Nursing Diagnosis for Depression: Symptoms and Strategies for Coping
There are moments in everyone’s life where the pressures and stress around us can get to us, causing us to feel unhappy, moody or sad. These feelings are acceptable and normal in those situations and are to be expected and worked through over time. But, there comes a point when the gloomy, unhappy feeling doesn’t go away and we are left wondering why we just can’t snap out of it. In some cases those feelings can increase in intensity and make our thoughts skewed, our perceptions inaccurate and affect our physical body. When the feelings begin to interfere with daily life one may be diagnosed with depression and be advised to seek additional medical, psychological and self care treatments in order to attempt to remedy their condition.
Depression is no small thing. Studies indicate that it may be one of the leading causes of disability in developed nations.[i] Some people may not know how to react to the depression, may say things that are insensitive or show they are not in tune with the depth of the feeling and the factors that trigger it. In order to really connect with someone that has depression it is important to understand what depression is and how it influences the person’s life that is suffering from it.
Types of Mood Disorders
The way that depression works in our brains is still not widely understood. There is evidence from MRI scans that a person’s brain who is suffering from depression looks different than a person’s brain who is not. The areas of the brain at work for different sensations, problem solving, sleep and the reward center reveal changes when scanned while a person is suffering from depression. However, an MRI cannot yet be used to diagnose depression since the actual physiological cause of depression is still debated.
There are four types of depressive mood disorders that have similar symptoms and can be diagnosed by a medical or mental health professional. Each has a slightly different treatment plan that should be tailored to the individual and situation. The four types are: Depressive disorders( including major depressive disorder), bipolar disorders, mood disorders due to a general medical condition and substance-induced mood disorders.
Facts About Depression
Major depression includes severe symptoms like changes in work, sleep, study, eating habits and the inability to enjoy life are.[ii] These symptoms indicate that the sadness, loneliness or helplessness that someone is feeling has begun interfering with the life of the person suffering and may be affecting their relationships in a negative way as well. No one is alone in their depression. Facts show that many people suffer from the disorder and it is widely suffered. Here are a few facts about depression that show us how prevalent it is and a little bit about how it works:
- Some people may have one depressive episode during their lifetime that is based on circumstances or events that are eventually remedied. However, many people may have multiple episodes that are triggered by events or negative feelings that recur throughout life. Others have depressive episodes with no identifiable triggering event.
- The National Institute of Mental Health includes depression as a top cause of disability.
- Depression affects 14.8 million American adults which is the equivalent to 6.7 percent of the United States population age 18 and older. [iii]
- Studies now show that major depressive disorders are more prevalent in woman then men. This is partially due to hormonal factors. Women are also more likely to suffer from seasonal affective disorder which is a seasonal depression that is triggered during cold, cloudy months of winter. [iv]
- While the disorder has no set age of development, the median age is 32 years old.
- Only 31% of depressed adults seek treatment[v]
- More than 80% of people diagnosed with depression can be treated successfully by drug therapy, psychotherapy or combinations of procedures.
Symptoms of Depression
The diagnosis for Major Depressive Disorder is made after the symptoms have been experienced daily for at least two weeks. Compiled from the National Institute of Mental Health and the Mayo Clinic, these are some of the symptoms of depression. It is by no means an exhaustive list or meant to officially diagnose.
- Pessimism or hopeless feelings
- Feelings of guilt, personal blame, worthlessness
- Feelings of helplessness, restlessness
- Persistent sadness or “empty” feelings
- Irritability, Angry outbursts
- Fatigue, Insomnia
- Overall lack of energy
- Decreased interest in activities that were once loved
- Difficulty remembering details
- Difficulty making decisions
- Slowed thinking, speaking and body movements
- Changes to appetite
- Persistent physical problems like headaches, digestive issues, aches and pains that do not improve with treatment
For the medical professional it may be difficult to diagnose depression. Diagnosis of depression has been shown to be missed up to 50% of the time in primary care settings.[vi] The defining characteristics of depression can be triggered during various changes in health status from hospitalization to home rehabilitation making every medical professional encounter an opportunity for depression to be caught, evaluated, and treatment programs to be initiated.
For doctors, nurses, pharmacists and others that are concerned with patient care, the following are notes for assessing the presence of depression in a patient. These steps commonly include[vii]:
- Identifying the defining characteristics
- Identifying specific stressors
- Assessing available coping mechanisms
- Evaluating support systems and resources
- Assessing a readiness to change lifestyle and evaluating decision making and problem-solving abilities.
The results of these assessments and evaluations may provide the healthcare professional with the needed information to diagnose and suggest treatment for a patient suffering with depression.
It is extremely important over the course of treatment to set realistic goals for the patient and communicate those needs with any support system they have. It is unlikely that someone will wake up the following day after diagnosis without any symptoms. Additionally, the act of grieving that may be necessary to return to health can take time and someone that needs to learn new behaviors for coping will need time to implement those behaviors and practice the communication techniques that will get them through their depression.
Depression and Positive Thought
The way our brain works means that thoughts associated with strong emotions sometimes get stuck turning over and over again in our minds. When these thoughts are associated with negative thoughts there it is tough to let them go and over time they can spiral out of control leading to deeper melancholy and depression. The repetition is what builds a habit and habits can be hard to break, especially ones ingrained in our mind.
The seriousness of depression often points to a need for psychiatric aide and a strong support system. Beyond these measures a person that has been diagnosed with depression can take some steps to help their mind and body cope. Relaxation, exercise and positive thinking habits can result in better overall results for someone undergoing treatment for depression and give them the tools to manage the onset of depression if it were to attempt to reoccur in the their future.
The good news is that you can retrain your mind to have the habit of optimism. Everyone has obstacles to overcome in the way we think, get the tools that will help you identify those obstacles and change the way you think into more positive, constructive and beneficial thinking. By working to re-wire your mind, you are working to establish more positive pathways and coping mechanisms that will serve you in the future. This re-wiring takes time, but is worth the effort and will be a positive and noticeable change in the way you approach the world around you.
Healing from depression can feel lonely and be very trying, but no one is alone in the battle. Whether for yourself or a someone close to you listen to someone who has been through it to get the tips, experience, support and tools that you need to get through mental illness. These experiences will help you know how to act, what to say, how to communicate clearly, and when to get additional help on the path to healing.
After you begin your journey to healing it will be important to include ongoing, positive practice that can help you maintain control and strength during any season of life. There are key practices that will help everything from blood pressure to managing anxiety and depression. For example, meditating regularly can help improve mental and physical well being and this added mindfulness can be a key to reduce stress, feelings of fear and tiredness.
[i] According to the National Institute of Mental Health, Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44. http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#MajorDepressive
[ii] Information from the National Institute of Mental Health, What is Depression? http://www.nimh.nih.gov/health/topics/depression/index.shtml
[iii]Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005 Jun;62(6):593-602.
[iv] Information from Nanda Books website for Nursing Diagnosis http://nandabooks.blogspot.com/2012/10/depression-9-nursing-diagnosis-care-plan.html
[v] Depression Care Guidelines from the Peters Institute of Pharmaceutical Care http://www.pharmacy.umn.edu/img/assets/10745/Depression%20Care%20Plan.pdf
[vi] Depression Care Guidelines from the Peters Institute of Pharmaceutical Care http://www.pharmacy.umn.edu/img/assets/10745/Depression%20Care%20Plan.pdf
[vii] Information from Meg Gulanick, RN, PhD http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick15.html
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