset is 20 and 40 years.
5. PREVALENECE
Higher incidence in women who are divorced
or separated
Affecting about million people worldwide.
leading causes of disability worldwide.
6. CAUSES OF DEPRESSION
1. Genetic or Hereditary
depression is 1.5 to 3 times more common
among first-degree
The occurrence rate for monozygotic twins is
65%and for dizygotic twins is 15%
7. 2. Neurochemical
deficiency of the neurotransmitters norepinephrine,
serotonin, and dopamine.
NOTE
Norepinephrine is a key component to deal with stressful
situations.increases alertness and attention, .
serotonin regulate functions, such as mood, anxiety,
irritability, thinking, cognition, appetite and circadian
rhythm.
dopamine influence over human mood and behaviour.
8. 3. Endocrine theories
• Malfunction of hypothalamic
pituitary adrenal axis [HPA]
may lead to depression.
• HPA is a system that mediates
the stress response.
9. 4. Circadian rhythm theories
Responsible for daily
regulation of wake-sleep
cycle.
Malfunction of circadian
rhythm may lead to
depression.
10. 5.Changes in Brain anatomy
Loss of neurons in frontal lobe and
cerebellum has been identified in
depression
11. 6. Psychoanalytical theory
According to Freud, depression result due to loss of loved
object and fixation in oral phase of development.
7.Behavioural theory
According to this theory depression is conditioned by
repeated loss in the past.
12. 8.Cognitive theory
According to this theory depression is due to negative
cognition which includes
Negative expectation of the environment
Negative expectation of the self
Negative expectation of the future
13. 9.Social theory
Stressful life events for example death , marriage, financial
loss , divorce may lead to depression.
10. Medications;
Some medication like beta blockers, corticosteroids , oral
contraceptives may precipitate depression.
NOTE-
Research suggests that corticosteroids lower serotonin levels
in the body.
Oestrogen and progesterone influence the activity of neurotransmitters gamma-
aminobutyric acid, serotonin and dopamine
14. SIGNS AND SYMPTOMS
Depressed mood:
Persistent sad, anxious, or "empty" feelings
loss of pleasure in almost all activities
present throughout the day (persistent sadness).
Depressive cognitions:
Hopelessness ('no hope in future’)
helplessness (no help is possible),
worthlessness
unreasonable guilt and self-blame over matters in the past
Irritability, restlessness
15. SIGNS AND SYMPTOMS
Suicidal thoughts:
Patient feel life is no longer worth living
death had come as a welcome release.
Preoccupations with thought of suicide.
thoughts of and plans for suicide
Psychomotor activity:
Psychomotor retardation is frequent.
patient thinks, walks and acts slowly.
Slowing of thought is reflected in the patient's speech;
questions answered after a long delay
monotonous voice.
Marked anxiety, restlessness and feelings of uneasiness
16. SIGNS AND SYMPTOMS
Psychotic features:
delusions and hallucinations
nihilistic delusions (belief of being dead,
decomposed , having lost one's own internal organs
or even not existing entirely as a human being.),
delusions of guilt,
delusions of poverty,
delusion of control.
17. SIGNS AND SYMPTOMS
Somatic symptoms
Significant decrease in appetite or weight.
Early morning awakening, at least 2 or more hours before
the usual time
depression being worst in the morning.
Other Features
Difficulties in thinking and concentration.
Subjective poor memory.
Menstrual or sexual disturbances.
Vague physical symptoms such as fatigue, aching
discomfort, constipation, etc.
18. ICD 10 CLASSIFICATION
F32 Depressive episode
G1. The depressive episode should last for at least 2 weeks.
G2. There have been no hypomanic or manic symptoms
sufficient to meet at any time in the individual's life.
G3. The episode is not attributable to psychoactive substance
use (F10F19) or to any organic mental disorder (in the sense
of F00-F09).
To qualify , four of the following symptoms should be present:
(1) marked loss of interest or pleasure in activities that are
normally pleasurable;
(2) lack of emotional reactions to events
19. ICD 10 CLASSIFICATION
F32 Depressive episode
(3) waking in the morning 2 hours or more before the
usual time;
(4) depression worse in the morning;
(5) marked psychomotor retardation
(6) marked loss of appetite;
(7) weight loss (5% or more of body weight in the
past month);
(8) marked loss of libido.
21. F32 Depressive episode
F32.0 Mild depressive episode
F32.1 Moderate depressive episode
F32.2 Severe depressive episode without psychotic
symptoms
F32.3 Severe depressive episode with psychotic
symptoms
F32.8 Other depressive episodes
F32.9 Depressive episode, unspecified
22. 32.0 Mild Depression
Symptoms at the mild level of depression are identified by
those associated with normal grieving.
This can occur with the loss of a loved one, pet, friend, home,
or significant other.
As one is able to work through the stages of grief, the loss is
accepted,
symptoms subside and activities of daily living are resumed
within a few weeks.
If this does not occur, grief is prolonged or exaggerated, and
symptoms intensify.
23. 32.1 Moderate depression
Moderate depression occurs when grief is prolonged or
exaggerated.
The individual becomes fixed in the anger stage of the
grief response.
All of the feelings associated with normal grieving are
exaggerated and the individual is unable to function
without assistance.
24. F32.0 Mild depressive episode
COMMON FEATURES
(1) depressed mood to a degree that is definitely abnormal
for the individual, present for most of the day
(2) loss of interest or pleasure in activities that are normally
pleasurable;
(3) decreased energy or increased fatiguability.
25. (1) loss of confidence and self-esteem
(2) inappropriate guilt;
(3) thoughts of death or suicide,
(4) evidence of diminished ability to think or concentrate,
(5) change in psychomotor activity,
(6) sleep disturbance
(7) change in appetite (decrease or increase) .
26. 32.2 Severe depression without psychotic symptoms
Severe depression is an intensification of the symptoms
associated with the moderate level.
The individual who is severely depressed may also
demonstrate a loss of contact with reality.
This level is associated with a complete lack of pleasure
in all activities, and recurrent thoughts about suicide are
common.
27. F32.2 Severe depressive episode without psychotic symptoms
no hallucinations, delusions, or depressive stupor.
28. F32.3 Severe depressive episode with psychotic
symptoms
All the features related to severe episode are present.
delusions or hallucinations,
depressive stupor may be present.
30. MANAGEMENT
Management depends upon severity of depression
MILD DEPRESSION
Counselling
Frequent follow up
Patient improve no further treatment required
If not start antidepressant.
Counselling continue
31. Cognitive therapy:It aims at correcting the depressive negative
cognitions like hopelessness, worthlessness, helplessness and
pessimistic ideas, and replacing them with new cognitive and
behavioral responses. • Supportive psychotherapy: Various
techniques are employed to support the patient. They are
reassurance, ventilation, occupational therapy, relaxation and
other activity therapies. • Group therapy: Group therapy is
useful for mild cases of depression. In group therapy negative
feelings such as anxiety anger, guilt, despair are recognized and
emotional growth is improved through expression of their
feelings. • Family therapy: Family therapy is used to decrease
intrafamilial and interpersonal difficulties and to reduce or
modify stressors, which may help in faster and more complete
recovery. • Behavior therapy: It includes socialskills training,
problem solving techniques, assertiveness training, self-control
therapy, activity scheduling and decision making techniques.
32. Cognitive therapy:
aims at correcting the depressive negative cognitions like
hopelessness,
worthlessness,
helplessness and
pessimistic ideas,
replacing them with new cognitive and behavioral responses.
Supportive psychotherapy:
Various techniques are employed to support the patient.
They are reassurance, ventilation, occupational therapy,
relaxation and other activity therapies.
33. Group therapy:
useful for mild cases of depression.
In group therapy negative feelings such as anxiety anger,
guilt are recognized
emotional growth is improved through expression of their
feelings.
Family therapy:
used to decrease intrafamilial and interpersonal difficulties
to reduce or modify stressors, which may help in faster and
more complete recovery.
34. Behavior therapy:
It includes
social skills training,
problem solving techniques,
activity scheduling and
decision making techniques.
39. Course and Prognosis of Mood
An average depressive episode lasts for 4-9 months.
Good Prognostic Factors
Abrupt or acute onset
Well-adjusted premorbid personality
Good response to treatment
Poor Prognostic Factors
Recurrent depression
Co-morbid personality disorders or alcohol dependence
Chronic ongoing stress
Poor drug compliance
Marked hypochondriacal features
psychotic features
40. NURSING MANAGEMANT
ASSESSMENT
History [marked helplessness, hopelessness and
worthlessness]
MSE
Assess severity of symptoms
Identifying the possible causes,
Assess suicidal tendency and attempts
The social resources available to the patient.
41. NURSING MANAGEMANT
DIAGNOSIS
Risk for suicide related to Depressed mood, feelings
of hopelessness and worthlessness
Complicated grieving related to loss of loss object.
Low self-esteem related to helplessness, feelings of
abandonment by significant other,
42. NURSING MANAGEMANT
DIAGNOSIS
Hopelessness related to Absence of support systems
and perception of worthlessness
Altered sleep and rest, related to depressed mood and
disturbed cognition evidenced by difficulty in falling
asleep.
43. NURSING MANAGEMANT
Self- care deficit related to depression as evidence by
monitoring the patient’s daily activities.
Imbalanced nutrition, less than body requirement
related to helplessness, hopelessness and
worthlessness as evidenced by refusal to take food.
Ineffective individual coping related to symptoms
secondary to depressive disorder as evidenced by
verbalization by family members
44. NURSING MANAGEMANT
NURSING INTERVENTION
Risk for suicide
Ask the patient directly "Have you thought about harming
yourself in any way? If so, do you plan to do? Do you have the
means to carry out this plan?“
Create a safe environment for the patient.
Remove all potentially harmful objects from patient’s
environment (sharp objects, straps, belts, glass items, alcohol,
etc.).
Supervise closely during meals and medication administration.
Formulate a short-term verbal or written contract that the patient
will not harm self..
45. NURSING MANAGEMANT
NURSING INTERVENTION
Risk for suicide
Do not leave the patient alone. Place the client near the nursing
station
Do not allow the patient to put the door of bathroom or toilet.
If the patient suddenly becomes unusually happy or gives any
other clues of suicide, special observation may be necessary.
Encourage the patient to express his feelings, including anger
46. Low self-esteem
Be accepting to patient and spend time, even though
negativism may seem.
Focus on strengths and accomplishments and minimize
failures.
Provide simple and easily achievable activity.
Encourage the patient to perform activities without
assistance.
Teach coping skills.
47. Complicated grieving
Assess stage of fixation in grief process.
Be accepting to patient and spend time with him. Show
empathy, care and unconditional, positive regard.
Explore feelings of anger and help patient direct them
towards the intended object or person.
Provide simple activities which can be easily and quickly
accomplished.
48. Disturbed sleeping pattern
Plan daytime activities according to the patient's
interests,
Do not allow him to sit idle. Do not allow the patient to
sleep during the day.
Ensure a quiet and peaceful environment for sleep.
Provide comfort measures (back rub,, warm milk, etc.).
Give sedatives as prescribed.
49. Altered nutritional status
Closely monitor the client's food and fluid intake; maintain
intake and output chart.
Record patient's weight regularly.
Find out the likes and dislikes of the person before he was
sick and serve the best preferred food.
Serve small amounts of a light diet frequently that is
nourishing.
Record the client's pattern of bowel elimination.
Encourage more fluid intake, roughage diet and green leafy
vegetables
50. Self- care deficit
Ensure that he takes his bath regularly.
Do not ask the patient's permission for a wash or bath.
Lead the patient to the action with positive suggestions, e.g.
"The water is ready, let me take you for a bath."
When the patient has taken care of himself, express
realistic appreciation.
