Major Depressive Disorders: Symptoms and Risk Factors (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:00 So each time we are talking to our patients, we really want to make sure that we find out how they feel.

    00:08 And people really do confide in us.

    00:12 People are not afraid to tell us that, "Oh, I can't get out of bed in the morning.

    00:20 It's really hard, I used to be able to get up and get dressed and get to work.

    00:26 And now my alarm goes off.

    00:29 And all I can think of is I just can't do this", that kind of negative self talk.

    00:36 Unbelievable changes where they are able to tell you, "This is not the way I am, this is not who I used to be." You also will see that they have decreased interest.

    00:49 So what other things do you like to do? "I don't know, I used to like to do this, but I'm not doing that anymore.

    00:56 I used to take long walks with my dog but I just don't have that energy." And then, when you get closer into how they feel about themselves, they might be able to say to you, "You know, I used to be a really good mom.

    01:12 But lately, I can't even get up and make dinner for my kids.

    01:16 I feel so guilty about that.

    01:18 I'm so ashamed of myself." Guilt and shame come as part and parcel of this depressive disorder.

    01:27 Because remember, this individual is going through an emotional, physical and mental change, that they are not able to change, they are not able to stop.

    01:40 It is not within their capacity.

    01:43 You know, oftentimes we hear people say, "Oh, you have to snap out of it, get over it." If a person has a depressive disorder, there is no snapping, there is no getting over it.

    01:55 So their drop in energy, this kind of lead feeling like they can't move their legs, they can't get on a treadmill.

    02:06 It's not that they don't want to.

    02:08 I've had clients who actually I have said to them, just try to get up and walk to the door and come back and use your step counter to show you how many steps you've walked.

    02:22 And just be really proud of having walked those many steps.

    02:27 You have a disorder.

    02:29 And this disorder takes away your energy.

    02:32 It's not you, it is the disorder, and we can treat that disorder.

    02:38 If they tell you they can't concentrate anymore, they are completely foggy, you can let them know, when we are getting help, when a person is able to take the medications and get the therapy, that lack of concentration will start to lift a bit.

    02:58 Now if there's somebody who they say, well, I've never been able to concentrate, that lack of concentration is probably just amplified by this depression, it is never going to go away.

    03:10 And we don't make promises that we can't keep.

    03:13 We don't say, "Oh, you're going to be just fine." We say, "You know what, let's try this." Let's see how it feels. Let's take one small step after another and move from depression into a more stable and positive attitude.

    03:34 So the person might also have a change in appetite.

    03:38 And that might be that they've gained a lot of weight because all they want to do is eat or that they've lost a lot of weight because in truth, they cannot get out of bed.

    03:49 They sleep all the time, we call it hypersomnolence.

    03:54 So if that person is sleeping all the time, and they're not eating, what happens to our body? Remember, a psychiatric diagnosis, a person who is got a psychiatric disorder, it doesn't just affect one part of their body.

    04:11 It is their physical health, it is their emotional health and it is their mental health.

    04:18 And when we're not fueling our body, when we can't eat, we end up being even more tired.

    04:26 So we have to help them understand that maybe for a little while, they have to be in a hospital.

    04:33 We're going to take care of that for them until they start getting their strength back.

    04:39 That because they have no strength, they might have something that we call psychomotor retardation, where you find that every movement they make is really slow.

    04:52 You can't hurry them, you can't rush them.

    04:56 If they see something coming towards them, they might really just be moving so slowly.

    05:04 Can you imagine how this might affect someone who is driving a car? Let us think about for one minute, this person has lost interest in where they're going.

    05:18 They feel guilty and worried about the way they've treating their family and the people they love.

    05:24 They're in their car, they have no energy, they're driving to work, it's really hard to concentrate, they haven't eaten any breakfast.

    05:35 And now, there's somebody who suddenly runs in front of their car and they have this slow response.

    05:44 And then...

    05:47 they're not going to hit the person, they're going to be able to stop just in time.

    05:51 But what does that do to their entire body? Depressive disorders affect our whole system.

    06:00 And we have to be able to notice when a person needs our help.

    06:06 Because once they get to a place where it doesn't seem like there's any help, there's no way for them to do any good, that they are a burden to everyone, we have to worry about suicide.

    06:21 And when we think that this person might be contemplating killing themselves by suicide, and we no longer say commit suicide.

    06:31 Now we say you're going to kill yourself by suicide.

    06:35 And the reason is we don't want anyone to have a commitment, that's a positive word.

    06:40 Suicide is not positive.

    06:43 Suicide is a permanent solution to a temporary problem.

    06:47 And it's our responsibility to assess for suicide, and keep that person safe to focus on that person and their problem in this moment, and to evaluate what we've done before what they've done before, and how to move them out of that very critical thought of killing themselves.

    07:14 So let's think about a clinical picture.

    07:18 When we are thinking of somebody who might have a depressive disorder, we really want to think back and determine what might biologically predispose them for this.

    07:33 And that might be a genetic predisposition.

    07:36 We might say to them, "Has anyone in your family ever felt this way?" And they might say, "Oh, my mother never got out of bed.

    07:43 My father had to do everything.

    07:45 My mother cried all of the time.

    07:48 And my grandmother, she also took her life when she was in her 50's." We automatically want to think, "That's something." If they say my mother was very depressed for a long time, I think she was on something called Lexapro.

    08:08 We want to think about that.

    08:10 Because if Lexapro worked for mom, chances are it's going to work for this person in front of us.

    08:17 We want to think about their early childhood experiences.

    08:21 ACES's or having a childhood experience that is adverse, adverse childhood experience, that puts a person in early life into a category of being at high risk for mental illness.

    08:38 And depression is one of those diagnoses, that if a child has a stressful early life, depression, and that feeling of I can't do anything that powerless, hopeless sensation might become not something that they think they're going through, but really something that they have no control over and that will never leave.

    09:02 Remember what I was saying that when a person has depression, they are in capable of knowing that tomorrow might be better.

    09:14 It is not within their lexicon, they can't imagine.

    09:18 And that is why suicide becomes their alternative.

    09:22 We have to be able to intervene at that point and start working them step by step, small steps to get them back to believing in themselves and in life.

    09:34 Traumatic events also are very high risk factors.

    09:38 And so we want to be able to identify if this depression is existing on its own or if it is something that has come from a traumatic event.

    About the Lecture

    The lecture Major Depressive Disorders: Symptoms and Risk Factors (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Mood Disorders: Major Depressive and Bipolar Disorders (Nursing).

    Included Quiz Questions

    1. “I always used to be an early riser, but now I’m finding it really difficult to get out of bed in the morning.”
    2. “I quit the soccer league I was the captain of, I’m just not enjoying it anymore.”
    3. “I tried singing lessons, but I didn’t enjoy it. I signed up for guitar lessons instead, and I’m really excited to try it!”
    4. “I’m getting less sleep during the night because of my back pain, but after a nap in the afternoon I feel refreshed.”
    1. “Once you start taking the antidepressants, you’ll go back to your old self in no time.”
    2. “Depression usually increases your ability to concentrate.”
    3. “The lack of energy you’re experiencing is a common symptom of depression.”
    4. “People associate lack of appetite with depression, but a lot of people with major depressive disorder experience an increase in appetite.”
    1. “We say that someone ‘killed themselves by suicide’ instead of ‘committed suicide’, as the word ‘committed’ has positive connotations.”
    2. “We say that someone ‘killed themselves by suicide’ instead of ‘committed suicide’, to incorporate person-first language as recommended by the Diagnostic and Statistical Manual of Mental Disorders.”
    3. “We say that someone ‘committed suicide’ instead of ‘killed themselves by suicide’, to avoid the negative connotations of the word ‘killed’."
    4. “We say that someone ‘committed suicide’ instead of ‘killed themselves by suicide’, to recognize that the individual was experiencing a mental illness and was therefore making a decision they wouldn’t usually make.”
    1. The client who has a mother diagnosed with MDD
    2. The client who has no relatives with MDD, and witnessed the death of both their parents at the age of five
    3. The client who had cancer as a child and was in and out of the hospital for most of their childhood
    4. The client who has a family history of hypertension
    1. “I just don’t see the purpose of being here anymore.”
    2. “At this point, I don’t really think anyone can help me.”
    3. “I am finally starting to look forward to things in my life again.”
    4. “I was feeling pretty hopeless before, but since starting therapy I’m starting to feel more like myself.”

    Author of lecture Major Depressive Disorders: Symptoms and Risk Factors (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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