Major Depressive Disorder in Clinical Presentation

Introduction

Clinical depression, also called major, is a serious mental disorder with tremendous sociological and clinical importance. This condition affects millions of people around the world. The pathophysiology of depression has not been understood and defined clearly. However, the known psychopathological state involves different signs and symptoms. Depression is a heterogeneous disorder with different subtypes and multiple etiologies. This clinical presentation discusses the pathophysiology of major depressive disorder, including signs and symptoms, diagnostic testing and rationale, and evidence-based treatment modalities. The relevance of this information to a master’s prepared nurse will also be highlighted.

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Pathophysiology, Signs, and Symptoms

The current evidence on the pathophysiology of major depressive disorder points to a complex relationship between neurotransmitters, regulation of receptors, and sensitivity concerning the affective symptoms. Preclinical and clinical trials show that a disturbance of serotonin (5-HT) activity in the nervous system contributes significantly to depression. Other related transmitters associated with this condition include dopamine, norepinephrine, brain-derived neurotrophic factor, and glutamate (National Institute of Mental Health, 2018). In other cases, vascular lesions can cause depression due to the disruption that occurs to the neural networks of emotion regulation.

Brain structures also contribute to this condition. In most cases, people suffering from major depressive disorder appear normal. However, when the condition becomes severe, patients will show depressed and irritable moods, loss of interest in most activities (anhedonia), loss of appetite, insomnia or hypersomnia, psychomotor agitation or retardation, indecisiveness, feelings of worthlessness, fatigue, and increased suicidal thoughts (American Psychiatric Association, 2017).

Diagnostic Testing

The commonly used diagnostic tests for major depressive disorder are the Hamilton Depression Rating Scale (HDRS) and the Geriatric Depression Scale (GDS). These scales have different items with several scores. The rationale behind these tests is to determine the severity of the condition by evaluating the patients’ scores. Laboratory tests can also be conducted to establish the presence of different chemicals in the blood that could be causing the symptoms of depression (American Psychiatric Association, 2017). For instance, hypothyroidism is associated with depression.

Treatment

Treatment for major depressive disorder is done through medication or therapy. The commonly used drugs are called antidepressants, and they work to alleviate the symptoms. Antidepressants are divided into five major groups, including “serotonin and noradrenaline reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and noradrenaline and specific serotoninergic antidepressants (NASSAs)” (National Institute of Mental Health, 2018, para. 5). However, preferred medications are SSRIs and SNRIs.

SNRIs work by raising the levels of serotonin and norepinephrine to stabilize mood. On the other hand, SSRIs function by blocking the absorption or reuptake of serotonin in the brain. SSRIs are highly effective because they are selective in their function, and they only target serotonin, but not other neurotransmitters (Vuorilehto, Melartin, Riihimäki, & Isometsä, 2016). Psychotherapy is also used for the management of depression.

Some of the evidence-based psychotherapeutic interventions for depression among adults include behavioral therapy, cognitive therapy, self-management therapy, problem-solving therapy, interpersonal psychotherapy, and cognitive-behavioral analysis system of psychotherapy (American Psychiatric Association, 2017). Cognitive-behavioral therapy is commonly used in children and adolescents.

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Application to Nursing

The information presented in this case informs the practice of a master’s prepared nurse in several ways. First, a nurse understands the pathophysiology of the condition together with the associated signs and symptoms. The diagnosis and treatment options are also highlighted, and these elements prepare a nurse to handle patients suffering from this condition from the point of clinical understanding. Such a nurse will be in a position to make informed and timely decisions when handling severely depressed patients.

A master’s prepared nurse can use the information presented in this case to design a patient education session for someone suffering from this condition in the following ways. The first step would be to define what major depressive disorder is and highlight the underlying signs and symptoms. Information on the available diagnosis and treatment methods would then be included. Similarly, information on the management of the condition would be added. A nurse can also include self-care strategies based on suitable therapy for the patient.

The most important information presented in this case is the signs and symptoms of the condition. As noted in the case, depression is a complex condition, and its symptoms may overlap with others associated with different mental illnesses. Additionally, the information on symptoms is critical, as it will help nurses to identify patients suffering from this condition and offer the necessary help.

The most challenging information presented in this case is the pathophysiology of depression. It has been stated that the causes of this condition are not known, and this aspect raises the question of the effectiveness of the available management and treatment options. It is a challenge to understand how a cure for a certain condition can be established if the causes are unknown.

One of the patient safety issues to be addressed for patients suffering from depression is drug usage. The available medications for this condition are supposed to be taken strictly according to the physician’s directions to avoid adverse effects. Some people, such as pregnant women and children, may require special attention when administering these drugs.

References

American Psychiatric Association. (2017). What is depression? Web.

National Institute of Mental Health. (2018). Depression. Web.

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Vuorilehto, M. S., Melartin, T. K., Riihimäki, K., & Isometsä, E. T (2016). Pharmacological and psychosocial treatment of depression in primary care: Low intensity and poor adherence and continuity. Journal of Affective Disorders, 202, 145-152. Web.

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