Acute depression: treatment and nursing strategies for this affective disorder

Depression is a major affective disorder characterized by feelings of loss, worthlessness, fatigue, and a general decrease in interest in the usual activities of daily living. This complex disorder is the most common mental health problem in the United States, more common in women, adults over 60 years of age, and those of lower socioeconomic status. According to the DSM III, the major subclassifications related to depression are major depression and bipolar disorder. An integrated causation theory is useful in describing the etiology of this disorder. Generally, signs and symptoms involve changes in affect, cognition, behavior, and physical functioning. Depression may be treated with antidepressant psychotropic medications (tricyclics and MAO inhibitors), lithium carbonate (for bipolar disorder), electroconvulsive therapy, and a variety of psychotherapies. Careful monitoring of the drugs via blood level values must be ongoing. Nursing care of hospitalized depressed persons involves careful monitoring of clients' status and the effectiveness of treatments. Nursing care focuses on three areas of need. Immediate needs are those related to critical and safety issues. Short-term needs are concerned with identifying and reducing or eliminating obvious problem areas which hamper return to community living. Long-term needs are issues related to maintenance of persons in the least depressive state for as long as possible. To provide a sound basis for planning and implementing such care, nurses must understand the dynamics of depression, the issues which dictate selected treatment methods, and the issues which are likely to shape and change the treatment of depression in the future. Nursing must accept the responsibility of acting in a responsible, professional manner to ensure the best possible treatment for clients within the restraints imposed by policy decisions.