Acute Depression

Cheah Jia Jing E. Purani

Cheong Ai Wei Juniati
Chong Shing Chen
Outline
Video
Introduction
Major impact of disease condition
Family life
Physical aspect
Psychological aspect
Social aspect
Activity of daily living/study/employment/career advance
Summary
Q&A

Video
Introduction
What is Acute Depression?

AKA major depressive disorder (MDD)
Is a serious clinical mood disorder
Constant sense of hopelessness and despair
Marked by depressed mood most of the day
Loss of interest in normal activities and relationships
Symptoms present everyday for at least 2 weeks
Can cause problems with a persons diet, sleep, work life, and ability to connect with others
More likely to use alcohol or illegal substances
Are at increased risk for other mental and physical health problems
Are at a much greater risk for suicide than the general population
(Kerr, 2012)
Introduction

Acute Depression in Singapore

According to the Singapore Mental Health Study (SMHS)
conducted in 2010, acute depression is:
Most common mental disorder in Singapore
One in 17 people in Singapore have suffered from acute
depression at some time in their life time
First onset of mental illness is usually in their twenties
Large treatment gap was found in help-seeking behaviour
(Subramaniam et al., 2012)


Introduction
Possible causes of acute depression
Problems with a persons genes
tends to run in families, can also occur in those with no family history of disease
Alcohol and drug abuse
Medical conditions such as hypothyroidism, certain types of cancer
Medications such as steroids
Loneliness
Lack of social support
Early childhood trauma or abuse
Can be triggered by stressful events in a persons life:
job loss
divorce/separation
physical or emotional abuse
Death or illness of a friend or family member

Introduction
Symptoms of acute depression
(Adults)

Fatigue, loss of energy almost everyday
Irritability or restlessness
Insomnia or hypersomnia almost everyday
Markedly diminished interest in almost all
activities nearly everyday
Recurring thoughts of death or suicide
Impaired concentration
Feelings of worthlessness almost everyday

(Children & Teenagers)

o Sadness*
o Becoming withdrawn
o Regressing in their school performance
o Fail to thrive
o Anxiety
o Irritability
o Frequent complains of physical problems
(headaches and stomach-aches)
o Persistent boredom
o Change in eating or sleeping patterns
Introduction
Treatment for acute depression
Cognitive behavioural therapy (CBT) (Cherry, 2014)
type of psychotherapeutic treatment that helps patients understand the thoughts
and feelings that influence behaviours.
Interpersonal therapy (Interpersonal Therapy for Depression, n.d.)
Short term and limit focus treatment.
Psychodynamic therapy*** (Psychodynamic Therapy | Psych Central, n.d.)
insight-oriented therapy, focuses on unconscious processes as they are manifested
in a persons present behaviour.
Relaxation techniques
blended approach of the above methods is used
Introduction
Treatment of acute depression
In most cases, the best approach is the combination of:
social support ~ family and friends
lifestyle changes ~ activities in a group
emotional skills building ~ make them feel stronger

The aim of therapy is to teach practical techniques on how to reframe negative thinking and
employ behavioural skills in combating depression.
It helps the client understand why they feel a certain way, what triggers their depression and
what they can do to stay healthy.
(Depression,2014)
Impacts on Family Life
Irritability that sets off conflicts and derails family dynamics
Capacity to participate in household or child-rearing responsibilities, engaged in share
positive interactions and family support can be diminished
If depressed individual is the principal income earner, family may experience financial
strain due to lost time from work as well as cost of mental health care
Families feel guilt, fear, frustration arising from speculation that they contribute to the
development of depression
Families feel isolated
Contribute to elevated health and psychological problems in other family members
(Hara, 2011)
Impacts on Physical Aspect
Increased aches and pain(occurs in 2 out of 3 with MDD)
Chronic fatigue
Decreased interest in sex
Decreased appetite
Insomnia/over-sleeping
Depression increases risk of physical illness

(WebMD, 2014)
Impacts on Psychological Aspect
Feeling sad, empty, hopeless or numb
Loss of interest in things you used to enjoy
Irritability or anxiety
Trouble making decisions
Feeling guilty or worthless
Thoughts of death and suicide
Impacts on Social Aspect


People started to feel pessimistic and hopeless about their
changing.

Decreased in self esteem and self confidence.

Get less joy out of things and lose interest in their hobbies

Started to have negative thoughts.

Contd...






Feel isolated and separated from everything and every one.

Their self esteem will further damage if gain weight.

Feels of guilt when anything happened to them.













Impacts on ADL
Trouble working or concentrating on tasks such as decision
making, doing housework.

Decreased abilities to feed themselves(Loss of appetite)

Impaired ability to care for self-showering , hygiene, unable
to do laundry, wash dishes.

Impacts on Employment/Career
Advancement/Study
MDD negatively impacts those who are currently employed
Increases risk for job loss
Elevated rates of absenteeism among depressed employees due to
fatigue/insomnia/hypersomnia
Prone to detriments in time management tasks and overall job performance due to
indecisiveness
Impairments in cognitive functioning and declined productivity (unable to concentrate)
Decrease career advancement
Easily confused by other people comment, got easily cheated with other company
making poor judgment in office, poor recognition from supervisor
Poor performance in school
feeling lethargy and unable to focus during lesson
occupied mind with negative thoughts thus not being able to content school teaching
Nursing Intervention for Acute Depression
Intervention: Rationale:
1) Closely monitor patients mood, behavior and
signs of isolation regularly.
It can enable the palliative nurse to assess
whether the patient is at risk of developing self
injuring behavior and intervene promptly.
2) Prevent suicide by helping him feel that life is
worth living.

Make yourself available for him to confide and
listen for cues of suicidal tendencies. Explain to
him that a person having suicidal thoughts is not
a bad person instead it is just part of the illness.

3) Build a trusting relationship with patient using
empathic communication approach and
manner
Building rapport and trust with patient allows
patient to express his/her feelings so that the
palliative nurse is bale to address to patients
concern effectively.
4) Encourage family and social support to
patient such as encourage patient to
participate in support group activities.
Family and social support are essential for
patient to know that she/he is not alone.
Nursing Intervention for Acute Depression
Intervention: Rationale:
5) Appraise his strengths and recognize an activity
accomplished
This way you could help him improve his feelings
about himself
6) Place a fall risk wrist tag on patient. To alert
other nurses.
Patient is taking anti-anxiety and anti-depressants
and has diminished mental status.
7) Encourage patient to drink plenty of water. To prevent constipation due to changes in usual
eating pattern and use of pharmacological
agents
8) Ask family members to bring home food. Patient may prefer home food. Thus, this may
increase the intake of food
Summary
Depression is different from normal sadness in that it engulfs your day-to-day life
and interferes with your ability to work, study, eat, sleep and have fun. The
feelings of helplessness, hopelessness and worthlessness are intense and
unrelenting.
Therefore, Acute Depression affects the quality of lives.
As a nurse, you should provide emotional support, by lending a listening ear.
If you suspect anyone of having acute depression, encourage them to seek
professional help.
Q&A
What are the 3 symptoms of Acute Depression in
Adults ?

ANSWER:
1. What are the 3 symptoms of Acute Depression in Adults ?

Fatigue, loss of energy almost everyday
Irritability or restlessness
Insomnia or hypersomnia almost everyday
Markedly diminished interest in almost all activities nearly everyday
Recurring thoughts of death or suicide
Impaired concentration
Feelings of worthlessness almost everyday






Q&A
What are the 3 possible causes of Acute Depression ?

ANSWER:


What are the 3 possible causes of Acute Depression ?
Problems with a persons genes
Alcohol and drug abuse
Medical conditions such as hypothyroidism, certain types of cancer
Medications such as steroids
Loneliness
Lack of social support
Early childhood trauma or abuse
Can be triggered by stressful events in a persons life eg. Job loss, divorce, death or
illneses of a friend or family member

References
Cherry, K. (2014). What Is Cognitive Behavior Therapy. Retrieved
from:http://psychology.about.com/od/psychotherapy/a/cbt.htm
Grohol, J. M. (2013). Psychodynamic Therapy. Retrieved from:
http://psychcentral.com/lib/psychodynamic-therapy/000119
Healthline Networks, Inc. (2014). Major Depressive Disorder (Clinical Depression). Retrieved from:
http://www.healthline.com/health/clinical-depression
Kazama, M., Kondo, N., Suzuki, K., Minai, J., Imai, H., & Yamagata, Z. (2011). Early impact of
depression symptoms on the decline in activities of daily living among older Japanese: Y-HALE
cohort study. Environmental Health and Preventive Medicine, 16(3), 196201. doi:10.1007/s12199-
010-0186-6
MacLeod, C. (2014). When Depression Is A Factor In Your Loneliness And Social Problems. Retrieved
from: http://www.succeedsocially.com/depression







References
Mort, J. R. (2004). Depression and Activities of Daily Living. Retrieved from:
http://www.sdfmc.org/classlibrary/page/information/datainstances/159/files/623/depression_a
nd_activities_of_daily_living.pdf
Subramaniam, M., Vaingankar, J., Heng, D., Kwok, K. W., Lim, Y. W., Yap, M., & Chong, S. A.
(2012). The Singapore Mental Health Study: an overview of the methodology. International
Journal of Methods in Psychiatric Research, 21(2), 149157.
Think Psychological Services. (2014). Depression. Retrieved from: http://think-psych.com/adult-
psychological-counselling-services/psychotherapy-
counselling/depression/?gclid=COHl8Y_w078CFU0mjgodSrMAVA
WebMd, LLC. (2014). Depression Health Center. Retrieved from:
http://www.webmd.com/depression/guide/interpersonal-therapy-for-depression
WebMd, LLC. (2014). Major Depression (Clinical Depression). Retrieved from:
http://www.webmd.com/depression/guide/major-depression



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