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▍Psychiatric Education Information
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Depressive disorder (by Tseng & Tsai)

Major Depression

By D020 Nurse head SJ Tseng and Chief SJ Tsai, M.D

1. What is major depression?

Depression is a syndrome with mental and somatic symptoms. When a person is confronted with psychological stress from the society, he or she may show low mood, self-blaming and guilty feelings and other depressive reactions, and if the duration prolongs, with increase in severity of the symptoms, the individual may have repeated idea of death, and may precipitate self-harm or suicide behavior.

 

2. Etiology

Depression can be caused by encounters with life’s many different stress sources, when the individual feels unable to cope, but depression is also related to one’s stress-coping abilities, personality or genetic factors. The main reason is due to the insufficiency of neurotransmitters within the brain, such as serotonin, or norepinephrine, which are at lower concentrations than normal people.

 

3. Symptoms

At least five of the symptoms listed below last over two weeks, amongst them must include depressive mood or loss of interest or loss of sense of happiness, and also affecting daily life functions:

  1. Low mood, such as sadness, crying or a sense of emptiness.

  1. Significant loss of interest.

  1. Weight loss or gained without dieting, for example: bodyweight change over 5% within one month.

  1. Insomnia or increase in need of sleep.

  1. Psychomotor retardation or agitation.

  1. Easily feel exhausted or lack of vitality.

  1. Worthless or guilty feeling.

  1. Inability to concentrate, hesitation or reduced ability to think.

  1. Repeating idea of death, attempt in committing suicide or definite suicide plan.

The above symptoms are not necessary for depression, if you have the above described symptoms, please see your psychiatrist for treatment.

 

4. Treatment

  1. Medical treatments: taking antidepressants or mood stabilizers as prescribed by psychiatrists.

  1. Non-medical treatments: individual psychotherapy, cognitive-behavior-therapy, phototherapy, with assessments done by professionals to determine depressive symptoms and causes, and to assist the learning of new behaviors and coping skills.

  1. Electro-convulsive therapy: requires assessment by physicians, hospitalized and executed when necessary.

  1. Transcranial magnetic stimulation: requires assessment by physicians, without hospitalization, outpatient treatment may be performed.

 

5. Prevention of recurrence

  1. Coordinate with health care workers, regularly taking medication, accepting treatment, with support and encouragement from family and friends.

  1. Taking medication, use small bags or boxes for medications, aliquot them in a prominent place, as a reminder for oneself to take medication. Do not try to stop medication or to decrease dosage.

  1. Try to communicate with family, relieve oneself from psychological stress or guilty feeling during appropriate times, and do not accumulate stress.

  1. Family and friends should encourage, care and listen during appropriate times.

  1. Bring up an interest and keep a good regular exercise routine/habit, it is able to eliminate stress, and allow relaxation.

  1. Arrange one’s own routine schedule, and keep a regulated lifestyle.

  1. When returning to work or school, start from the habituation period, increase the workload in step-wise manner, in order to avoid responsibility overload.

  1. Return psychiatrist clinic regularly, and discuss reactions to using this drug, its side/adverse effects, dosage, frequency of treatment etc.

  1. If sleep quality decreases, the symptoms appear and also interferes with daily life, please visit your psychiatrist as soon as possible, in order to avoid recurrence of the syndrome.

 

 

 

Reference

Lu, S. F., Chen, C. C., & Huang, C. F. (2012). Nursing Experience with the Patient Suffering from Major Depression by Utilizing Watson’s caring theory. The Kaohsiung Journal of Nursing 29(1), 69-79.

American Psychiatric Association (2014). Desk Reference to the Diagnostic Criteria From DSM-5R (Taiwan Society of Psychiatry translation). Taipei: Hochitw.

Apostolo, J., Queiros, P., Rodrrigues, M., Castro, I. & Cardoso, D. (2015). The effectiveness of nonpharmacological interventions in older adults with depressive disorders:a systematic review. Joanna Briggs Institute Database of Systematic Reviews & Implementation Report 13(6), 220-278. doi:10.11124/jbisrir-2015-1718.

Solomon, D., & Adams, J. (2015). The use of complementary and alternative medicine in adults with depressive disorders. A critical integrative review. Journal of Affective Disorder 179, 101-113. doi:10.1016/j.jad.2015.03.031

 

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