Depression
Wednesday, September 15, 2021 10:52
• Depression
○ Term used many different ways and means something different to
many people bu not the same as sadness (term we use to describe
what we feel in relation to stress, loss, and other factors) while
depression is a disorder
○ The word “depression” can denote a:
§ A sign or symptom
§ An emotional state
§ A reaction
§ A clinical disorder
○ “The opposite of depression is not happiness but vitality”
• Epidemiology of major depression
§ Depression is very common and tends to be chronic in most
people and is recurrent
§ Symptoms are relieved between episodes
§ Are other chronic forms even with the treatment
§ The depression will continue to have residual symptoms and
worsen at intervals
○ Major depression affects 15 million people 18 years and older each
year in the US (6-7% of population)
○ Lifetime risk: 7-12% men, 20-30% women (19% prevalence over 7
years?)
○ Dysthymia affects about 1.5% of the US population over 18 each
year
§ More chronic version of depression
§ Not as common as major depression
§ Diagnosed more frequently in women
○ Varies among cultures, some see as heart broken to relate it to a
disorder of the heart (heart sickness)
○ Depressive disorders are more prevalent in women (diagnostic
bias? Hormonal factors?)
○ 80% who have MDD will have recurrent episodes
○ 43% of people with MDD also have another psychiatric disorder
(most often: anxiety disorders)
, (most often: anxiety disorders)
○ Only 1/3 of people with depression are treated; untreated episodes
last 6-24 months
○ Most treatment is not by MH professionals and may not be
efficacious (e.g. antidepressants may not be properly titration or
well-matched to individual pt needs); counseling often neglected
○ Depression is associated with cancers and other disorders such as
CVD, increased morbidity and mortality
○ 60% of suicides are related to depression, more commonly found in
elderly (>60% above age 65 will present with depression)
○ Depression is a fatal disease to it takes ever effort we can to catch
and treat it aggressively
• Risk or contributing factors
○ Losses/stressors
○ Inadequate coping
○ Prior mood disorders
○ Family history of mood disorders
○ Pt or family history of other psychiatric disorders
○ Current substance abuse
○ Medical illness (e.g. cardiovascular, CVA, hypothyroidism, cancers
○ History of abuse, neglect
○ Inadequate social support
○ Dysfunctional family of origin
○ Inactivity
○ Insomnia
○ Rotating shifts
§ Risk factor for RN’s
• Variations on depression
§ Need to be ruled out when looking at someone with features
of depression
○ Sadness
○ Grief - always have as a reaction of loss
○ Major depression (clinical depression, formerly melancholia)
○ Major depression with psychosis
○ Major depression with mixed features (of mania)
○ Premenstrual dysphoric disorder
○ Persistent depressive disorder (dysthymia)
○ Postpartum (prepartum onset also)
○ Seasonal affective disorder
, ○ Seasonal affective disorder
• Grief
§ Varies differently between person to person and culture to
culture and is expressed differently as well
○ Complicated grief - grief that has maladaptive responses to the loss
○ Is a universal human experience
○ Is a subjective state that follows loss
○ Is not pathology (unless it is delayed or persists past 12 mos)
○ Uncomplicated grief runs a relatively consistent course but can vary
with circumstances
○ Although sadness is prominent, it is not the same as clinical
depression
○ However, in some cases it can develop into depression, and it is
important to distinguish the two
○ In grief, the person remains connected to his family, while in
depression he may withdraw or self-isolate
○ In grief the person is usually consolable, but in depression the
sadness is pervasive and responds less, or not at all, to suppport
from others
○ In grief the person can usually function to a degree, but in severe
depression function is greatly impaired
○ Grief varies; people have ups and downs and the intensity of the
grief varies from day to day. In depression the sadness is pervasive
and consistent
○ Persons experiencing grief are rarely suicidal, but suicide is a
significant risk in depression
• Diagnostic criteria for major depression
○ For at least two weeks the person has experienced a change in
usual functioning related to depressed mood and/or anhedonia,
often unaccompanied by any/all of the following:
§ Persistent, pervasive depressed mood
§ Marked change in appetite with weight loss or gain
§ Increased or decreased sleep
§ Fatigue or energy loss (can be profound)
§ Psychomotor retardation (or sometimes, agitation) - more
common in elderly
□ Irritability, anger, and hostility will be more of a
prominent mood in children
§ Feelings of worthlessness, guilt, or self-blame
Wednesday, September 15, 2021 10:52
• Depression
○ Term used many different ways and means something different to
many people bu not the same as sadness (term we use to describe
what we feel in relation to stress, loss, and other factors) while
depression is a disorder
○ The word “depression” can denote a:
§ A sign or symptom
§ An emotional state
§ A reaction
§ A clinical disorder
○ “The opposite of depression is not happiness but vitality”
• Epidemiology of major depression
§ Depression is very common and tends to be chronic in most
people and is recurrent
§ Symptoms are relieved between episodes
§ Are other chronic forms even with the treatment
§ The depression will continue to have residual symptoms and
worsen at intervals
○ Major depression affects 15 million people 18 years and older each
year in the US (6-7% of population)
○ Lifetime risk: 7-12% men, 20-30% women (19% prevalence over 7
years?)
○ Dysthymia affects about 1.5% of the US population over 18 each
year
§ More chronic version of depression
§ Not as common as major depression
§ Diagnosed more frequently in women
○ Varies among cultures, some see as heart broken to relate it to a
disorder of the heart (heart sickness)
○ Depressive disorders are more prevalent in women (diagnostic
bias? Hormonal factors?)
○ 80% who have MDD will have recurrent episodes
○ 43% of people with MDD also have another psychiatric disorder
(most often: anxiety disorders)
, (most often: anxiety disorders)
○ Only 1/3 of people with depression are treated; untreated episodes
last 6-24 months
○ Most treatment is not by MH professionals and may not be
efficacious (e.g. antidepressants may not be properly titration or
well-matched to individual pt needs); counseling often neglected
○ Depression is associated with cancers and other disorders such as
CVD, increased morbidity and mortality
○ 60% of suicides are related to depression, more commonly found in
elderly (>60% above age 65 will present with depression)
○ Depression is a fatal disease to it takes ever effort we can to catch
and treat it aggressively
• Risk or contributing factors
○ Losses/stressors
○ Inadequate coping
○ Prior mood disorders
○ Family history of mood disorders
○ Pt or family history of other psychiatric disorders
○ Current substance abuse
○ Medical illness (e.g. cardiovascular, CVA, hypothyroidism, cancers
○ History of abuse, neglect
○ Inadequate social support
○ Dysfunctional family of origin
○ Inactivity
○ Insomnia
○ Rotating shifts
§ Risk factor for RN’s
• Variations on depression
§ Need to be ruled out when looking at someone with features
of depression
○ Sadness
○ Grief - always have as a reaction of loss
○ Major depression (clinical depression, formerly melancholia)
○ Major depression with psychosis
○ Major depression with mixed features (of mania)
○ Premenstrual dysphoric disorder
○ Persistent depressive disorder (dysthymia)
○ Postpartum (prepartum onset also)
○ Seasonal affective disorder
, ○ Seasonal affective disorder
• Grief
§ Varies differently between person to person and culture to
culture and is expressed differently as well
○ Complicated grief - grief that has maladaptive responses to the loss
○ Is a universal human experience
○ Is a subjective state that follows loss
○ Is not pathology (unless it is delayed or persists past 12 mos)
○ Uncomplicated grief runs a relatively consistent course but can vary
with circumstances
○ Although sadness is prominent, it is not the same as clinical
depression
○ However, in some cases it can develop into depression, and it is
important to distinguish the two
○ In grief, the person remains connected to his family, while in
depression he may withdraw or self-isolate
○ In grief the person is usually consolable, but in depression the
sadness is pervasive and responds less, or not at all, to suppport
from others
○ In grief the person can usually function to a degree, but in severe
depression function is greatly impaired
○ Grief varies; people have ups and downs and the intensity of the
grief varies from day to day. In depression the sadness is pervasive
and consistent
○ Persons experiencing grief are rarely suicidal, but suicide is a
significant risk in depression
• Diagnostic criteria for major depression
○ For at least two weeks the person has experienced a change in
usual functioning related to depressed mood and/or anhedonia,
often unaccompanied by any/all of the following:
§ Persistent, pervasive depressed mood
§ Marked change in appetite with weight loss or gain
§ Increased or decreased sleep
§ Fatigue or energy loss (can be profound)
§ Psychomotor retardation (or sometimes, agitation) - more
common in elderly
□ Irritability, anger, and hostility will be more of a
prominent mood in children
§ Feelings of worthlessness, guilt, or self-blame
