Depression could be defined as a mental disorder marked by a long-lasting foul mood. Nowadays, this illness, as well as numerous other mental disorders, is romanticized. Furthermore, according to Gilbert (2016), many specialists label depression as “the common cold of psychopathology” (p. 3). Nonetheless, it is a great mistake to underestimate the seriousness of this mental disturbance because it leads to severe consequences, including suicide. There are several types of depression: major depressive disorder, persistent depressive disorder, psychotic depression, peripartum and postpartum depression, to name but a few. The present paper analyzes major depressive disorder, describes its clinical picture, epidemiology, comorbidities, statistics, and treatment, and proposes three nursing interventions.
Major depressive disorder (MDD) is one of the most widespread types of depression. MDD is marked by alteration in the hippocampus and the salience and cognitive control networks (Otte et al., 2016). It has such symptoms as “depressed mood, diminished interests, impaired cognitive function and vegetative symptoms, such as disturbed sleep or appetite” (Otte et al., 2016, p. 1). The critical point is that these symptoms, especially low mood or loss of pleasure, should last for more than two weeks. The advanced cases of depression are characterized by the tendency to suicidal thoughts and self-injury. People who suffer from MDD might also have such symptoms as overwhelming tiredness, short attention span, low self-esteem, and excessive irritation. The problem with these features of MDD is that most people regard them as personality traits or merely fatigue but not as signs of a mental disorder that should be treated.
According to the data provided by the World Health Organization (WHO) (2020), almost 265 million people all over the world are suffering from depression. In the US, nearly 19 percent of the population experience mild to severe symptoms of depression (Villarroel and Terlizzi, 2020). Furthermore, numerous studies note that women are two times more likely to experience this problem in comparison with men (McKeever, Agius, and Mohr, 2017; WHO, 2020). The COVID-19 pandemic turned in a three-fold increase in the number of people who experience symptoms of depression (Ettman et al., 2020). The reason for such a sharp rise lies in forced self-isolation, loss of work, uncertainty about the future, and a constant threat to health. Overall, the major risk factors for the development of MDD are excessive and regular stress, substance use, and poor nutrition. Other causes of this disorder include genetics and personal circumstances such as, for example, the death of a loved one or divorce.
A significant share of patients diagnosed with MDD suffers from other mental disorders. The study conducted by Huang et al. (2019) reveals that 41.6 percent of individuals with MDD experience anxiety disorders. These comorbid anxiety disorders are explained by the severe symptoms of depression and the patient’s resistance to treatment (Huang et al., 2019). The group of anxiety disorders includes phobias, panic disorder, post-traumatic stress disorder, and obsessive-compulsive disorder. In addition to that, MDDs concomitant pathologies include substance abuse, eating disorders, and psychotic disorder. Apart from mental disorders, MDDs comorbidities are cardiovascular disease and immuno-inflammatory dysregulations (Penninx, 2017). From the written above, it could be inferred that depression is a severe illness that threatens both the psychological and physical well-being of a patient.
Test and Diagnosis
Psychiatrists use several methods to test a patient for MDD. Firstly, a doctor will ask a patient if there are any noticeable changes in the mood. Secondly, a specialist will conduct a physical exam. Even though MDD is a mental disorder, it is accompanied by some physical health disturbances. For instance, a test for endocrine disorders such as hypothyroidism should be conducted. In addition to that, a doctor should check if a patient had head trauma, stroke, sclerosis, or cancer. Thirdly, it is necessary to conduct blood tests to check the function of the kidneys and liver because these two organs are responsible for eliminating the drug from the body and, hence, for the quality and efficiency of the prescribed treatment.
A wide range of factors, including genetic mutations, might lead to the development of MDD. However, even though there are studies that prove that genetic factors are related to the onset of MDD, some replication studies debunk these findings (Shadrina, Bondarenko, and Slominsky, 2018). Still, MDD is commonly associated with mutations of such genes as SLC6A4, SLC6A3, DRD4, MAOA, and HTR1A (Shadrina et al., 2018). Additionally, homoplasmic mutations “in the ATP synthase 8 (ATP8), ATP synthase 6 (ATP6), ND5 and cytochrome b (CYTB) genes” are also regarded as factors leading to depression disorder (Shadrina et al., 2018, p. 13). Overall, the role of genetics in the onset of MDD remains understudied and requires further investigation.
Statistical Data and Prevalence Among Children and Adults
As it has been noted above, almost 19 percent of American adults are diagnosed with MDD (Villarroel and Terlizzi, 2020). Furthermore, women are nearly two times more likely to become depressed in comparison with men (Villarroel and Terlizzi, 2020). The study on symptoms of depression among American adults reveals that 13.5 percent of women and less than 10 percent of men experience mild symptoms of MDD; moderate symptoms are experienced by 4.9 percent of women and 3.4 percent of men, and 3.5 percent of women, and 2.1 percent of men suffer from severe symptoms (Villarroel and Terlizzi, 2020). According to the survey by Ghandour et al. (2019), 3.2 percent of children aged from 3 to 17 years have depression. Nevertheless, a more significant percentage of children of the same age suffer from anxiety problems (7.1%) and behavioral problems (7.4%) (Villarroel and Terlizzi, 2020). What is more important, the number of children, adolescents, and adults who experience symptoms of MDD is steadily increasing.
The most effective way to treat MDD is to combine medications and psychotherapy. Medicines that are known as antidepressants are needed to normalize the blood level of serotonin. Psychotherapy, in its turn, enables a patient to discuss all the worries and life troubles with a specialist who could suggest effective ways to cope with them. Psychotherapy helps patients improve self-esteem, replace a negative cognitive attitude with a positive one, regain control over personal life, and develop new behavioral patterns that will help avoid relapse. In mild cases, MDD might be treated with the use of psychotherapy only.
Firstly, a nurse caring for a patient with MDD should estimate how high the risk is that a person will commit suicide. When the risk of suicide is high, patients must be hospitalized because the MDD makes them dangerous for themselves. To understand whether a person is prone to commit suicide or not, a nurse should encourage a patient to express his or her thoughts and fears. A conversation will make a nurse know if a patient has already attempted to end the life or developed a suicide plan, has nobody to talk to, or abuses drugs or alcohol.
Another possible nursing intervention is to discuss a treatment plan with a patient. A nurse should explain what is going on with a patient, what depression is, why it occurred and how medications and psychotherapy will improve the quality of life. What is more, a nurse should establish trustful relationships with a patient because it is a way to encourage him or her not to give up taking prescribed medications and attend psychotherapy sessions.
Finally, a nurse should inform a patient of the possible side effects of the medications and clearly explain the importance of medication compliance. A patient needs to be aware of what to do in case of the manifestation of adverse effects. Overall, apart from the conduction of physical tests, the main task of nurses in dealing with MDD patients is to be good communicators and listeners.
Drugs Used to Treat MDD
One of the most well-known drugs used to treat MDD is Prozac. Prozacs generic name is fluoxetine, which is one of the selective serotonin reuptake inhibitors. Adults are commonly recommended to take 20 mg of this drug a day. Children and adolescents have usually prescribed 10 or 20 mg of Prozac once a day. In some cases, the daily dose of Prozac could be higher, but it should not be more than 80 mg/day. The overdosage with fluoxetine might lead to death, and in case of overdosage, a patient should be hospitalized. Prozac causes such side effects as headaches, nausea, insomnia, allergy, altered appetite, and seizures.
Another drug that could be prescribed for the treatment of MDD is Norpramin. The generic name of this drug is desipramine. Norpramin should not be taken by children; adolescents could take from 25 mg to 100 mg; the recommended daily dose for adults is from 100 mg to 200 mg. The daily dose of desipramine should not exceed 300 mg. Norpramins side effects include hypo- and hypertension, hallucinations, disorientation, panic attacks, numbness, seizures, and even stroke.
Ettman, C. K., Abdalla, S. M., Cohen, G. H., Sampson, L., Vivier, P. M., & Galea, S. (2020). Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA network open, 3(9), 1-12.
Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., & Blumberg, S. J. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in US children. The Journal of pediatrics, 206, 256-267.
Gilbert, P. (2016). Depression: The evolution of powerlessness. Routledge.
Huang, Y. C., Lee, Y., Lin, P. Y., Hung, C. F., Lee, C. Y., & Wang, L. J. (2019). Anxiety comorbidities in patients with major depressive disorder: the role of attachment. International journal of psychiatry in clinical practice, 23(4), 286-292.
McKeever, A., Agius, M., & Mohr, P. (2017). A review of the epidemiology of major depressive disorder and of its consequences for society and the individual. Psychiatr. Danub, 29, 222-231.
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M.,… & Schatzberg, A. F. (2016). Major depressive disorder. Nature reviews Disease primers, 2(1), 1-20.
Penninx, B. W. (2017). Depression and cardiovascular disease: epidemiological evidence on their linking mechanisms. Neuroscience & Biobehavioral Reviews, 74, 277-286.
Shadrina, M., Bondarenko, E. A., & Slominsky, P. A. (2018). Genetics factors in major depression disease. Frontiers in psychiatry, 9, 1-18.
Villarroel, M.A. and Terlizzi, E. P. (2020). Symptoms of Depression Among Adults: the United States, 2019. NCHS Data Brief, 379, 1-8.
World Health Organization (2020). Depression.