“It is okay not to be okay.” A feeling of being sad or blue once in a while is normal and expected to human nature. Be that as it may, depression is an unorthodox notion. WebMD (2020) suggested that 5 symptoms of depression which concurrently experienced for at least 14 days, characterized from mild to severe, are called “major depression, major depressive disorder, or clinical depression.”
Depression is defined as an alteration in mood that is expressed by feelings of sadness, despair, and pessimism. Depression is a universal, frequently used, and most abused diagnosis in psychiatry.
This condition is prevalent in society and referred to as “the common cold of psychiatric disorders”.
Depression is a mood disorder presented with chronic sadness and loss of interest, which directly affects how patients feel, think, behave, and their relationships towards others, leading to different emotional and physical symptoms causing a decline in a person’s daily function at home and work.
The exact causes of depression are still inconclusive up to date. The heterogeneity of mental disorders is generally linked to several factors, such as:
- Biological differences
The interaction between mind and body is still incognito. Depressed people appear to have psychosomatic symptoms in the process of battling against depression.
- Brain chemistry
The interactivity between the brain chemicals called neurotransmitters and neuro-circuits plays a vital role in developing depression due to its ability to maintain mood stability. Serotonin, dopamine, and norepinephrine are the neurotransmitters that affect happiness and pleasure, which is found to be an imbalance in depressed people.
- Hormonal changes
Hormonal imbalances may trigger depression, which is very common during menopausal, childbirth, and thyroid problems. On the flip side, mood-boosters called “happy hormones” such as dopamine (the feel-good hormone responsible for pleasure sensations), serotonin (mood-regulator, appetite, and sleep hormone), oxytocin (love hormone which increases affection), and endorphins (body’s natural pain reliever).
Depression runs in the blood through inherited traits; however, the exact genes involved in the depressive state’s occurrence is still unknown.
American Psychiatric Association (2020) and Mayo Clinic (2020) shared the same concepts of contributing risk factors that aggravate the occurrence of depression and other mental disorders:
- Personality traits concerning defense and coping mechanisms (e.g. low self-esteem, dependent, self-critical, or pessimistic).
- Traumatic experience and stressful events (e.g. abuse, death or loss of significant others, a difficult relationship, or financial problems).
- LGBT or having issues in the development of genital organs leading confusion on being femaleness or maleness.
- History of other mental health disorders such as anxiety, eating and stress disorders.
- Alcoholism and drug abuse.
- Chronic illness.
- Medication-induced stress/anxiety.
Types of Depressive Episodes
Depression can be characterized from mild to severe and may vary from person to person. Mayo Clinic (2020) identify specific features for each type of depressive episodes, such as:
1. Anxious distress – depression accompanied by bizarre restlessness on worrying about upcoming events or fear of getting out of control.
2. Mixed features – are presented by elevated self-esteem, talkativeness, and hyperactive during the attack of depression (mixed depression and mania).
3. Melancholic features – unresponsiveness to stimuli that give pleasure or excessive, inappropriate guilt over pleasure during a severe depressive episode.
4. Atypical features – a depression that seeks temporary relief from binge eating, attending happy events, oversleeping, and over sensitivity to rejections.
5. Psychotic features – depression accompanied by hallucinations and delusions.
6. Catatonic features – depression manifested by fixed or inflexible posture.
7. Peripartum onset – the depression that occurs during pregnancy or postpartum stage.
8. Seasonal pattern – moods affected by sudden changes in season, resulting in depression, which may be reduced by sunlight exposure.
Nursing Care Plan of Depression
- Depression Nursing Care Plan – Self-Esteem Disturbance
- Nursing Care Plan Postpartum Depression & Blues,Psychosis Comparison
Nursing Diagnosis for Depression
Hopelessness / Social isolation / Suicidal attempt / Suicidal thoughts / Verbalize suicidal or harming self dreams / States desire to die / Self harm / States to kill self
At risk for self-inflicted, life-threatening injury
Risk for suicide
Feelings of abandonment / Negative view of self / Difficulty in accepting positive reinforcement / Withdrawal into isolation / Being highly critical and judgmental of self and others / Expressions of worthlessness / Fear of failure / Inability to recognize own Accomplishments / Setting up self for failure by establishing unrealistic goals / Unsatisfactory interpersonal relationships / Negative, pessimistic outlook / Hypersensitive to slight or criticism / Grandiosity
Negative self-evaluation / feelings about self or self-capabilities.
Seeking to be alone / Assuming fetal position / Expression of feelings of aloneness or Rejection / Discomfort in social situations / Dysfunctional interaction with others / Sad, dull affect / Being uncommunicative, withdrawn; lacking eye contact / Preoccupation with own thoughts; performance of repetitive, meaningless actions
Social isolation manifesting anti-social behaviors in a negative or threatened state.
Insufficient and / or ineffective quality of social exchange.
Social isolation / Impaired Social Interaction
Reports lack of control (e.g., over self-care, situation, outcome) / Non-participation in care / Reports doubt regarding role performance / Reluctance to express true feelings / Apathy / Dependence on others / Passivity
Lack of control over a situation, including a perception that one’s actions do not significantly affect an outcome.
Inaccurate interpretation of environment / Delusional thinking / Altered attention span—distractibility / Egocentricity / Impaired ability to make decisions, problem-solve, reason / Negative ruminations
Disruption in cognitive operations and activities.
Disturbed thought processes
Loss of weight / Lack of interest in food / Pale mucous membranes / Poor muscle tone / Amenorrhea / Poor skin turgor / Edema of extremities / Electrolyte imbalances / Weakness / Constipation / Anemia
Insufficient intake of nutrients to meet the daily metabolic needs requirements.
Imbalanced nutrition, less than body requirements
Verbal complaints of difficulty falling asleep / Awakening earlier or later than desired / Interrupted sleep / Reports not feeling well-rested / Awakening very early in the morning and being unable to go back to sleep / Excessive yawning and desire to nap during the day / Hypersomnia; using sleep as an escape
Time-limited interruptions of sleep amount and quality due to internal or external factors.
Disturbed sleeping pattern
Suicidal ideas or behavior / Slowed mental processes / Disordered thoughts / Feelings of despair, hopelessness, and worthlessness / Guilt / Anhedonia (inability to experience pleasure)/Disorientation / Generalized restlessness or agitation / Sleep disturbances: early awakening, insomnia, or excessive sleeping / Anger or hostility (may not be overt) / Rumination / Delusions, hallucinations, or other psychotic symptoms / Diminished interest in sexual activity / Fear of intensity of feelings /Anxiety
Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources.
Withdrawn behavior / Verbalization diminished in quantity, quality, or spontaneity / Rumination / Low self-esteem / Unsatisfactory or inadequate interpersonal relationships / Verbalizing or exhibiting discomfort around others / Social isolation / Inadequate social skills / Poor personal hygiene
Insufficient or excessive quantity or ineffective quality of social exchange.
Impaired Social Interaction
Anergy (overall lack of energy for purposeful activity) / Decreased motor activity / Lack of awareness or interest in personal needs / Self-destructive feelings / Withdrawn behavior / Psychological immobility / Disturbances of appetite or regular eating patterns / Fatigue
Impaired ability to perform or complete self-feeding activities.
Impaired ability to perform or complete toileting activities for self.
Impaired ability to perform or complete bathing activities for self.
Impaired ability to perform or complete dressing activities for self.
Self-Care Deficit, Feeding / Toileting / Bathing / Dressing
Feelings of inferiority / Defeatist thinking / Self-criticism / Lack of involvement / Minimizing of own strengths / Guilt / Feelings of despair, worthlessness
Longstanding negative self-evaluating / feelings about self or self-capabilities.
Chronic Low Self-Esteem
Accurately diagnosing depression can be perplexing because it can look different, and symptoms vary from person to person. It is hard to understand the behavior of the brain during the depressive state wherein the use of physiologic parameters and subjective cues requires to weigh-in.
Depression can strike at any time with anyone, even to a person who lives in an ideal life, circumstances and environment. Depression is treatable with medications and psychotherapy, but it worsens if not treated, resulting in different complications affecting emotional, behavioral, medical, and other health-related aspects. It is a serious disorder that can charge the affected person and family with a long-term or lifetime detrimental effects.
- Web MD. (2020). Depression: Do you know the symptoms?. Web MD LLC. Retrieved on 05 September 2020 from https://www.webmd.com/depression/understanding-depression-symptoms
- *Townsend, M.C. (2015). Psychiatric Nursing: Assessment, Care Plans and Medications, 9th F.A. Davis Company | Philadelphia.
- American Psychiatric Association. (2020). What is depression?. Retrieved on 05 September 2020 from https://www.psychiatry.org/patients-families/depression/what-is-depression
- Mayo Clinic. (2020). Depression (Major Depressing Disorder). Mayo Foundation for Medical Education and Research (MFMER). Retrieved on 05 September 2020 from https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
- Abbey, A.E. & Legg, T.J. (2020). Causes of Depression. Healthline Media, a Red Ventures Company. Retrieved on 06 September 2020 from https://www.healthline.com/health/depression/causes#treatment
- Raypole, C. & Legg, T.J. (2019). How to Hack Your Hormones for a Better Mood. Healthline Media, a Red Ventures Company. Retrieved on 06 September 2020 from https://www.healthline.com/health/happy-hormone
- *Schultz, J. M. & Videbeck, S. L. (2013). Lippincott’s Manual of Psychiatric Nursing Care Plans, 9th edition. © Wolters Kluwer Health | Lippincott Williams & Wilkins.
- Castelao, C.D. (2016). The Difficulty of Diagnosing Depression. Retrieved on 06 September 2020 from https://sapienlabs.org/the-difficulty-of-diagnosing-depression/