Depression: Understanding the Basics

Depression: What is it?

• Diagnostic Criteria (DSM-5): Five or more symptoms experienced during the same two-week period, with at least one symptom being depressed mood or loss of interest/pleasure.
• Symptoms:
  • Depressed mood most of the day, nearly every day
  • Markedly diminished interest or pleasure in activities
  • Significant weight loss/gain or appetite changes
  • Slowed thinking and movement
  • Fatigue or loss of energy
  • Feelings of worthlessness or guilt
  • Diminished ability to think or concentrate
  • Recurrent thoughts of death, suicidal ideation

What might depression look like in a person?

• Disconnect from family
• Increased days off work
• Cessation of attending activities
• Sleep disturbances (excessive sleeping or insomnia)
• Changes in appetite
• Loss of interest in children

Types of depression

• Unipolar depression/Major Depressive Disorder: Characterized by persistent sadness and loss of interest.
• Bipolar depression/Bipolar Affective Disorder: Episodes of mania and/or hypomania alternating with periods of depression.
• Postnatal depression: Depression occurring after childbirth.

What might look like depression but might be something else?

• Adjustment disorder: Emotional or behavioral difficulties in response to a stressful life event.
• Grief: Emotional response to loss.
• Dysthymia: Chronic low-grade depression lasting at least two years.

Depression: What it is and What it Looks Like

• Diagnosis: An individual must experience at least five or more symptoms during the same 2-week period, with at least one being either depressed mood or loss of interest/pleasure.

• Symptoms:

  • Depressed mood most of the day, nearly every day.
  • Markedly diminished interest or pleasure in all, or almost all, activities.
  • Significant weight loss (without dieting) or weight gain, or decrease/increase in appetite.
  • Slowing down of thought and physical movement (observable, not just feelings).
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive/inappropriate guilt.
  • Diminished ability to think/concentrate, or indecisiveness.
  • Recurrent thoughts of death, suicidal ideation (without a specific plan), or a suicide attempt/plan.

• Possible manifestations in a person:

  • Disconnect from family.
  • More days taken off work.
  • Stop attending activities.
  • Poor sleep (sleeping all day or not sleeping at all).
  • Change in appetite.
  • Loss of interest in children.

Types of Depression

• Unipolar Depression/ Major Depressive Disorder:
  • Characterized by persistent low mood and loss of interest or pleasure in activities.
• Bipolar Depression/ Bipolar Affective Disorder:
  • Involves alternating episodes of mania (elevated mood, energy, and activity) and depression.
• Postnatal Depression:
  • Depression experienced by mothers after childbirth.

What Might Look Like Depression But Could Be Something Else

• Adjustment Disorder:
  • A temporary condition in response to a stressful life event, such as a job loss or bereavement.
• Grief:
  • A natural emotional response to loss.
• Dysthymia (Persistent Depressive Disorder):
  • A chronic form of depression characterized by low mood, but not meeting the full criteria for Major Depressive Disorder.

Anxiety

• Excessive and persistent worry that is difficult to control.
• Physical symptoms include restlessness, feeling on edge, fatigue, difficulty concentrating, and poor sleep.
• Characterized by hyper-alertness and a tendency to look for perceived threats.
• Various types of anxiety disorders, such as GAD, social anxiety disorder, specific phobias, and OCD.

When Anxiety Becomes An Issue

• Interferes with a person's daily life, impacting work, socializing, attending school, and leaving the house.
• Leads to a feeling of losing control over the anxiety.

Anxiety Statistics

• In 2019, anxiety disorders were the most common mental disorder globally.
• Women experience anxiety disorders more frequently than men.
• Anxiety symptoms often emerge during childhood or adolescence.
• Only 25% of individuals with anxiety disorders receive treatment.

Panic Attacks

• Sudden and intense episodes of fear or anxiety.
• Symptoms include shortness of breath, heart palpitations, chest tightness, trembling, sweating, nausea, and feeling lightheaded.

Generalised Anxiety Disorder (GAD)

• May manifest in a patient as withdrawal from social supports, pacing, fidgeting, increased irritability, sweating, sleep disturbances (increased or decreased sleep), difficulty maintaining eye contact, and fixating on an event or scenario.

Agoraphobia

• Characterized by anxiety about being in situations where escape may be difficult or embarrassing, or where help might not be readily available if panic attacks or panic-like symptoms occur.
• Individuals with agoraphobia often become housebound due to fear.

Social Anxiety Disorder

• May manifest in a patient as withdrawal from social supports, panic around large social events, avoidance of crowds, fear or dread of being judged by others, and difficulty forming or maintaining relationships.

Obsessive-Compulsive Disorder (OCD)

• More than just "liking things to be organized."
• Involves repetitive checking or counting, specific rituals or patterns of behavior, intense fear of bad outcomes if checks are not completed, and interferes with a person's ability to function.

Treatments for Anxiety

• Medications, including benzodiazepines, are often used to manage symptoms.
• Benzodiazepines can be highly addictive and are generally not recommended for long-term use.
• They can be used to manage crisis or acute anxiety.

Talking Therapies

• Talking therapies are typically used for the long-term management of anxiety.
• Explore the causes of anxiety and work towards resolving them..
• Help individuals develop coping strategies to manage increased anxiety or triggering situations.
• Support individuals in identifying their own warning signs and triggers.
• Require active engagement from the client.

Exposure Therapy

• Can be helpful for specific fears, such as spiders or large crowds.
• Should be undertaken when a person feels ready and is often not conducted in an inpatient or acute setting.

Nursing Interventions for Anxiety

• Provide emotional support and reassurance.
• Administer PRN medications to help patients manage increased anxiety levels.
• Participate in checks with individuals living with OCD and reassure them of their safety.
• Empower patients to recognize their own triggers.

Anxiety

• Excessive or persistent worry
• Difficulty controlling worry
• Physical symptoms include: restlessness, feeling on edge, fatigue, difficulty concentrating, poor sleep, hyper alertness, perceived threats
• Different types: Generalized Anxiety Disorder, Social Anxiety Disorder, Specific Phobias, OCD
• Impact: Impacts daily functioning, work, socialization, attending school, leaving the home
• Loss of control: People feel as though they have lost control of their anxiety

Statistics

• Most common mental disorder in 2019
• More women than men are affected
• Symptoms often appear in childhood/adolescence
• Only 1 in 4 people with an anxiety disorder receive treatment

Panic Attacks

• Sudden, intense episode of fear or anxiety
• Symptoms: shortness of breath, heart palpitations, chest tightness, trembling/shaking, sweating, nausea, lightheadedness

Generalised Anxiety Disorder

• Withdrawal from social support
• Pacing/fidgeting
• Increased irritability
• Sweating
• Poor sleep
• Difficulty maintaining eye contact
• Fixation on an event or scenario

Agoraphobia

• Anxiety about being in situations that are difficult or embarrassing to escape
• Anxiety about situations where help may not be easily accessible if panic-like symptoms occur
• Often house bound due to fear

Social Anxiety Disorder

• Withdrawal from social support
• Panic around large social events
• Avoiding crowds
• Fear/dread of being judged by others
• Difficulty forming/maintaining relationships

OCD

• Not "liking things to be organized"
• Repetitive checking or counting
• Specific rituals/patterns of behavior
• Intense fear of bad outcomes if checks are not completed
• Interrupts a person's ability to function

Treatments

• Medications: Used to manage symptoms
• Benzodiazepines: Highly addictive, not recommended long-term, can be used for crisis or acute anxiety
• Talking therapy: Long-term management, explores causes of anxiety, helps resolve causes, teaches coping strategies, identifies warning signs and triggers. Requires active engagement from the patient
• Exposure therapy: Helpful for specific fears, undertaken when the person feels ready (often not in an inpatient/acute setting)

Nursing Interventions

• Emotional support/reassurance
• PRN medications to help a patient manage increased anxiety
• Participate in a patient with OCD's checks, reassure them they are safe
• Empower patients to recognize their own triggers