PSYCHO EDUCATION ON

DEPRESSION
S.NO SPECIFIC TIME CONTENT TEACHER’S LEARNER’S AV EVALUATION
OBJECTIVES ACTIVITY ACTIVITY AIDS
1 INTRODUCTION Teaching listening Black

Depression is a common illness worldwide, with board

more than 264 million people affected(1). Depression is

different from usual mood fluctuations and short-lived
emotional responses to challenges in everyday life.
Especially when long-lasting and with moderate or severe
intensity, depression may become a serious health
condition. It can cause the affected person to suffer
greatly and function poorly at work, at school and in the
family. At its worst, depression can lead to suicide. Close
to 800 000 people die due to suicide every year. Suicide
is the second leading cause of death in 15-29-year-olds.
2 DEFINITION
Depression is a mood disorder that causes a
persistent feeling of sadness and loss of interest. Also
called major depressive disorder or clinical depression, it
affects how feel, think and behave and can lead to a
variety of emotional and physical problems. may have
trouble doing normal day-to-day activities, and sometimes
may feel as if life isn't worth living.
CAUSES

Biology

We still don't know exactly what happens in

the brain when people become depressed. But studies
show that certain parts of the brain don't seem to be
working normally.

Depression might also be affected by changes in the

functioning of certain chemicals in the brain.

Genetics

Researchers know that if depression runs in your family,

you have a higher chance of becoming depressed. But
genetics don't fully explain why clinical depression
occurs.

Gender

Women are about twice as likely as men to become

depressed. No one's sure why. The hormonal changes that
women go through at different times of their lives may
play a role.
Age

People who are elderly are at higher risk of depression.

Health Conditions

Chronic and disabling medical conditions that may have

no cure can raise your risk of becoming depressed. These
include:

 Cancer
 Heart disease
 Stroke
 Thyroid problems
 Chronic pain

Trauma and Grief

Trauma such as violence or physical or emotional abuse --

whether it's early in life or more recent -- can trigger
depression in people who are biologically vulnerable to it.

Grief after the death of a friend or loved one is a normal

emotion, but like all forms of loss, it can sometimes lead
to clinical depression.

Changes and Stressful Events

It's not surprising that people might feel sad or down

during stressful times -- such as during a divorce or while
caring for a sick relative. Yet even positive changes -- like
getting married or starting a new job -- can sometimes
trigger a clinical depressive syndrome that is more than
just normal sadness.

Medications and Substances

Many prescription drugs can cause symptoms of

depression.

Alcohol or substance abuse is common in depressed

people. It often makes their condition worse by causing or
worsening mood symptoms or interfering with the effects
of medications prescribed to treat depression.

There are many different types of depression. Events in

life cause some, and chemical changes in brain cause
others.

Whatever the cause, your first step is to let your doctor

know how you're feeling. She may refer you to a mental
health specialist to help figure out the type
of depression you have. This diagnosis is important in
deciding the right treatment .
Major Depression

You may hear your doctor call this "major depressive

disorder." You might have this type if you feel depressed
most of the time for most days of the week.

Some other symptoms you might have are:

 Loss of interest or pleasure in your activities

 Weight loss or gain
 Trouble getting to sleep or feeling sleepy during
the day
 Feelings restless and agitated, or else very sluggish
and slowed down physically or mentally
 Being tired and without energy
 Feeling worthless or guilty
 Trouble concentrating or making decisions
 Thoughts of suicide

Your doctor might diagnose you with major depression if

you have five or more of these symptoms on most days for
2 weeks or longer. At least one of the symptoms must be a
depressed mood or loss of interest in activities.

Talk therapy can help. You'll meet with a mental health

specialist who will help you find ways to manage
your depression. Medications called antidepressants can
also be useful.

When therapy and medication aren't working, two other

options your doctor may suggest are:

 Electroconvulsive therapy (ECT)

 Repetitive transcranial magnetic stimulation
(rTMS)

ECT uses electrical pulses and rTMS uses a special kind of

magnet to stimulate certain areas of brain activity. This
helps the parts of your brain that control your mood work
better.

Persistent Depressive Disorder

If you have depression that lasts for 2 years or longer, it's

called persistent depressive disorder. This term is used to
describe two conditions previously known
as dysthymia (low-grade persistent depression) and
chronic major depression.

You may have symptoms such as:

 Change in your appetite (not eating enough or

overeating)
 Sleep too much or too little
 Lack of energy, or fatigue
  Low self-esteem
 Trouble concentrating or making decisions
 Feel hopeless

You may be treated with psychotherapy, medication, or a

combination of the two.

Bipolar Disorder

Someone with bipolar disorder, which is also sometimes

called "manic depression," has mood episodes that range
from extremes of high energy with an "up" mood to low
"depressive" periods.

When you're in the low phase, you'll have the symptoms of

major depression.

Medication can help bring your mood swings under

control. Whether you're in a high or a low period, your
doctor may suggest a mood stabilizer, such as lithium.

The FDA has approved three medicines to treat the

depressed phase:

 Seroquel
 Latuda
 Olanzapine-fluoxetine combination
Doctors sometimes prescribe other drugs "off label" for
bipolar depression, such as the
anticonvulsant lamotrigine or the atypical antipsychotic
Vraylar .

Traditional antidepressants are not always recommended

as first-line treatments for bipolar depression because
there's no proof from studies that these drugs are more
helpful than a placebo (a sugar pill) in treating
depression in people with bipolar disorder. Also, for a
small percentage of people with bipolar disorder, some
traditional antidepressants may increase the risk of causing
a "high" phase of illness, or speeding up the frequency of
having more episodes over time.

Psychotherapy can also help support you and your family.

Seasonal Affective Disorder (SAD)

Seasonal affective disorder is a period of major depression

that most often happens during the winter months, when
the days grow short and you get less and less sunlight. It
typically goes away in the spring and summer.

If you have SAD, antidepressants can help. So can light

therapy. You'll need to sit in front of a special bright light
box for about 15-30 minutes each day.
Psychotic Depression

People with psychotic depression have the symptoms of

major depression along with "psychotic" symptoms, such
as:

 Hallucinations (seeing or hearing things that aren't

there)
 Delusions (false beliefs)
 Paranoia (wrongly believing that others are trying
to harm you)

A combination of antidepressant and antipsychotic drugs

can treat psychotic depression. ECT may also be an
option.

Peripartum (Postpartum) Depression

Women who have major depression in the weeks and

months after childbirth may have peripartum depression.
Antidepressant drugs can help similarly to treating major
depression that is unrelated to childbirth.

Premenstrual Dysphoric Disorder (PMDD)

Women with PMDD have depression and other symptoms

at the start of their period.
Besides feeling depressed, you may also have:

 Mood swings
 Irritability
 Anxiety
 Trouble concentrating
 Fatigue
 Change in appetite or sleep habits
 Feelings of being overwhelmed

Antidepressant medication or sometimes

oral contraceptives can treat PMDD.

'Situational' Depression

This isn't a technical term in psychiatry. But you can have

a depressed mood when you're having trouble managing a
stressful event in your life, such as a death in your family,
a divorce, or losing your job. Your doctor may call this
"stress response syndrome."

Psychotherapy can often help you get through a period of

depression that's related to a stressful situation.
Atypical Depression

This type is different than the persistent sadness of typical

depression. It is considered to be a "specifier" that
describes a pattern of depressive symptoms. If you
have atypical depression, a positive event can temporarily
improve your mood.

Other symptoms of atypical depression include:

 Increased appetite
 Sleeping more than usual
 Feeling of heaviness in your arms and legs
 Oversensitive to criticism

Antidepressants can help. Your doctor may suggest a type

called an SSRI (selective serotonin reuptake inhibitor) as
the first-line treatment.

She may also sometimes recommend an older type of

antidepressant called an MAOI (monoamine oxidase
inhibitor), which is a class of antidepressants that has been
well-studied in treating atypical depression.
Low Mood

Depressed mood is consistent with both major depression

and persistent depressive disorder. In major depression, a
person must feel depressed most of the day, nearly every
day, as indicated by either subjective report or
observations made by others. Children or adolescents, on
the other hand, may appear more irritable than sad.

People with persistent depressive disorder experience a

depressed mood more days than not for at least two years.
As with MDD, children may appear more irritable than
depressed but for a PDD diagnosis, they must experience it
more days than not for at least one year. It may be chronic
and less severe than a full-blown major depression, but
could also represent symptoms of a major depression that
have persisted for more than two years.

Decreased Interest or Pleasure

The second core symptom of major depressive disorder is

a decreased interest or pleasure in things that were once
enjoyed. A person exhibiting this symptom will show
markedly diminished interest or pleasure in all, or almost
all, daily activities such as favorite hobbies or sports or
even sex.

Changes in Appetite

Significant changes in weight (a gain or loss of 5% or

more in a month) while not attempting to gain or lose may
be indicative of MDD. In children, changes in appetite
may also present as a failure to make expected weight
gains.

Sleep Disturbances

Sleep disturbances including difficulty falling asleep,

staying asleep, feeling sleepy despite a full night's rest, or
daytime sleepiness can indicate either MDD or PDD.

Psychomotor Agitation or Retardation

Agitation, restlessness, or lethargy that affects a person's

daily routine, behavior, or appearance is a symptom of
MDD. These symptoms can be evident in body
movements, speech, and reaction time and must be
observable by others.

Fatigue

A loss of energy and chronic feelings of fatigue can be

symptoms of both persistent depressive disorder and major
depressive disorder. Feeling tired most of the time can
interfere with a person's ability to function normally.

Feelings of Worthlessness or Guilt

Excessive, inappropriate guilt, and feelings of

worthlessness are common symptoms of major depressive
disorder. The feelings of guilt may be so severe that the
person becomes delusional.

Difficulty Concentrating

Both major depressive disorder and persistent depressive

disorder involve difficulty concentrating and making
decisions. People with depression may recognize this in
themselves or others around them may notice that they're
struggling to think clearly.

Recurrent Thoughts of Death

Recurrent thoughts of death that go beyond the fear of

dying are associated with major depressive disorder. An
individual with major depression may think about suicide,
make a suicide attempt, or create a specific plan to kill
themselves.
Assessment and Diagnostic Findings

A number of tests should be conducted to diagnose

depression.

 Beck Depression Inventory is a psychological

test used to determine symptom onset, severity,
duration, and progression.

 Dexamethasone suppression test showing

failure to suppress cortisol secretion in
depressed patients (although test has high
false-negative rate).

 Toxicology screening suggesting

drug-induced depression.

 Diagnosis is confirmed if DSM-V-TR criteria

is met.

commonly used to treat depression:

 Tricyclic antidepressants (TCAs) — were among

 the first developed antidepressants. They have
more side effects than newer antidepressants but
can be more effective for certain patients. These
include Elavil (amitriptyline), Tofranil
(imipramine) and Pamelor (nortriptyline).
 Monoamine oxidase inhibitors (MAOIs) — are
another older type of antidepressant. If you are
taking an MAOI, you will have to follow
certain dietary restrictions to prevent a reaction
that can cause high blood pressure. You will also
have to be careful about interactions with certain
other medications. Like tricyclics, these are not
generally used first line, but can sometimes be
helpful for more difficult to treat depressions.
MAOIs include Marplan (isocarboxazid), Nardil
(phenelzine) and Parnate (tranylcypromine).
 Selective serotonin reuptake inhibitors (SSRIs)
— are the most commonly prescribed medication
for depression today. Prozac (fluoxetine), Paxil
(paroxetine), Zoloft (sertraline) Celexa
(citalopram) and Luvox (fluvoxamine)
are commonly prescribed brand names. Compared
to other antidepressant types, SSRIs tend to have
fewer side effects. SSRIs should not be prescribed
in conjunction with the older MAOIs due to the
 potential for a dangerously high level of serotonin
to build up, which can cause serotonin syndrome.
 Serotonin and norepinephrine reuptake
inhibitors (SNRIs) — are a newer type of
antidepressant that works similarly to SSRIs only
they also block the reuptake of norepinephrine
along with serotonin. Common medications in this
class are Effexor (venlafaxine), Cymbalta
(duloxetine) and Pristiq (deslavenfaxine).
 Norepinephrine and dopamine reuptake
inhibitors (NDRIs) — Wellbutrin (bupropion) is
in a class all by itself. Wellbutrin is less likely to
have the sexual side effects that are common in the
other antidepressants.4
 Esketamine — Sold under the brand name
Spravato, esketamine was FDA approved in
March 2019. It is approved for adults
with treatment-resistant depression, meaning other
medication options have not worked for them, and
needs to be prescribed together with an oral
antidepressant. The medication itself is a nasal
spray that works quickly in the body—within
hours, compared to the weeks or months other
medications take to work. However, there are risks
associated with it. Esketamine is a variant of the
 hallucinogenic drug ketamine and may cause
sedation and out-of-body experiences. Patients
receiving the drug are monitored for several hours
after taking it, and can only receive the drug at a
certified location

1. Interpersonal therapy is relatively short in

duration. Sessions are highly structured. It's based
on the idea that your relationships are at the
forefront of depression. The goal of treatment is to
help patients improve skills, such as
communication skills and conflict-resolution
skills.
2. Cognitive behavioral therapy focuses on helping
people identify and replace cognitive distortions
and behavioral patterns that reinforce depressive
feelings. It is usually short-term and it focuses on
present problems and skills teaching.
3. Social skills therapy teaches patients how to
establish healthy relationships. The goal is for
patients to improve communication and learn how
to build a strong social network with individuals
based on honesty and respect.
4. Psychodynamic therapy is often featured in
movies or pop culture. It involves helping patients
 explore their unconscious and unhealed emotional
wounds from the past. The goal is to help people
learn how their depression is related to past
experiences and unresolved conflicts. The
therapist helps patients address those issues so they
can move forward in a productive manner.
5. Supportive counseling is unstructured and
focuses on listening to the patient. Patients are
invited to address whatever issues they want to talk
about and the therapist uses empathy to provide
understanding and support.
6. Behavioral activation raises awareness of
pleasant activities. The therapist seeks to increase
positive interactions between the patient and the
environment. By getting active and engaging in
more pleasurable activities, symptoms of
depression may be reduced.
7. Problem-solving therapy aims to define a
patient's problems. Then, multiple solutions are
offered. The therapist helps the patient evaluate
options and choose a solution.1

Family or Couple Therapy

Family or couple therapy may be considered when

depression affects others in the household. Therapy that
involves other family members focuses on the
interpersonal relationships.

The roles played by various family members in a patient's

depression may be examined. Education about depression
in a general way may also be a part of family therapy

nursing Management

These are the nursing responsibilities for taking care of

patients with major depression:

Nursing Assessment

 Subjective cues. Include verbalization of

inability to cope or ask for help, sleep
disturbance and fatigue, abuse of chemical
agents, and reports of muscular or emotional
tensions, and lack of appetite.

 Objective cues. Include lack of goal-directed

behavior or resolution of problem; inadequate
problem solving, decreased use of social
support, inability to meet role
expectations/basic needs, and destructive
 behavior toward self (e.g.
overeating, smoking/drinking, overuse of
prescribed/OTC medications, and illicit drug
use)

Nursing Diagnosis

 Ineffective Coping related to situational or

maturational crises

 Hopelessness related to long-term stress

 Fatigue related to stress and anxiety

Planning and Goals

Main article: 6 Major Depression Nursing Care Plans

 To determine degree of impairment

 To assess coping abilities and skills

 To assist client to deal with current situation

 To provide for meeting psychological needs

 To promote wellness

Nursing Interventions
 Provide for patient’s physical needs. Assist
with self-care and personal hygiene. Encourage
patient to eat. Give warm milk or back rubs at
bedtime to improve sleep.

 Plan activities for times when the patient’s

energy level peaks.

 Assume active role in initiating

communication. This can be done by sharing
observation of patient’s behavior, speaking
slowly and allowing ample time for him to
respond, encouraging him to talk and write
down feelings, and by providing a structured
routine which may include noncompetitive
activities.

 Avoid feigned cheerfulness, but don’t hesitate

to laugh with him and point out the value
of humor.

 Educate patient about depression. Explain

that depression can be eased by expressing
feelings and engaging in pleasurable activities.
Emphasize that there are effective methods
available for relief of symptoms.

 Help patient recognize distorted perceptions

 and link them to his depression.

 Ask patient whether he thinks about death

or suicide. Signal an immediate need for
consultation and assessment. Risk of suicide is
higher with lifting of depressed mood.

 Stress the need for medication

compliance. Review adverse effects with the
patient.

Evaluation

 Patient’s ability to assess current situation

accurately.

 Patient’s ability to identify ineffective coping

behaviors and consequences.

 Verbalization of awareness of own coping

abilities and of feelings congruent with
behavior.

 Meet physiological needs as evidenced by

appropriate expression of feelings,
identification of options, and use of resources.
CONCLUSION
still now we have seen about the causes, types, signs and symptoms, management, nursing responsibilities and psychotherapy of dementia.
BIBLIOGRAPHY

 R.Sreevani “a guide to mental health and psychiatric nursing”,3rd edition ; jaypee brothers medical publishers 2010,pg no (123 to 127)
 Niraj ahuja “ A short text book of psychiatry”,7th edition ; jaypee brothers medical publishers 2011 ,pg no (142 to 145)
 Mary C Townsend “psychiatric mental health nursing”,6th edition; F.Adavis company 2009,pg no (647 to 662)