Depression

A Nursing Perceptive

SUICIDE HOTLINE: 1-800-273-8255

TTY SUICIDE HOTLINE: 1-800-799-4889

The Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM IV (the diagnostic book psychiatrists use), defines depression as a mood disorder. A psychiatrist will listen to your story, observe your symptoms, and begin to assimilate the information to make a diagnosis by using his/her experience and the DSM 1V. There are several diagnoses related to depression. You will have to meet certain criteria to get a diagnosis of major depression. The criteria includes your presenting problem and symptoms, your psychiatric history, your family history, and the amount of time you have been depressed and why.

The signs and symptoms of Depression

• Lack of energy
• Lack of psychological energy
• Increased or decreased appetite
• Increased or decreased hours of daily sleep
• Feelings of hopelessness, helplessness, and worthlessness
• Feeling sad and empty
• Unstoppable tears
• Poor concentration
• Poor memory
• Lack of interest in previously enjoyed activities
• Increased internal and external irritability
• Feeling restless, like you will jump out of your skin
• Somatic features like, chronic pain, stomach aches, and headaches etc.
• Pushing loved ones away
• The desire to be left alone
• Planning suicide
• Giving treasured tangible items away
• Suicide

This “mood disorder” takes over your entire life. A person affected with major depression is unable to ‘just snap out of it.’ This disorder is complicated because it affects the mind and body. Both issues need to be addressed vigorously to ultimately avoid death.

Prevalence

The prevalence of depression is unrelated to ethnicity, education, income, or marital status. Depression affects 15 to 25% of women and 5 to 12% of men. An episode of depression can begin at any age. The average age for an onset of depression is 21 through 26. If a person experiences an episode of major depression, the chance they will have another episode in their lifetime is 60%.The chances of a third major depression are at 70% and so on. I will discuss nuances of depression in childhood, postpartum, and the elderly later in this article.

Mortality

15% OF PEOPLE SUFFERING FROM AN UNTREATED MAJOR DEPRESSION MAY END THEIR LIVES BY SUICIDE.

Causes

• Chronic physical illness including exposure to environmental toxins

• Chronic pain

• Loss of a loved one- grief

• Family discord

• Loss of income, home, family and friends

• Isolation

• Overwhelming feelings of fear and guilt

• Chemical changes in the brain and body

• Lack of support from key people in your life including the community

• Growing up in an abusive home

• Feeling trapped in an abusive adult relationship

• Possible genetic factors and biological vulnerabilities

• Traumatic experience

The list can go on indefinitely. Your situation and symptoms are unique to you. If your depression lasts more than a week and/or if you experience intrusive thoughts, such as ruminating on how to kill yourself, SEEK HELP IMMEDIATELY!A depressed person who is isolated is in very bad company. Contact another human being even if it is the Suicide Hot-line. Just the act of talking about your situation and having another person understand your pain provides SOME RELIEF AND HOPE.

PMS, Premenstrual Dysphoric Disorder, Abortions, Pregnancy, Postpartum, and Menopause

Women’s reproductive events include the menstrual cycle, pregnancy, the post-pregnancy period, infertility, menopause, and sometimes, the decision not to have children. These events bring fluctuations in mood and for some women this includes depression. Hormones have an effect on brain chemistry which can alter emotions and mood.Many women experience certain behavioral and physical changes associated with phases of their menstrual cycles. In some women, these changes are severe, occur regularly, and include depressed feelings, irritability, and other emotional and physical changes. These symptoms have been named premenstrual syndrome (PMS). PMS typically begins after ovulation and gradually worsens until menstruation starts. PMS is recognized as a disorder and is completely treatable. Premenstrual dysphoric disorder (PMDD) typically has more severe symptoms, but again, the disorder is treatable. I want to give a warning to the women who see drug therapy for PMDD. The SSRI (selective serotonin re-uptake inhibitor) antidepressant Prozac is also named Fluoxetine, but most importantly, the drug company renamed the medication Sarafem. If you are on Prozac and Sarafem or Fluoxetine and Sarafem consult your doctor and pharmacist immediately. You don’t want to double dose yourself! Pregnancy rarely causes depression (if the pregnancy is wanted). Mood fluctuations can occur during pregnancy, but usually not to the extremes as with other depressive disorders. Usually by the time women get to the second trimester the mood stabilizes, however there are so many variables in pregnancy I can say nothing definitive here. Women with infertility problems may feel extreme anxiety or sadness, but those feelings would fall under the category of a ‘normal reaction’ to a stressful situation.Women who receive an abortion are at risk for a depression. There are many social, moral, and ethical issues involved; lack of emotional support and harsh judgment from loved ones can be factors as well. A depression occurring post-abortion is similar to postpartum depression. Hormones can play havoc on your system. Motherhood may be a time of heightened risk for depression because of the stress and demands on the mind and body. Postpartum depression can range from feeling blue to an episode of severe, incapacitating psychotic depression. Typically, women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed and treated. Postpartum depression is a serious problem if left untreated. A new mother can become psychotically depressed and harm herself, family, or her infant. Psychotic depression is different than other categories of depression. Psychosis means being out of touch with reality. A psychotic depressed person may hallucinate and experience delusions. A hospitalization is needed for the mother to provide safety and mood stabilization. Menopause is a time when hormones are changing. Again, if you have experienced a depression before then menopause would be a time you would watch for depressive symptoms. This stage of life for a woman is often emotional, spiritual, and a very personal experience.

Childhood Depression

Childhood depression is on the rise compared to past decades. The psychiatric community is diagnosing more depression in children and teens due to increased information about the illness.The information regarding treatment of children and adolescents with depression is far less extensive than concerning adults. Short term treatments for depression in youth are relatively safe. Long term treatment for youth is less understood.

Given the challenging nature of the problem, it is prudent to include a child psychiatrist and psychologist in the evaluation, diagnosis, and treatment of a child or adolescent. A second opinion is always a good idea too, especially if medication is required. You must remember if a depressed child is started on antidepressant medication therapy; the child will usually experience increased energy anywhere from the 5^Th day up to 4 weeks after starting the medication therapy. This is especially important because the child may not have had enough energy to carry out the suicide before the antidepressant treatment was started but, does now. It is absolutely paramount you watch you children carefully during this time period. This principle is true for anyone starting antidepressant therapy including adults. The need for support from loved ones and professionals is vast.

Symptoms

The diagnostic criteria and key defining features of a major depressive disorder in children and adolescents are the same as they are for adults. However, recognition and diagnosis of the disorder may be more difficult in children for various reasons. The way symptoms are expressed varies with the developmental stage the child is currently in. Children and young adolescents with depression may have difficulty identifying and describing their emotional state of mind. For example, instead of communicating how bad they feel, they may act out and be aggressive toward others, which may be interpreted simply as misbehavior.

Signs to be aware of in children and adolescents

• Frequent, vague, physical complaints such as headaches, muscle aches, stomach aches, and feeling tired

• Frequent absences from school or poor performance in school classes

• Running away from home

• Outbursts, complaining, unexplained irritability, or tearfulness

• Decreased interest in activities

• Alcohol and drug abuse

• Social isolation and poor communication

• Increased fear

• Increased anger and hostility

• Reckless behavior

• Difficulty with relationships

While the recovery rate from a single episode of major depression in children and in teens is very high, depressive episodes are likely to reoccur. Prompt diagnosis and treatment of depression can reduce its duration and severity. This principle applies to anybody at any age. Children and teens that develop major depression are more likely to have a family history of the condition.

Other risk factors include:

• Increased stress

• Cigarette smoking

• Loss of a loved one and this includes pets

• Break-up from a romantic relationship

• Attention, conduct, and learning disorders

• Chronic illness

• Abuse and neglect from care givers

• Body changes due to trauma

• Natural disasters

• Terrorism

Children and teens are our most valuable asset for the future. They will be taking care of us, our community, and our country. They are worth the extra effort to love, cherish, and protect from harm.

Older Adults

Suicide is more common among the elderly than in any other age group. In any given year, between one and two percent of people over age 65 suffer from major depression. Depression, however, is not a normal part of aging. Clearly, the importance of diagnosing and treating depression in older persons is essential. Because major depression is typically a recurrent disorder, relapse prevention is a high priority for the older adult.The older adult is at increased risk for major depression. Physical disability, medical illness, loss of family and friends due to death, loneliness, physical impairments, isolation, fixed incomes, and various body changes can all add to a depressive episode.

• Physical disability can lead to decreased mobility which can lead to lethargy and this can lead to depression.

• Medical illnesses can be challenging for anyone at any age. Typically, the older adult’s body takes longer to heal.

• Loss of family members and friends can take a heavy toll on anyone; however, with the elderly, sadness and grief are common emotions in an older adult as they experience and witness enormous loss of family members, friends, and pets dying. Bodily changes, decreased endurance, and health issues are included are additional stressors.

• Isolation and loneliness are two very big reasons why the older adult may take their own life. They may have out lived their family and friends, their body may be breaking down with physical aliments, and stress is at an all time high for a variety of reasons. This is a perfect stew for depression to present it self. Prevention is absolutely needed in this situation.

In summary, depression is a medical and psychological condition which is absolutely treatable. Once a person of any age experiences a major depression it is likely to reoccur. Depression can be caused by a chemical imbalance and suffering situational stressors can intensify the darkness of depression. Depression causes an enormous amount of pain. It can also cause somatic pain such as chronic headaches, stomach aches, and chronic physical pain just to name a few. If left untreated depression can get worse. Thoughts can become erratic and death by suicide is not uncommon.The most important thing to remember is, Get help! Depression is a treatable disorder. You do not have to suffer.

Here are some relevant web sites I have found to be helpful.

• National Alliance on Mental Health (NAMI) www.nami.org This is a site of information and resources. The folks who work for NAMI help educate and connect people with community resources. They also have people dedicated and working for the Veteran. The following is some information from their web site.

“The NAMI Veterans Council advocates for an improved continuum of care for veterans and active military and dependents with severe and persistent mental illness. The council is composed of persons with mental illnesses, relatives of persons with mental illnesses, or friends with mental illnesses who have an involvement and/or interest in issues impacting and veterans and active personnel who suffer from severe and persistent mental illness. Some of the roles that council members play include serving as a liaison to Veterans Integrated Service Networks, providing outreach to veteran’s service organizations, and working closely with NAMI state and affiliate offices on issues affecting veterans. The council holds regular monthly conference calls where featured speakers present new information on treatment, delivery and service initiatives for veterans and active personnel with severe and persistent mental illness.”

I highly recommend using this agency to assist in your own wellness. They have proven to be extremely helpful to clients I have taken care of over the years.

• WebMD.com is a good site to learn about various disorders including depression. Try to stay away from the drug company’s web sites to learn about depression unless you want to know about a specific drug. They usually have very good explanations about depression, however, they will try to sell their drug to you. Picking a medication which will be right for you is a collaborative effort between you and you doctor.

• National Institute of Mental Health
  Office of communications and public liaison. Toll Free information services, 1-800-421-4211, www.nimh.nih.gov. NIMH is a well established service. This institute helps educate people on anxiety, depression, and other psychiatric disorders. This site primarily deals with educating health care workers and the public.

• www.julieRN.com

My site will give you information, encouragement, support, and hope.

If you have a computer at home or if you use your local library for your computer needs, you can ‘Google’ key words like, Depression, PTSD, and Bipolar Disorder. Please look at the addresses before you open the page. Make sure the writers of the web site are credible. Don’t stop seeking information until you feel better. Increased knowledge will give you a sense of control over your life situation. You are worth the effort!

Tags: depression, help