Depression goes much deeper, and usually lasts longer, than a bout of sadness. Some women experience monthly depression with hormonal changes. Moody teenagers can have predictable episodes depending on circumstances. Men may experience depression but won’t talk about it.
“Talking it out” with a friend is cheaper than therapy, but you should recognize when a seriously depressed person needs help beyond cheering up sessions.
Major depression can be set off by a triggering event like job loss, a major move, the loss of a relationship, a death in the family, postpartum depression (which includes some fathers), a divorce, or some other major life change that causes major re-adjustment.
If the depressed person is considering or talking about suicide, take it seriously. Some teens might have periods of “depression” and pull out of it all right. But if a teenager talks about how the world would be better off without him and begins to give away prized personal possessions, take notice and seek help.
Some people experience Seasonal Affective Disorder (SAD), beginning in October or November and lasting until mid-February or mid-April. They often recognize it and know it won’t last forever so they often deal with it themselves. (There is also a summer version of SAD.) This disorder may be clinically diagnosed after three predictable episodes, and a person can be prescribed medication for it. Most people recover on their own, but “bright light therapy” can help them get back to normal mode quicker.
Some people experience diagnosed bipolar disorder with great mood swings, from depression to elation.
Family history and recent life experiences play an important role in the diagnosis of depression.
If you know the individual well, you might be able to figure out what triggered the depression and how serious it is. As a friend or family member, you want to do the right thing, but sometimes that means getting the person to a doctor or emergency room for diagnosis and help.
Keep a couple phone numbers on hand for intervention or advice. For emergency services, such as a suicide attempt, drug overdose or psychotic episode, you can call the Suicide Hotline at 1-800-784-2433. For suicide prevention services, from anywhere in the world, you can call 1-800-HOPELINE (1-800 – 4673-5463). The services are “available to anyone, regardless of age, race, religion, sex, or financial ability.” For website information, see www.spsfv.org/hotlines.htm.
Volunteer paraprofessionals staff the phones 24/7 to help with personal problems like alcohol abuse, anxiety, sexuality, family or school problems.
Symptoms of Depression:
1. Mood: While depressed, the person’s mood is one of pervasive sadness and hopelessness.
2. Thought processing: The person’s thoughts may include obsessive, dark ideas, which they vocalize repeatedly. They may find it difficult to concentrate. If the disorder goes so far as to include hallucinations or delusional thinking, the individual is at risk. If he is not responding appropriately to the environment, he might believe someone is out to harm him. Try to encourage the patient to see a doctor or get him to the hospital emergency room.
3. Physical signs: A depressed person has little energy for daily living; he may show heightened sensitivity to somatic sensations and may overeat or become anorexic. He may suffer from sleep disturbances, either oversleeping or being unable to sleep.
4. Limited verbalization: When a person is so depressed, he cannot speak normally, he may require intervention.
5. Socialization: Depressed people withdraw from social contacts. This can begin a downward spiral of hopelessness and worthlessness.
Treatment: Medication and/or Counseling.
Even a general practitioner can diagnose and give a prescription for an anti-depressant while the seriously-depressed person regains his footing.
If the person seems out of touch with reality or has pervasive feelings of despair, emergency rooms are staffed with doctors who can diagnose and treat the symptoms. They also have the ability to “involuntarily commit” the person if he acts as if he might harm himself or others.
A chronically-depressed person might be able to get help with overwhelming, negative thoughts and feelings through psychotherapy. He might be going through a prolonged grieving process or he might be in crisis-mode after a triggering event.
How you can help:
Although actively listening to a depressed person while giving feedback might temporarily help to alleviate the symptoms, serious depression is a warning sign that might demand active intervention. In that case, your best action may be to encourage the person to seek medical help. You can drive him to the doctor’s office or hospital, while reassuring him that a professional can help him better than you can. Let him know you care and do not leave him alone if he’s in a critical phase.
If the person will go to counseling, offer to go with him. Make it a family affair if possible, because such patients need strong support and the professionals will advise the family how to best deal with that specific form of depression.
If a person is hospitalized for depression, the following are some of the expected treatments.
Hospitalization Intervention and Rationale: (Psychiatric Nursing Manual)
1. Create a safe environment. Remove potentially harmful objects.
2. Have the patient create a no-suicide pact daily and with each change of shift.
3. Let the person know a staff member is always available to him. Create trust so the patient will verbally ask for help if he is in crisis.
4. Ask the patient to verbalize his feelings honestly.
5. Allow the patient to express his anger within safe boundaries. Provide a method for releasing hostile feelings safely through physical means.
6. Discuss community resources for outpatient care. Ask the patient to repeat the information so you know he knows his options.
7. Never belittle a patient’s fears, but always offer him a reality-check if he seems off base.
8. By spending time with a patient, you show caring and give a sense of security. Make the person understand he is valuable.
This is the treatment plan and rationale for in-patient nursing care. If the person is not in a serious depression and is able to live daily life on the outside, you might be able to use some of these techniques for ongoing care and prevent a major crisis.
Suicide Hotline numbers from “Telephone Hotlines Operated by Suicide Prevention Services” at http://www.spsfv.org/hotlines.htm. Retrieved 7-15-10.
Mary C. Townsend, “Nursing Diagnoses in Psychiatric Nursing,” 1994. Chapter 5: “Depressive Disorders,” “Symptomatology,” and “Interventions with Selected Rationale.”