TYPES OF DEPRESSION

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 DEPRESSION

By Prof Jones H.Munang’andu

Introduction

Depression is a common mental health condition that can affect anyone, regardless of age, background, or circumstances. It significantly impacts daily life, relationships, and overall well-being. Understanding depression is crucial for early detection, appropriate management, and reducing the stigma associated with it.

General Objective

By the end of this lecture, students should be able to demonstrate a comprehensive understanding of depression.

Specific Objectives

  1. Define depression
  2. Discuss the prevalence and importance of understanding depression in nursing
  3. State the types of depression
  4. Outline the signs and symptoms
  5. Discuss the causes of depression
  6. Explain the diagnosis and management of depression

Definition

Depression is a mood disorder characterized by persistent sadness, hopelessness, and a lack of interest in activities (anhedonia). These feelings last for at least two weeks and can affect an individual's thoughts, emotions, and behaviors (APA, 2022).

Prevalence

  • Approximately 5% of adults worldwide suffer from depression, with women being more affected than men.
  • This equates to roughly 280 million people globally, with 5.7% of adults over 60 years of age affected (WHO).

Classes of Depression

Endogenous Depression

  • Originates from within the body due to genetic, biochemical, or hormonal imbalances.
  • Often hereditary and may occur without a significant external trigger.
  • Example: Postpartum depression caused by hormonal changes.

Exogenous Depression

  • Triggered by external factors such as environmental, social, or psychological stressors.
  • Often easier to treat compared to endogenous depression.
  • Example: Reactive depression due to trauma, loss, or divorce.

Types of Depression ( MNEUMONIC; S.P.E.R.M ) (P4)

  1. Major Depressive Disorder (MDD): Characterized by one or more depressive episodes; may require hospitalization.
  2. Persistent Depressive Disorder (Dysthymia): Long-lasting, low-level depression for most of the day.
  3. Premenstrual Dysphoric Disorder: Depression occurring before menstruation.
  4. Seasonal Affective Disorder (SAD): Depression associated with seasonal changes, typically winter.
  5. Psychotic Depression: Accompanied by hallucinations or delusions.
  6. Postpartum Depression: Occurs after childbirth.
  7. Reactive Depression: Triggered by a specific event or circumstance such as the loss of a loved one or job-related stress.

Signs and Symptoms

Emotional

  • Persistent sadness, emptiness, or hopelessness
  • Loss of interest in previously enjoyed activities
  • Feelings of guilt or worthlessness
  • Irritability, anxiety, or panic attacks

Behavioral

  • Social withdrawal or isolation
  • Changes in appetite or sleep patterns
  • Fatigue, loss of energy
  • Difficulty concentrating or making decisions

Physical

  • Weight changes
  • Unexplained physical symptoms like headaches or digestive issues
  • Changes in sleep (insomnia or hypersomnia)

Cognitive

  • Difficulty concentrating
  • Memory problems
  • Suicidal thoughts or ideation

Causes of Depression

Biological

  • Genetics: Family history of depression
  • Neurotransmitter imbalances: Deficiency in serotonin, dopamine, and norepinephrine
  • Hormonal changes: Due to conditions like thyroid disorders, menopause, or pregnancy

Psychological

  • Trauma: Childhood trauma or abuse
  • Chronic stress
  • Low self-esteem: Negative self-image
  • Negative thinking patterns: Such as catastrophizing or rumination

Social

  • Social isolation: Lack of support or loneliness
  • Relationship problems: Conflicts or separation
  • Work stress: Job loss or chronic stress

Environmental

  • Childhood adversity
  • Chronic illness
  • Substance abuse

Diagnostic Criteria

Diagnosis requires a period of at least two weeks with either a depressed mood or loss of interest in activities, accompanied by at least five of the following symptoms:

  • Depressed mood most of the day
  • Significant weight changes
  • Sleep disturbances
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Difficulty concentrating
  • Suicidal thoughts

Management

Investigations

  • History taking
  • Physical examination
  • Mental state examination
  • Lab tests to rule out medical conditions (e.g., FBC, LFTs)

Medical Management

  1. Tricyclic Antidepressants (TCAs): Inhibits serotonin and norepinephrine reuptake.
    Example: Amitriptyline
  2. Selective Serotonin Reuptake Inhibitors (SSRIs): Increases serotonin availability.
    Example: Fluoxetine
  3. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Inhibits serotonin and norepinephrine reuptake.
    Example: Venlafaxine
  4. Monoamine Oxidase Inhibitors (MAOIs): Inhibits MAO enzyme, increasing serotonin, dopamine, and norepinephrine.
    Example: Phenelzine
  5. Antipsychotics: Block dopamine receptors to reduce psychotic symptoms.
    Example: Risperidone

Nursing Management

Aims

  • Promote safety
  • Enhance coping mechanisms
  • Improve mood and reduce symptoms
  • Support recovery and prevent relapse

Therapeutic Relationship

  • Build rapport with the patient and family
  • Promote trust and respect
  • Ensure the patient feels valued

Environment

  • Create a safe, low-noise, non-slippery environment
  • Remove sharps or harmful objects

Observation

  • Monitor eating, sleep, and social habits
  • Observe for signs of aggression
  • Check vital signs

Psychological Care

  • Reassure the patient
  • Explain treatment plans and side effects
  • Engage the patient in therapeutic activities

Rest and Sleep

  • Encourage activity during the day to promote nighttime sleep
  • Administer medication if necessary

Hygiene

  • Supervise bathing and provide hygiene products
  • Ensure nail, oral, and hair care

Nutrition

  • Monitor eating patterns
  • Serve balanced, nutritious meals in small portions

Medication

  • Administer the prescribed medication and ensure patient compliance

Elimination

  • Promote high fluid and fiber intake to prevent constipation
  • Assist with toilet orientation and check input/output

Health Education

  • Emphasize the importance of medication adherence
  • Provide information about relapse symptoms
  • Educate on community support and reducing stigma

Importance of Understanding Depression in Nursing

  1. Early Identification and Intervention
  2. Empathetic Care
  3. Effective Communication
  4. Suicide Prevention
  5. Reducing Stigma

Conclusion

Depression is a treatable condition that affects millions of people. By recognizing the signs and symptoms, understanding the causes, and seeking appropriate management, nurses can play a critical role in supporting patients through their recovery journey.

References

  • American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  • National Institute of Mental Health (2020) Depression.
  • World Health Organization (2019) Depression.
  • Beck, A. T., & Alford, B. A. (2009) Depression: Causes and Treatment. Philadelphia, PA: University of Pennsylvania Press.

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