Depression, medically referred to as Major Depressive Disorder (MDD) or clinical depression, is one of the most prevalent and disabling mental health conditions worldwide. It is characterized by a persistently low mood, loss of interest in daily activities, feelings of hopelessness, fatigue, and impaired concentration. In psychiatric care, depression is not just viewed as sadness but as a complex disorder influenced by biological, psychological, and social factors.
The World Health Organization (WHO) estimates that depression affects over 280 million people globally, making it a leading cause of disability. Without treatment, it can severely impact relationships, work, education, and physical health, and in severe cases, lead to suicide.
This article explores depression through the lens of psychiatric care, highlighting pathophysiology, risk factors, signs and symptoms, diagnosis, pediatric considerations, and treatment approaches.
Pathophysiology of Depression
The pathophysiology of depression revolves around neurotransmitter imbalances in the brain. Individuals with MDD often show:
- Low Serotonin: Impacts mood regulation, sleep, and appetite.
- Low Dopamine: Reduces motivation, pleasure, and reward sensitivity.
- Low Norepinephrine: Contributes to fatigue, lack of focus, and low energy.
In simple terms, depression can be described as a state where everything is “low and slow”: mood, energy, and motivation.
Risk Factors for Depression
Several biological, psychological, and social risk factors contribute to depression.
- Stressful Life Events – Divorce, job loss, bereavement.
- Chronic Illness – Diabetes, cancer, cardiovascular disease.
- Genetics – Family history of depression or bipolar disorder.
- Gender (Female) – Women are twice as likely as men to experience depression.
- Substance Abuse Disorders – Alcohol or drug misuse can trigger or worsen depression.
Example in Clinical Care:
A nurse may encounter a patient who has recently become unemployed and reports feeling depressed. This highlights that unemployment is a significant potential stressor for depression.
Signs and Symptoms of Depression
To be diagnosed with Major Depressive Disorder (MDD), a person must experience five or more symptoms for at least two weeks, with at least one symptom being either depressed mood or loss of interest/pleasure (anhedonia).
Diagnostic Symptoms:
- Depressed Mood (feeling hopeless, empty).
- Anhedonia (loss of interest in previously enjoyable activities).
- Weight Loss or Gain (anorexia or overeating).
- Psychomotor Retardation (slower speech, decreased movement, delayed response).
- Insomnia or Hypersomnia (difficulty sleeping or oversleeping).
- Fatigue/Anergia (low energy).
- Feelings of Worthlessness or Guilt.
- Difficulty Concentrating.
- Suicidal Thoughts (Recurrent).
Side Note: Pediatric Depression
Adolescents (ages 10–19) often present depression differently compared to adults:
- Angry outbursts or aggression.
- Vandalism, skipping classes, withdrawal.
- Sudden weight loss or gain.
- Low self-esteem and social isolation.
For example, a 17-year-old who suddenly loses 15 pounds in 4 weeks without a medical cause should be screened for depression.
Neurotransmitters and Depression
Depression is strongly linked to dysregulation of neurotransmitters, often referred to as the chemical messengers of the brain.
| Neurotransmitter | Role in Mental Health | Effect When Low |
|---|---|---|
| Serotonin | Regulates mood, sleep, appetite | Sadness, insomnia, appetite changes |
| Dopamine | Controls motivation, reward, pleasure | Lack of interest, anhedonia, low motivation |
| Norepinephrine | Affects energy, alertness, stress response | Fatigue, poor concentration, low energy |
This biochemical imbalance explains why antidepressants target serotonin, dopamine, and norepinephrine pathways.
Diagnosis of Depression
Diagnosis of MDD is primarily clinical, based on history and symptoms, often using standardized criteria such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition).
A person must meet:
- At least 5 of the 9 listed symptoms,
- Symptoms must persist for ≥2 weeks,
- Symptoms must cause significant distress or impairment in functioning.
Management and Treatment of Depression
Effective depression management requires a comprehensive, multidisciplinary approach that includes psychotherapy, pharmacological treatment, and lifestyle modifications.
1. Psychotherapy
- Cognitive Behavioral Therapy (CBT): Helps patients identify and change negative thought patterns.
- Interpersonal Therapy (IPT): Focuses on relationship issues and grief processing.
- Group Therapy: Provides peer support and reduces isolation.
2. Pharmacotherapy
- SSRIs (Selective Serotonin Reuptake Inhibitors): Fluoxetine, Sertraline.
- SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): Venlafaxine, Duloxetine.
- Atypical Antidepressants: Bupropion (dopamine reuptake inhibitor).
- TCAs and MAOIs: Used in resistant cases, but with higher side effects.
3. Lifestyle and Holistic Approaches
- Regular physical activity.
- Adequate sleep hygiene.
- Mindfulness and meditation.
- Avoiding alcohol and drugs.
- Support from family and community.
Nursing Considerations in Depression
Nurses play a vital role in identifying, assessing, and supporting patients with depression.
- Encourage patients to verbalize feelings.
- Monitor for suicidal ideation and ensure safety protocols.
- Provide structured daily activities to reduce hopelessness.
- Educate families about symptoms and support strategies.
- Use therapeutic communication: Listen empathetically and avoid judgment.
Quick Reference Table: Depression in Mental Health
| Aspect | Key Points |
|---|---|
| Pathophysiology | Low serotonin, dopamine, norepinephrine |
| Risk Factors | Stressful events, chronic illness, genetics, female gender, substance abuse |
| Core Symptoms | Depressed mood, anhedonia, weight changes, psychomotor retardation, insomnia, suicidal thoughts |
| Pediatric Presentation | Anger, aggression, withdrawal, weight loss, low self-esteem |
| Diagnosis | 5/9 symptoms, ≥2 weeks duration |
| Treatment | Psychotherapy, antidepressants (SSRIs/SNRIs), lifestyle changes |
FAQs on Depression
Q1: Is depression just sadness?
No. Depression is a clinical disorder involving biochemical changes, impaired functioning, and persistent symptoms far beyond ordinary sadness.
Q2: Can depression run in families?
Yes. Genetics play a role, and individuals with a family history of depression are at higher risk.
Q3: How is pediatric depression different from adult depression?
Children often show irritability, aggression, and behavioral problems rather than classic sadness.
Q4: Can depression be cured?
While some people achieve full remission, others may experience recurrent episodes. Long-term management focuses on preventing relapse.
Q5: What should nurses do first when a patient reports suicidal thoughts?
Ensure immediate safety, remove harmful objects, and notify the psychiatric care team.
