Chapter 12
Mood Disorders: Depression
Depression
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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
Theory
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Heterogeneous, systematic illness involving an array of
different neurotransmitters, neurohormones, & neuronal
pathways
Biological: Genetic link
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Biochemical: Neurotransmitter abnormalities can probably cause
depression
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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
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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
Depressiove disorders
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Major Depressive Disorder
 Defined
as 1 or more major depressive episodes and
no history of manic or hypomanic episodes
 Subtypes
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Psychotic features
Catatonic features
Melancholic features
Postpartum onset
Seasonal features
Atypical features
Depressive disorders
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Dysthymia Disorder
 Chronic
depressive syndrome usually present
for most day, more days than not, for at least
2 yrs
 Early and insidious onset
 Depressive 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
Application of the nursing process
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Assessment
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Assessment Tools
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Beck Depression Scale, Hamilton Depression Scale, Geriatric Depression Scale
Assessment of Suicide Potential
Areas to Assess
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Undiagnosed & untreated depression often associated with more severe presentation
of depression, greater suicidality, somatic problems, & severe anxiety
Mood, physical changes, cognition
Assessment Guidelines
Diagnosis: risk for suicide
Outcomes Identification: Goal for safety
Planning
Application of nursing process
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Implementation
 Communication
Guideline
 Health Teaching and Promotion
 Milieu Therapy
 Psychotherapy: CBT and Behavioral therapy
 Group: widespread modality for treatment
 Pharmacological/Biological/Integrative: ECT,
Antidepressant drugs (SSRI’s, TCA, Atypical,
MAOs)
Application of the nursing process
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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