1. Nursing Instruction
  2. Overview
  3. Psychiatry
Major Points:
  1. Depression can change patient’s daily life, social, and occupation function.
  2. Severe depression may have self-injury or self-killing behaviors.
  3. The principle of care is to take medicine regularly, work and rest normally, and build exercise habits.
 
What is major depression?
When a person is confronted with socio-psychological stress, he/she may show low moods, reduced energy, guilty feelings, insomnia, lack of appetite, and difficulty in concentration etc.  If the duration is prolonged and there is an increase in severity of the symptoms, then the individual may have repeated ideas of death, which may precipitate self-harm or suicidal behavior.
 
What are the common Symptoms of major depression?
Depression can be caused by many stressors in life that make the individual feel as if he/she is unable to cope. At least five of the following symptoms may occur almost daily for two weeks and may also affect one’s functioning in daily life in social, occupational, and in other important areas (such as marriage, parent-child). These must include a depressive mood, and loss of interest or a sense of happiness.
  1. Depressed emotions felt almost every day: such as sadness, helplessness, feelings of emptiness.
  2. Loss of interest in all activities nearly every day.
  3. Insomnia or drowsiness, and feeling tired almost every day.
  4. Inability to eat or increased appetite, significant weight loss or gain, and body weight change of more than 5% within one month.
  5. Being observed by others to be sluggish or agitated almost every day.
  6. Decreased ability to concentrate, or make decisions felt almost every day.
  7. Feelings of hopelessness or intense guilt, recurring thoughts of death, suicidal ideation, or suicide attempts almost every day.
The above symptoms are not necessarily linked to depression; however, if you have the above described symptoms, please see your psychiatrist for treatment.
 
What are the common treatment strategies?
  1. Medical treatments: taking antidepressants is the main way. Antidepressants usually need to be taken for 2 to 3 weeks before the benefit starts to be felt. The symptoms of depression should be gradually improved in 6-8 weeks. One may also consider to add mood stabilizers, as prescribed by psychiatrists.
  2. Non-medical treatments: with assessments done by professionals to determine depressive symptoms and causes. Offered treatment may include group therapy, psychotherapy, cognitive behavior therapy, mindfulness-based cognitive therapy, individual exercise therapy, and phototherapy, and assisting in the learning of new behaviors and coping skills.
  3. Electro-convulsive therapy: must be assessed by physicians and performed in a hospital.
  4. Transcranial Magnetic Stimulation (rTMS): must be assessed by physicians, without hospitalization, and outpatient treatment may be performed. 
 
Principles of care:
  1. Coordinate with the instructions of medical staff and continue to take medication regularly. For taking medicine, use small bags or boxes for medicine and put them in a visible place as a reminder to oneself to take medication on time. Do not stop medication or decrease the dosage by yourself.
  2. Patients with depression need to maintain treatment and accompany. Family and friends should encourage, care for, and listen at appropriate times. The support and encouragement of family and friends are very important for recovery from the disease.
  3. Arrange one’s own routine schedule, and keep a regulated lifestyle. Avoid smoking and excessive drinking
  4. Develop an interest and keep a good habit of regular exercise. For example: walking will eliminate stress and allow relaxation.
  5. When returning to work or school, start from the adaptation period, and increase the workload in a step-wise manner, in order to avoid overload.
  6. When you feel irritated, remind yourself to relax first, take a deep breath, then leave the scene, avoid emotional suppression, and try to change your mood. During appropriate times, try to relieve yourself of psychological stress or guilt feelings, so that one does not accumulate stress. 
  7. If sleep quality decreases, or the symptoms appear and begin to interfere with your daily life, please visit your psychiatrist as soon as possible, in order to avoid recurrences.
 
Reference
  1. 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
  2. Cordner, Z. A., MacKinnon, D. F., & DePaulo Jr, J. R. (2020). The care of patients with complex mood disorders. Focus, 18(2), 129-138.  https://doi.org/10.1176/appi.focus.20200007
  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. 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

  5. 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

  6. Wittenborn, 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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