Depressive

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disorders
Dr Mosleh S. Kareem
Psychiatric nurse and senior psychotherapist
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Objectives

 What is Depression?
 How can we recognize it?
 How can we help ourselves & others?
 How can we apply nursing care as nurse for depressive cases

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Mood disorders

Mood disorders, also called affective disorders, are

pervasive alterations in emotions that are manifested
by depression, mania, or both.

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What is Depression?

 Nearly everyone has felt depressed, sad, or down in the dumps at one time or another.
 Feeling depressed can be a normal reaction to a stressful event, such as when one suffers a loss or
endures another of life’s various struggles or stresses. Typically after time our mood begins to lift
and we can move on.
 Depression is a serious medical condition that affects your behaviour, your thinking, your emotions
and physical health over time.
 While feeling down only lasts for a short while, depression affects you for at least 2 weeks and
affects your everyday life and ability to function.
 It can vary from mild to severe and can have a profound impact, affecting every aspect of the
individual, their relationships, family and work life.

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Classification of Depressive disorders

Mood disorders

Bipolar I

Unipolar Bipolar

 MDD Dysthymia Bipolar II 06/11/2024

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Other disorders classified with similarities to mood
disorders include the following:

 Disruptive mood dysregulation disorder is a persistent angry or irritable

mood, punctuated by severe, recurrent temper outbursts that are not in
keeping with the provocation or situation, beginning before age 10 years.
 Cyclothymic disorder is characterized by mild mood swings between
hypomania and depression without loss of social or occupational functioning.
 Substance-induced depressive or bipolar disorder
 Seasonal affective disorder

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Major Depressive Disorder
Diagnostic Criteria
 A. Five (or more) of the following symptoms have been present during the same 2-
week period and represent a change from previous functioning; at least one of the
symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
 Note: Do not include symptoms that are clearly attributable to another medical
condition.
 1. Depressed mood most of the day, nearly every day, as indicated by either
subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g.,
‘appears tearful). (Note: In children and adolescents, can be irritable mood.)

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Major Depressive Disorder
Diagnostic Criteria
 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation).
 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every day.
(Note: In children, consider failure to make expected weight gain.)
 4. Insomnia or hypersomnia nearly every day.
 5. Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down).

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Major Depressive Disorder
Diagnostic Criteria
 6. Fatigue or loss of energy nearly every day.
 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick).
 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others).
 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide.

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Major Depressive Disorder
Diagnostic Criteria

 B. The symptoms cause clinically significant distress or

impairment in social, occupational, or other important areas of
functioning.

 C. The episode is not attributable to the physiological effects of a

substance or to another medical condition.

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Major Depressive Disorder
Diagnostic Criteria
 Note: Criteria A–C represent a major depressive episode.
 Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural
 disaster, a serious medical illness or disability) may include the feelings of intense sadness,
 rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A,
 which may resemble a depressive episode. Although such symptoms may be understandable
 or considered appropriate to the loss, the presence of a major depressive episode in
 addition to the normal response to a significant loss should also be carefully considered. This
 decision inevitably requires the exercise of clinical judgment based on the individual’s history
 and the cultural norms for the expression of distress in the context of loss.1

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Major Depressive Disorder
Diagnostic Criteria

D. The occurrence of the major depressive episode is not better

explained by schizoaffective disorder, schizophrenia, schizophreniform
disorder, delusional disorder, or other specified and unspecified
schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode.
Note: This exclusion does not apply if all of the manic-like or
hypomanic-like episodes are substance-induced or are attributable to
the physiological effects of another medical condition.
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Severity of MDD

1. Mild
2. moderate
3. Severe

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Prevalence of MDD

in the United States is approximately 7%, with marked differences by

age group such that the prevalence in 18- to 29-year-old individuals is
threefold higher than the prevalence in individuals age 60 years or older.
Females experience 1.5- to 3 -fold higher rates than males beginning in
early adolescence.

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Risk and Prognostic Factors
 Temperamental. Neuroticism (negative affectivity) is a well-established
risk factor for the onset of major depressive disorder, and high levels
appear to render individuals more likely to develop depressive episodes in
response to stressful life events.
 Environmental. Adverse childhood experiences, particularly when there are
multiple psychological traumas.
 Genetic and physiological. First-degree family members of individuals
with major depressive disorder have a risk for major depressive disorder
two- to fourfold higher than that of the general population.
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Comorbidity

Other disorders with which major depressive disorder frequently co-

occurs are substance-related disorders, panic disorder, obsessive-
compulsive disorder, anorexia nervosa, bulimia nervosa, and borderline
personality disorder.

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Persistent Depressive Disorder (Dysthymia)
(chronic)
Diagnostic Criteria
A. Depressed mood for most of the day, for more days than not, as
indicated by either subjective account or observation by others, for at
least 2 years.
Note: In children and adolescents, mood can be irritable and duration
must be at least 1 year.

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Dysthymia = Diagnostic Criteria

B. Presence, while depressed, of two (or more) of the following:

1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
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Dysthymia = Diagnostic Criteria

C. There has never been a manic episode or a hypomanic episode, and criteria have
never been met for cyclothymic disorder.
D. The disturbance is not better explained by a persistent schizoaffective disorder,
schizophrenia, delusional disorder, and other psychotic disorders.
E. The symptoms are not attributable to the physiological effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition (e.g.
hypothyroidism).
F. The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
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Prevalence of Dysthymia

in the United States is approximately

0.5% for persistent depressive disorder.

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Risk and Prognostic Factors

1. Temperamental: higher levels of neuroticism (negative affectivity), and

the presence of anxiety disorders or conduct disorders.

2. Environmental: Childhood risk factors include parental loss or

separation.

3. Genetic and physiological: a higher proportion of first-degree relatives

with persistent depressive disorder.
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ETIOLOGY
Bio-psycho-social factors

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Treatment of depression

1. PSYCHOTHERAPY
2. Antidepressant medication
3. ECT

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Nursing care for depression
 Provide for the safety of the client and others.
 Institute suicide precautions if indicated.
 Begin a therapeutic relationship by spending nondemanding time with the client.
 Promote completion of activities of daily living by assisting the client only as necessary.
 Establish adequate nutrition and hydration.
 Promote sleep and rest.
 Engage the client in activities.
 Encourage the client to verbalize and describe emotions.
 Work with the client to manage medications and side effects.
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Nursing care for depression

 Reorient the client to person, place, and time as indicated (call the client by name, tell
the client your name, tell the client where he or she is, and so forth).
 Spend time with the client.
 If the client is ruminating, tell him or her that you will talk about reality or about the
client’s feelings.
 When approaching the client, use a moderate level tone of voice. Avoid being overly
cheerful.
 Use silence and active listening when interacting with the client. Let the client know that
you are concerned and that you consider the client a worthwhile person.
 When first communicating with the client, use simple, direct sentences; avoid complex
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Nursing care for depression

 Allow (and encourage) the client to cry.

 Teach the client about positive coping strategies and stress management
skills, such as increasing physical exercise, expressing feelings verbally
or in a journal, or méditation techniques. Encourage the client to
practice this type of technique while in the hospital.
 Teachthe client about the problem-solving process: explore possible
options, examine the consequences of each alternative, select and
implement an alternative, and evaluate the results.
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References

1. APA (2013) DSM-D. PP.155-171.

2. Sheila L. Videbeck (2017). PSYCHIATRIC –MENTAL

HEALTH NURSING. 7 EDITION. P. 474- 505.

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