Mood Disorders: Depression
Chapter 12
Defined as a depressed mood or loss of interest that lasts at least 2 weeks & is accompanied by symptoms such as weight loss & difficulty concentrating
Prevalence & Comorbidity 4th leading cause of disability in US Projected to be 2nd leading cause disability by 2020 Frequently accompanies other psychiatric disorders Mixed anxiety-depression most common psychiatric presentation Pts with medical disorder at high risk for depression Occurs in children, adolescents, adults and older adults
Cultural Considerations Rate is lowest in Asians as compared to Caucasians, African Americans
& Hispanics
Depression
Heterogeneous, systematic illness involving an array of different neurotransmitters, neurohormones, & neuronal pathways
Biological: Genetic link Biochemical: Neurotransmitter abnormalities can probably cause
depression Serotonin: regulator if sleep, appetite & libido Norepinephrine: decreased levels can result in anergia (lack energy)
anhedonia (inability to find meaning or pleasure) decreased concentration & decreased libido
Neuroendocrine: evidence of increased cortisol secretion Image Findings: CAT & MRI show ventricular enlargement,
cortical atrophy, & sulcal widening
Theory
Cognitive Theory Developed by Aaron T. Beck Applied CBT to depression Proposed that people acquire psychological predisposition to
depression through early life exp Becks Cognitive Triad
A negative self-depreciating view of self A pessimistic view of world A belief that negative reinforcement will continue
Learned Helplessness Seligman (1973) stated that although anxiety is initial response
to stress, anxiety is replaced by depression if person feels no control over outcome
Theory
Major Depressive Disorder Defined as 1 or more major depressive episodes and
no history of manic or hypomanic episodes Subtypes
Psychotic features Catatonic features Melancholic features Postpartum onset Seasonal features Atypical features
Depressiove disorders
Dysthymia DisorderChronic depressive syndrome usually present for
most day, more days than not, for at least 2 yrsEarly and insidious onsetDepressive mood disturbance cannot be
distinguished from person’s usual pattern of functioning
Age of onset is usually early childhood and teenage years to early adulthood
Depressive disorders
Assessment Undiagnosed & untreated depression often associated with more severe presentation
of depression, greater suicidality, somatic problems, & severe anxiety Assessment Tools
Beck Depression Scale, Hamilton Depression Scale, Geriatric Depression Scale Assessment of Suicide Potential Areas to Assess
Mood, physical changes, cognition Assessment Guidelines Diagnosis: risk for suicide Outcomes Identification: Goal for safety Planning
Application of the nursing process
ImplementationCommunication GuidelineHealth Teaching and PromotionMilieu TherapyPsychotherapy: CBT and Behavioral therapyGroup: widespread modality for treatmentPharmacological/Biological/Integrative: ECT,
Antidepressant drugs (SSRI’s, TCA, Atypical, MAOs)
Application of nursing process
Somatic Treatments Electroconvulsive therapy (ECT) Vagus Nerve Stimulation
Integrative Therapies Light Therapy St. John’s Wort Exercise Future Treatment
Transcranial Magnetic Stimulation Brain Imaging
Evaluation Short term indicators and outcome criteria are frequently
evaluated
Application of the nursing process