postnatal depression


depression

(de-presh'on) [L. depressio, a pressing down] 1. A hollow or lowered region. 2. The lowering of a part, such as the mandible.3. The decrease of a vital function such as respiration.4. Any of several mood disorders marked by loss of interest or pleasure in living. Disorders linked to depression include dysthymia, major depressive disorder, schizoaffective disorders, bipolar disorders, seasonal affective disorders, postpartum depressive disorders, and mood disorders caused by substance abuse or other medical conditions. Medical and psychiatric conditions that can trigger or exacerbate depression include anxiety disorders, autoimmune diseases, chronic pain, eating disorders, endocrine disorders, heart attack, infectious diseases, neurologic disorders (stroke), sleep disorders, substance abuse, and drugs (e.g., some beta blockers, calcium channel blockers, steroids, hormones, chemotherapeutic agents, appetite suppressants, and sedatives). The U.S. Preventive Services Task Force recommends screening for depression in primary care settings. Formal screening tools may be used (e.g., the Beck Depression Inventory, Hamilton Rating Scale for depression, and Geriatric Depression Scale). A simple means of screening for depression is to ask patients: (1) Over the past two weeks have you felt down, depressed, or hopeless? (2) Over the past two weeks have you felt little interest or pleasure in doing things?

Depressive disorders are common: about 20% of women and about 10% of men may suffer from major depression at some point during their lives. Worldwide, depression is considered to be the fourth most serious illness as far as the overall burden it imposes on people's health. Depressed patients have more medical illnesses and a higher risk of self-injury and suicide than patients without mood disorders.

Symptoms

Characteristic symptoms of the depressive disorders include persistent sadness, hopelessness, or tearfulness; loss of energy or persistent fatigue; persistent feelings of guilt or self-criticism; a sense of worthlessness; irritability; inability to concentrate; decreased interest in daily activities; changes in appetite or body weight; insomnia or excessive sleep; and recurrent thoughts of death or suicide. These symptoms cause pervasive deficits in social functioning.

Treatment

Psychotherapies, behavioral therapies, electroconvulsive therapy (ECT, shock therapy), and psychoactive drugs are effective in the treatment of depressive disorders.

CAUTION!

Depressed people who express suicidal thoughts should not be left alone, esp. if hospitalized.

Patient care

The patient is assessed for feelings of worthlessness or self-reproach, inappropriate guilt, concern with death, and attempts at self-injury. Level of activity and socialization are evaluated. Adequate nutrition and fluids are provided. Dietary interventions and increased physical activity are recommended to manage drug-induced constipation; assistance with grooming and other activities of daily living may be required. A structured routine, including noncompetitive activities, is provided to build the patient's self-confidence and to encourage interaction. Health care professionals should express warmth and interest in the patient and be optimistic while guarding against excessive cheerfulness. Support is gradually reduced as the patient demonstrates an increasing ability to resume self-care. Drug therapies are administered and evaluated: these may include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine and serotonin reuptake inhibitors, dopamine-norepinephrine reuptake inhibitors, and norepinephrine-serotonin modulators. Monamine oxidase (MAO) inhibitors also may be used, but these have a high risk for toxicity unless necessary dietary restrictions are strictly followed. These drugs may be used alone or in combination with specific psychotherapeutic approaches such as cognitive behavioral therapy (CBT) or brief psychosocial counseling. CBT helps patients understand how their thoughts can become distorted and contribute to depression and anxiety and helps them learn coping behaviors that reduce feelings of anxiety, distress, and helplessness caused by distorted thinking.

If ECT is required (usually for patients who haven’t responded well to drug therapy or for whom drugs pose a risk), the patient is informed that a series of treatments may be needed. Before each ECT session, the prescribed sedative is administered, and a nasal or oral airway inserted. Vital signs are monitored, and support is offered by talking calmly or by gentle touch. After ECT, mental status and response to therapy are evaluated. The patient may be drowsy and experience transient amnesia but should become alert and oriented within 30 min. The period of disorientation lengthens after subsequent treatments. Synonym: unipolar depression

agitated depression

Depression accompanied by restlessness and increased psychomotor activity.

anaclitic depression

Depression in infants suddenly separated from their mothers between the first months and 1 year of age. The loss of the love, affection, and nurturing usually present in the mother-child relationship may cause severe disturbances in health and in motor, language, and social development or may occasionally lead to death. Symptoms first found in affected infants include crying, panicky behavior, and increased motor activity. Later, psychologically abandoned or neglected infants manifest dejection, apathy, staring into space, and silent crying. Recovery is possible if the mother or a surrogate is available to meet the infant's needs for parental support.

atypical depression

Abbreviation: AD
A form of depression in which overeating and oversleeping are commonly observed, often but not exclusively in association with leaden paralysis, extreme sensitivity to interpersonal rejection, and highly reactive moods. The condition typically has an earlier age of onset than typical depression, is more likely to affect women than men, and shares some features with bipolar disorder.

bipolar depression

See: bipolar disorder

double depression

An episode of major depression superimposed on dysthymic disorder.

endogenous depression

Depression that occurs without an apparent precipitating cause. See: melancholia

hidden depression

Masked depression.

major depression

A mood disorder characterized by a period of at least 2 weeks of depressed mood or the loss of interest or pleasure in nearly all activities.

Symptoms

In children and adolescents, the mood may be irritable rather than sad. Establishing the diagnosis requires the presence of at least four of the following: (1) changes in appetite, weight, sleep, and psychomotor activity; (2) decreased energy; (3) feelings of worthlessness or guilt; (4) difficulty in thinking, concentrating, or making decisions; or (5) recurrent thoughts of death or plans for or attempts to commit suicide.The symptoms must persist for most of the day, nearly every day, for at least 2 consecutive weeks. The episode must be accompanied by clinically significant distress or impairment in social, occupational, or other important areas of functioning. Also, the disorder must not be due to bereavement, drugs, alcohol, or the direct effects of a disease such as hypothyroidism.

 Synonym: major depressive episode mood disorder

masked depression

Depression in older adults that usually presents with physical symptoms or illness. Synonym: hidden depression; somatic depression

minor depression

A mood disorder lasting at least 2 weeks in which fewer symptoms of depression are present than in major depression (two to five symptoms as opposed to more than five).

postnatal depression

Postpartum depression.

postpartum depression

Abbreviation: PPD
Depression occurring up to 6 months after childbirth and not resolving in 1 or 2 weeks. The disease occurs in about 10% to 20% of women who have recently delivered.

Symptoms

Affected mothers typically report insomnia or hypersomnia, psychomotor agitation or retardation, changes in appetite, tearfulness, despondency, feelings of hopelessness, worthlessness or guilt, decreased concentration, suicidal ideation, inadequacy, inability to cope with infant care needs, mood swings, irritability, fatigue, and loss of normal interests or pleasure.

Diagnosis

Two screening tools are available for PPD in English-speaking patients: the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Depression Screening Scale (PDSS), both of which appear to be more sensitive in screening PPD than the more general Beck Depression Inventory.

Treatment

Drugs (e.g., tricyclic antidepressants and serotonin reuptake inhibitors), counseling, or electroconvulsive therapy are all effective therapies. PPD support groups are generally helpful to women. Online support networks include Postpartum Support International (www.postpartum.net) and Depression After Delivery (www.charityadvantage.com/depression afterdelivery/Home.asp). Carefully designed studies have shown that nursing care aids in the diagnosis, prevention, and treatment of this disorder.

Synonym: postnatal depression See: postpartum blues

post-stroke depression

A dysphoric mood disorder that follows a cerebral infarction, found in about a quarter of stroke patients. Although for many years depression after strokes was thought to occur mainly in patients who had injured the nondominant hemisphere of the brain, research has shown that this phenomenon is most common in female patients and those who have had higher education.

reactive depression

Depression that is usually self-limiting, following a serious event such as a death in the family, the loss of a job, or a personal financial catastrophe. The disorder is longer lasting and more marked than an expected reaction to the stress experienced.

respiratory depression

a decrease in the ability to exhale and inhale. It is a common side effect of anesthetic, narcotic, and sedative drugs. Synonym: reduced ventilation

somatic depression

Masked depression.

unipolar depression

Depression (4).

winter depression

Seasonal affective disorder.

postnatal depression

Depression affecting the mother after childbirth. This is common and may vary from a mild sadness to a severe psychotic depressive illness with strong suicidal and sometimes infanticidal tendencies. Antidepressant drugs may be necessary.