Depression & Anxiety Concept Map

Etiology
Depression - Depression results from a complex interaction of biological, psychological, and
social elements. It is more common in those who have experienced negative life experiences.
Depression can exacerbate a person's living circumstances and result in increased stress and
dysfunction.
Anxiety- The exact cause of anxiety is unknown but does appear to be caused by an
interaction of biopsychosocial factors including chemical imbalances in the body and genetic
inheritance, as well as traumatic life events, psychological and sociocultural factors.

Diagnosis
Depression- is an affective disorder that is characterized by a persistently depressed mood
lasting for a minimum of 2 weeks, with the length of a depressive episode varying. The DSM-
5 states individuals experiencing 5 out of 9 symptoms during the same 2-week period meet
the criteria for depression. Approximately 20% of cases become chronic, and depression is
the leading cause of disability worldwide. The diagnosis for depression has specifiers that
describe specific features of the episode. They include: psychotic features, melancholic
features, atypical features, mixed features, catatonic features, postpartum onset and seasonal
patterns.
Anxiety is defined as a feeling of apprehension, uneasiness, uncertainty, or dread resulting
from a perceived or real threat. It has multiple degrees of severity, ranging from mild to panic.
Anxiety disorders include panic disorder, social anxiety disorder, general anxiety disorder and
phobias. Since many anxiety disorders have common physical, cognitive and behavioral
features. Diagnosis requires that the symptoms be considered excessive and unreasonable, and
that they cause significant distress or impairment in daily functioning. Symptoms must be
persistent, and last six months or longer.

Labs/Diagnostic Tests
Depression/ Anxiety There is no particular lab test that can diagnose depression or anxiety. You
may have a physical exam, ECG or your provider may order blood tests to find out if another
health condition, such as anemia or thyroid disease, may be causing depression or anxiety.
Assessment Findings
Depression- is diagnosed by using a patient's medical history, the results of a physical and
neurological examination, and evaluations conducted by medical professionals. Social history
with a focus on stressors and the use of drugs and alcohol may also be used. History and
physical examination are used to rule out organic causes of depression. Depressive symptoms
and their severity are also evaluated with the help of questionnaires.
Anxiety- is diagnosed through health history, physical and neurological assessment findings
and assessments by a psychiatrist or psychologist. Hamilton Anxiety or Depression Rating
Scale can help determine generalized anxiety disorder, panic disorder and major
 depressive disorder. It can also assess for substance use, psychosocial assessment and cultural
components.

Risk Factors
Depression- The risk factors of depression include biological differences; with structural
changes in the brain as well as alterations in brain chemistry. Hormonal changes,
especially postpartum can cause/trigger depression. Also family history of depression and
anxiety.
Anxiety-The risk factors for anxiety are: female gender, history of trauma, family history
of depression and anxiety, certain personality traits (shyness and low self-esteem), unmarried,
level of education, presence of stressors (illness or life situations), and drug or alcohol use.

Anxiety and major depressive disorder (MDD) often co-occur and share a broad range of risk
factors. Ones that intersect include family history of MDD, disturbed family environment,
childhood sexual abuse, low self-esteem, lower education level and Caucasian ancestry. Both
anxiety and depressive disorders are more prevalent in women especially during a woman’s
reproductive years. These disorders also commonly coexist during the same time frame. They are
considered moderately heritable, with a 40% chance and shared genetic risk across internalizing
disorders. Brain structure shows alterations in pathways that mediate emotion regulatory
processes, executive function and cognitive control. Anxiety disorders commonly begin during
preadolescence and early adolescence and major depression tends to emerge during adolescence
and early to mid-adulthood. With anxiety disorders generally preceding the presentation of
MDD.

Signs & Symptoms

Depression- Some of the signs and symptoms of depression include: Poor concentration,
feelings of excessive guilt or low self-worth, hopelessness about the future. Disrupted sleep,
trouble sleeping or sleeping too much. Changes in appetite or weight. Feeling sad or having a
depressed mood. Loss of interest or pleasure in activities once enjoyed. Loss of energy or
increased fatigue. Difficulty thinking, concentrating or making decisions. Thoughts of death or
suicide and pprevious suicide attempts.
Anxiety- Some of the signs and symptoms of anxiety include: Feelings of discomfort and
restlessness. Difficulty focusing, headaches and insomnia. Increased pulse, respiratory rate,
and perspiration. Voice and body tremors may occur, as well as intrusive thoughts and doom.

Potential Complications
Depression- Some of the potential complications of depression are loss interest in old hobbies,
and impaired social interaction. Reduced self-care and hygiene practices. Weight loss/gain due
to reduced appetite or increased cravings for food. Some SSRIs can cause nausea
and headaches, while other SSRIs and tricyclic and tetracyclic antidepressants can cause
weight gain or other metabolic syndromes.
 Anxiety- Some of the potential complications of anxiety include: symptoms of stress that can
manifest in the stomach due to the nervous system. People with anxiety and depression also
tend to have bowel problems like stomach pain, constipation, and diarrhea. It can also manifest
as chronic pain, headaches and insomnia. Psychosocial complications include impaired family
relationships, social functioning, other mental health disorders (including depression)
and substance misuse.

Medical Management
Depression- The use of cognitive behavioral therapies can impart new ways of thinking,
adjusting, or interacting with people. Other effective psychological treatments for depression
include: behavioural activation, cognitive behavioural therapy, interpersonal psychotherapy,
and problem-solving therapy. Antidepressant medications containing selective
serotonin reuptake inhibitors (SSRIs) are used when there is not enough serotonin in the
brain, these medications leave the available serotonin. Serotonin and norepinephrine reuptake
inhibitors can also be used to treat depression by blocking the reabsorption of both serotonin
and norepinephrine in the brain. As an adjunct to these therapies second generation
antipsychotics may be prescribed like olanzapine, clozapine, risperidone and quetiapine.
Psychological treatment can be used as an adjunct to pharmaceutical therapy. Other therapies
include Electroconvulsive Therapy (ECT) and Interpersonal Therapy (IPT).
Anxiety- The use of pharmacotherapy and psychotherapy is used to treat depression. First
line medication treatments include selective serotonin reuptake inhibitors (SSRIs), and
serotonin-norepinephrine reuptake inhibitors (SNRIs). Benzodiazepines are used for
short term management of anxiety as they are highly addictive. Effective forms of
psychotherapy for anxiety are cognitive behavioral therapy, exposure therapy and modelling.

Nursing Management/Care
Depression- The priority nursing diagnosis would be: Risk for suicide related to suicidal
ideations as evident by expressing thoughts of death. Goals would be the patient will identify
2 to 3 people to reach out to for emotional support. The client will not inflict any harm to
themselves. The interventions will be performing mental status assessment and identifying the
level of risk for suicide and determining if hospitalization is required.
Anxiety- The priority nursing diagnosis would be: Ineffective coping related to anxiety as
evident by verbal expressions of inability to handle stress. Goals would be the patient will
identify effective coping strategies to help manage stress and the patient will express
confidents in being able to manage stress. Interventions would be use of therapeutic
communication and assessing for a support system and available resources and making any
necessary referrals.

Teaching
Depression/ Anxiety- For both depression and anxiety the teaching would include medication
compliance and to never discontinue medications without discussions with the health care
provider. Which includes the black box warning. It would include coping management and
skills. Side effects of medications and additional resources that may be useful based on
individual circumstances.