Chapter 25: Depressive Disorders

Depressive Disorders details the various classifications recognized by the DSM-5, including Major Depressive Disorder, Persistent Depressive Disorder (Dysthymia), Disruptive Mood Dysregulation Disorder in younger populations, and Premenstrual Dysphoric Disorder. The text moves from clinical definitions to the multifaceted causes of these conditions, blending biologic theories like monoamine dysregulation (involving serotonin, norepinephrine, and dopamine) and endocrine system malfunctions of the HPA axis with psychological frameworks such as cognitive distortions, interpersonal conflicts, and learned helplessness. Students will learn to distinguish between objective signs of depression, such as psychomotor agitation or social withdrawal, and subjective symptoms like worthlessness, somatic physical pains, and altered perceptions. Special attention is given to vulnerable populations, including children, where irritability may mask depression, and older adults, where symptoms may be confused with dementia or medical illness. The nursing role is central to the psychotherapeutic management of depression, focusing on the nurse-patient relationship to rebuild self-esteem and trust. The chapter provides specific guidance on milieu management, addressing practical needs like nutritional intake for anorectic patients and sleep hygiene for those with insomnia. It covers the essential pharmacology of antidepressants, highlighting the differences between SSRIs, TCAs, and MAOIs, while emphasizing the nurse's responsibility in monitoring for side effects and suicidal ideation. A major portion of the chapter is dedicated to somatic therapies, particularly modern Electroconvulsive Therapy (ECT), debunking historical stigmas and explaining its role as a safe, effective treatment for treatment-resistant cases. Other interventions like Vagus Nerve Stimulation, Bright Light Therapy for seasonal affective patterns, and Transcranial Magnetic Stimulation are also explored. Finally, the text provides a rigorous framework for suicide risk assessment, teaching students to evaluate the lethality of a patient’s plan, method, and potential for rescue to ensure safety and effective intervention.