1. Depression and Other Mood Disorders
Chapter 21
Depression and Other Mood Disorders
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Learning Objectives
Describe the continuum of emotional responses.
Compare four theories relating to emotions and their disorders.
Explain how emotions affect individuals throughout the life cycle.
Compare the differences between a depressive episode and a depressive disorder.
List the diagnostic criteria for bipolar disorders.
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Learning Objectives
Explain seasonal affective disorder.
Discuss behaviors associated with postpartum depression.
Identify three drug classes used for the treatment of depression and other mood disorders.
Apply four nursing (therapeutic) interventions for clients with mood disorders.
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4. Continuum of Emotional Responses (p. 236)
The spectrum of human emotion ranges from elation to despair.
Emotional responses can be growth promoting and adaptive.
They can lead to ineffective behaviors that soon could become maladaptive
What are some types of emotions? What is maladaptive behavior?
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5. Theories Related to Emotions and Their Disorders (p. 236)
Biological evidence
Causes of mood disorders are complex.
Neurotransmitters and hormones are involved in mood regulation.
Monoamines are longer-acting neurotransmitters that modify the sensitivity of neurons.
The pituitary gland controls the hormones by balancing thyroid and adrenal hormones.
Biological rhythms of depressed persons differ from those of nondepressed persons.
Depression is related to physical illness.
When one’s immune system is unpredictable, the body is not only unable to fight off infections, but also depression.
There is a much higher incidence of depression and bipolar disorder in the children of people who have these afflictions.
Serotonin, norepinephrine, and dopamine have all been found to affect moods and behaviors.
How do hormones relate to emotions?
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6. Theories Related to Emotions and Their Disorders cont’d. (p. 237)
Other theories
Psychoanalytic theories see mood disorders as anger turned inward.
Behaviorists view depression as a group of learned responses.
Social theorists consider depression the result of faulty social interactions.
A holistic viewpoint is usually used by health care providers.
Depending on one’s background and field of expertise, theories about depression and other mood disorders vary.
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7. Emotions Throughout the Life Cycle (p. 237)
Emotions in childhood
Situational depression
Depressive responses in children are tied to a specific event or situation.
Depressed children have a distinct way of thinking.
The incidence of depression in childhood is increasing.
How do emotions affect individuals throughout the life cycle?
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8. Emotions Throughout the Life Cycle cont’d. (p. 238)
Emotions in adolescence
Depression in adolescence usually is related to four factors:
Self-esteem
Loneliness
Family strengths
Parent-teen communications
During adolescence:
Control issues developing—the teen wants to be in charge, thinks he or she knows everything and adults know nothing
Hormonal turmoil—contributes to emotional lability
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9. Emotions Throughout the Life Cycle cont’d. (p. 238)
Emotions in adulthood
Society expects adults to practice emotional control.
Adults must cope with a wide range of situations, events, developmental tasks, and responsibilities as well as emotional reactions.
Public stigma follows individuals with mood disorders.
During adulthood, behaviors and emotions are dictated by societal norms.
What are some examples of how society expects adults to act?
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10. Emotions Throughout the Life Cycle cont’d. (p. 238)
Emotions in older adulthood
Depression is very common in older adults.
Depression can be treated.
How to detect depression in older adults
Active listening
Gentle questioning
Alert assessment
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11. Characteristics of Mood Disorders (p. 239)
Mania
Emotions that are elevated, expansive, and irritable accompanied by loss of identity, increased activity, and grandiose thoughts and actions
Depression
Feelings of sadness, disappointment, and despair
What are the diagnostic criteria for bipolar disorder?
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Mood Disorders (p. 240)
Depression can occur on several levels.
Mild depression
Short-lived
Triggered by life events
Moderate depression (dysthymia)
Persists over time
Major depressive episode
When depression is severe and lasts longer than 2 weeks
Symptoms range from paralysis to agitation.
Suicidal thoughts may be entertained.
Compare the differences between a depressive episode and a depressive disorder.
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13. Mood Disorders cont’d. (p. 241)
Bipolar I
Episodes of depression alternate with episodes of mania.
More severe and incapacitating form of bipolar illness
Delusions common during periods of mania
Hallucinations may occur.
Bipolar II
Major episodes of depression alternate with periods of hypomania.
Often marked by 1 to 2 weeks of severe lethargy, withdrawal, and melancholy followed by several days of mania
Bipolar I: more serious and debilitating form—higher highs and lower lows
Delusions more common
Hallucinations not common, but may be present
Bipolar II: mood swings are less drastic
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14. Mood Disorders cont’d. (p. 242)
Cyclothymic disorder
Behavior of repeated mood swings alternating between hypomania and depressive symptoms
Seasonal affective disorder
Occurs in many people from October to April
Postpartum depression
Occurs after childbirth
Symptoms include
Tearfulness
Irritability
Hypochondria
Sleeplessness
Impaired concentration
Headache
Describe seasonal affective disorder.
What behaviors are associated with postpartum depression?
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15. Therapeutic Interventions (p. 242)
Therapeutic plan
Acute treatment phase
Continuation phase
Maintenance treatment phase
Current standard treatments for mood disorders include
Psychotherapy
Pharmacologic therapy
Electroconvulsive therapy
What is involved in each phase of the therapeutic plan?
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Drug Therapies (p. 243)
Antidepressants
Tricyclics
Nontricyclics
Monoamine oxidase inhibitors (MAOIs)
Selective serotonin reuptake inhibitors (SSRIs)
Atypical antidepressants
With many antidepressants, 2 to 4 weeks are required before their effects are noted and the client’s well-being improves.
Refer to slide 5 on theories of causes of depression as a disturbance in the neurotransmitters. Antidepressants help repair the disturbance.
Most clients want an “instant cure” for their depression. They are “sick and tired of feeling sick and tired.”
It is important for the nurse to stress that antidepressant medications take time to become effective. The drug is at therapeutic levels in 2 to 4 weeks.
Why are depressed people at high risk for medication noncompliance?
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17. Drug Therapy cont’d. (p. 244)
Antimanics
Lithium
Interaction between the level of lithium in the blood and common table salt
Therapeutic blood levels of lithium range from 0.6 to 1.2 mEq/L.
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18. Nursing (therapeutic) process (p. 246)
Assess for level of depression or mania.
Nursing diagnoses and therapeutic interventions then are chosen based on the client’s most distressing problems.
Holistic interventions should look at the following:
Physical
Emotional
Social
Intellectual
Spiritual
What are some nursing interventions that can be used for clients with mood disorders?
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Question 1
Which of the following words describes a nonintellectual response in the affective realm of human functioning?
Emotion
Mood
Depression
Dysthymic disorder
Correct Answer: 1
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Question 2
The nurse is admitting a client who has daily moderate depression that has lasted 3 years. The client’s condition is known as what?
Mood disorder
Dysthymic disorder
Bipolar disorder
Hypomania
Correct Answer: 1
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Question 3
What percentage of individuals with severe major depressive disorder dies by suicide?
10%
15%
25%
40%
Correct Answer: 2
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Question 4
The nurse is admitting a client with suspected bipolar disorder. The client has repeated patterns of mood swings alternating between hypomania and depressive symptoms; however, they are less intense than classic bipolar disease. What is this condition known as?
Seasonal affective disorder
Cyclothymic disorder
Substance-induced mood disorder
Mild bipolar disorder
Correct Answer: 2
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Question 5
All of the following are true regarding electroconvulsive therapy (ECT) except:
It is the introduction of a controlled grand mal seizure
It requires 30 minutes
Generally, 6 to 12 treatments are administered over several weeks
Each client is evaluated for ECT on an individual basis
Correct Answer: 2
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