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depression(de-presh'on) [L. depressio, a pressing down]
Depressive disorders are common: about 20% of women and about 10% of men may suffer from major depression at some point during their lives. Worldwide, depression is considered to be the fourth most serious illness as far as the overall burden it imposes on people's health. Depressed patients have more medical illnesses and a higher risk of self-injury and suicide than patients without mood disorders.
Characteristic symptoms of the depressive disorders include persistent sadness, hopelessness, or tearfulness; loss of energy or persistent fatigue; persistent feelings of guilt or self-criticism; a sense of worthlessness; irritability; inability to concentrate; decreased interest in daily activities; changes in appetite or body weight; insomnia or excessive sleep; and recurrent thoughts of death or suicide. These symptoms cause pervasive deficits in social functioning.
Psychotherapies, behavioral therapies, electroconvulsive therapy (ECT, shock therapy), and psychoactive drugs are effective in the treatment of depressive disorders.
CAUTION!Depressed people who express suicidal thoughts should not be left alone, esp. if hospitalized.
The patient is assessed for feelings of worthlessness or self-reproach, inappropriate guilt, concern with death, and attempts at self-injury. Level of activity and socialization are evaluated. Adequate nutrition and fluids are provided. Dietary interventions and increased physical activity are recommended to manage drug-induced constipation; assistance with grooming and other activities of daily living may be required. A structured routine, including noncompetitive activities, is provided to build the patient's self-confidence and to encourage interaction. Health care professionals should express warmth and interest in the patient and be optimistic while guarding against excessive cheerfulness. Support is gradually reduced as the patient demonstrates an increasing ability to resume self-care. Drug therapies are administered and evaluated: these may include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine and serotonin reuptake inhibitors, dopamine-norepinephrine reuptake inhibitors, and norepinephrine-serotonin modulators. Monamine oxidase (MAO) inhibitors also may be used, but these have a high risk for toxicity unless necessary dietary restrictions are strictly followed. These drugs may be used alone or in combination with specific psychotherapeutic approaches such as cognitive behavioral therapy (CBT) or brief psychosocial counseling. CBT helps patients understand how their thoughts can become distorted and contribute to depression and anxiety and helps them learn coping behaviors that reduce feelings of anxiety, distress, and helplessness caused by distorted thinking.
If ECT is required (usually for patients who haven’t responded well to drug therapy or for whom drugs pose a risk), the patient is informed that a series of treatments may be needed. Before each ECT session, the prescribed sedative is administered, and a nasal or oral airway inserted. Vital signs are monitored, and support is offered by talking calmly or by gentle touch. After ECT, mental status and response to therapy are evaluated. The patient may be drowsy and experience transient amnesia but should become alert and oriented within 30 min. The period of disorientation lengthens after subsequent treatments. Synonym: unipolar depression
atypical depressionAbbreviation: AD
bipolar depressionSee: bipolar disorder
hidden depressionMasked depression.
In children and adolescents, the mood may be irritable rather than sad. Establishing the diagnosis requires the presence of at least four of the following: (1) changes in appetite, weight, sleep, and psychomotor activity; (2) decreased energy; (3) feelings of worthlessness or guilt; (4) difficulty in thinking, concentrating, or making decisions; or (5) recurrent thoughts of death or plans for or attempts to commit suicide.The symptoms must persist for most of the day, nearly every day, for at least 2 consecutive weeks. The episode must be accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning. Also, the disorder must not be due to bereavement, drugs, alcohol, or the direct effects of a disease such as hypothyroidism.
postnatal depressionPostpartum depression.
postpartum depressionAbbreviation: PPD
Affected mothers typically report insomnia or hypersomnia, psychomotor agitation or retardation, changes in appetite, tearfulness, despondency, feelings of hopelessness, worthlessness or guilt, decreased concentration, suicidal ideation, inadequacy, inability to cope with infant care needs, mood swings, irritability, fatigue, and loss of normal interests or pleasure.
Two screening tools are available for PPD in English-speaking patients: the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Depression Screening Scale (PDSS), both of which appear to be more sensitive in screening PPD than the more general Beck Depression Inventory.
Drugs (e.g., tricyclic antidepressants and serotonin reuptake inhibitors), counseling, or electroconvulsive therapy are all effective therapies. PPD support groups are generally helpful to women. Online support networks include Postpartum Support International (www.postpartum.net) and Depression After Delivery (www.charityadvantage.com/depression afterdelivery/Home.asp). Carefully designed studies have shown that nursing care aids in the diagnosis, prevention, and treatment of this disorder.