1. Nursing Instruction
  2. Overview
  3. Psychiatry
Major Points
  1. Depression can change a patient’s daily life, social, and occupational function.
  2. Severe depression may lead to impulsive behaviors such as self-harm or even suicide.
  3. The principles of care for depression are to take medicine regularly, work and rest normally, and develop interests and exercise habits.

What is major depression?

Depression can happen when someone faces stress in their life. It may cause low mood, low energy, feelings of guilt, trouble sleeping, poor appetite, and difficulty concentrating. If these symptoms last a long time and get worse, the person may think about death repeatedly and could have urges to harm themselves or attempt suicide.


What are the symptoms of major depression?

Depression often develops when a person faces many life stressors and feels unable to cope. If these symptoms last for more than two weeks and cause changes in daily life, social interactions, work, or other important areas (such as marriage or parenting), depression may be present. Depression is defined as experiencing five or more of the following symptoms almost every day, and one of them must include either a “depressed mood” or a “loss of interest or pleasure.”

  1. Depressed mood: Such as feeling sad, helpless, or empty.
  2. Loss of interest or pleasure in almost all activities.
  3. Insomnia or hypersomnia, feeling fatigued or lacking energy.
  4. Significant decrease or increase in appetite, with a weight change of more than 5% within one month.
  5. Psychomotor agitation or retardation observable by others.
  6. Decreased ability to concentrate, think, or make decisions.
  7. Feelings of worthlessness or excessive guilt, recurrent thoughts of death, suicidal ideation, or suicide attempts.
Having the above symptoms does not necessarily mean you have depression. If you experience these symptoms, please visit a psychiatric outpatient clinic for evaluation.

What are the common treatment strategies?
  1. Medical treatments:
    1. Primarily involves antidepressants. You'll typically start to see effects within 2 to 3 weeks of antidepressant treatment, with gradual improvement in depressive symptoms around 6 to 8 weeks. If necessary, your doctor may adjust the dosage of mood stabilizers after evaluating your condition.
    2. Esketamine nasal spray: This offers a rapid and sustained antidepressant effect for treatment-resistant depression. It's usually administered twice a week, with the frequency adjusted by your doctor based on your clinical symptoms and mood changes.
  2. Non-medical treatments:
    Professionals assess the symptoms and causes of depression, providing various approaches such as group therapy, psychotherapy, cognitive therapy, mindfulness-based cognitive therapy, individualized exercise therapy, and light therapy. They may also implement relevant interventions for couples and families. These therapies aim to help you learn new behavioral patterns and stress management techniques by changing thought processes.
  3. Electroconvulsive therapy:
    This requires a doctor's evaluation and is administered as inpatient treatment.
  4. Transcranial Magnetic Stimulation (rTMS):
    This also requires a doctor's evaluation. It doesn't necessarily require hospitalization and can be performed as outpatient treatment.

How should I take care of myself after being diagnosed with major depression?
  1. Follow medical instructions diligently: Take your medications exactly as prescribed by your healthcare team. If you're worried about forgetting a dose, try using a pill organizer or small medicine bags to sort your pills by meal and keep them in a visible spot. Never reduce or stop your medication on your own.
  2. Lean on your support system: Depression often requires long-term treatment and support. The encouragement, care, and active listening from family and friends are incredibly important for recovery..
  3. Establish a healthy routine: Plan your daily schedule and cultivate good lifestyle habits. Avoid smoking and excessive alcohol consumption.
  4. Develop hobbies and exercise regularly: Encourage yourself to find new interests and make regular exercise a habit. For example, walking can help relieve tension and promote mental and physical relaxation.
  5. Gradual return to work or school: When you're ready to go back to work or school, start with an "adaptation period." This means gradually increasing your time, perhaps starting with 4-hour workdays, to avoid overwhelming yourself.
  6. Manage stress and negative feelings: When you feel agitated, remind yourself to relax and take a deep breath. Try to step away from the situation to avoid excessive suppression of your emotions. Work on shifting your mindset and releasing psychological stress or guilt as needed. Don't let stress build up.
  7. Seek prompt medical attention for worsening symptoms: If you notice your sleep worsening, or if depressive symptoms return and start affecting your daily life, return to your clinic as soon as possible to prevent a relapse.

Reference
  1. A-Tjak, J.G.L.,Morina, N., Topper, M., & Emmelkamp, P. M.G. (2021). One year follow-up and mediation in cognitive behavioral therapy and acceptance and commitment therapy for adult depression. BioMed Central Psychiatry, 21(1), 1-17. https://doi.org/10.1186/s12888-020-03020-1
  2.  Baldwin, D. S., Dang, M., Farquharson, L., Fitzpatrick, N., Lindsay, N., Quirk, A., Rhodes, E., Shah, P., Williams, R., & Crawford, M. J. (2021). Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the national clinical audit of anxiety and depression. Comprehensive Psychiatry, 104, 152212. https://doi.org/10.1016/j.comppsych.2020.152212
  3. Hong, R. H., Murphy, J. K., Michalak, E. E., Chakrabarty, T., Wang, Z., Parikh, S. V., Culpepper, L., Yatham, L. N., Lam, R. W., & Chen, J. (2021). Implementing measurement-based care for depression: Practical solutions for psychiatrists and primary care physicians. Neuropsychiatric Disease and Treatment, 17, 79–90. https://doi.org/10.2147/NDT.S283731
  4.  Kim, J. W., Suzuki, K., Kavalali, E. T., & Monteggia, L. M. (2024). Ketamine: Mechanisms and relevance to treatment of depression. Annual Review of medicine, 75(1), 129-143. https://doi.org/10.1146/annurev-med-051322-120608
  5. McCartney, M., Nevitt, S., Lloyd, A., Hill, R., White, R., & Duarte, R. (2021). Mindfulness based cognitive therapy for prevention and time to depressive relapse: Systematic review and network meta-analysis. Acta Psychiatrica Scandinavica, 143(1), 6-21. https://doi.org/10.1111/acps.13242
  6. Vasiliu, O. (2023). Esketamine for treatment resistant depression: A review of clinical evidence. Experimental Therapeutic Medicine, 25(3), 1-10. https://doi.org10.3892/etm.2023.11810
  7. Wittenborn, A. K., Woods, S. B., Priest, J. B., Morgan, P. C., Tseng, C. F., Huerta, P., & Edwards, C. (2022). Couple and family interventions for depressive and bipolar disorders: Evidence base update (2010–2019). Journal of Marital and Family Therapy, 48(1), 129-153. https://doi.org/10.1111/jmft.12569
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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