help with pathophysiology of depression

CharlieRN · Sep 26, 2005

Its been a long time since I was in school, can you be a bit more specific about what you need? I know a lot about depression, but not much about what it is you need.

short form: Depression is a distubance of mood. Etiology can sometimes be determined in which case it may be termed a stituational depression. Ie: one related to an intolerable event in the person's life. More commonly the etiology is unknown, and the depression is discribed by its symptoms. All depressions are believed to be characterized by an inbalance in the brain chemistry, with the amounts of various neurotransmitters being subtlly abnormal. Generally speaking blood chemistrys and psych testing are not that helpful in determining the course of treatment. The TSH is usually ordered as well as cbc and comprehensive metabolic workup. These serve more to rule out systemic disease that might cause depression as a secondary sx. Sometimes the Becks Depression Inventory is ordered periodicly throughout tx. It is a symple psych test that can be administered and scored by nurses.

As a psychiatrist told me once, "If it looks like depression, I'm going to treat it as depression, regardless of the labs or psych tests."

eko · Sep 26, 2005

mycase is a 17 year old with depression

by SO: He sleeps all the time. Has absolutely no energy"

father states that son's behavior has changed fromsomeone active at school tosomeone who's not now. has fatigue. verbalized "a person doesn't have to play football to be allright." main crisis is parents' divorce. changed schools, not good relationship with mother. nothing much about PE.thanks verymuch for your help..

CharlieRN · Sep 27, 2005

I would characterize this as a mild to moderate depression. This is only my own "rule of thumb", but hypersomnia is generally a lesser sx than insomnia.

On our assessment of depression we ask about:episodes of crying or feeling blue or sad,sleep disturbance(too little, too much, mid cycle awakening, can't get to sleep, awaken too early, nightmares) appetite(weight up or down), feelings of worthlessness or guilt, feeling helpless, feeling isolated or isolating self, suicidal ideation or preoccupation with death, anhedonia, lack of energy, difficulty with concentrating or being decisive, hoplessness, and we assess adl's, and look for either psychomotor agitation or retardation.

In an adolescent one needs to look at school behavior and relationship to parents and sibs. A child is a part of a family, not a self suffiscient unit. Reading between the lines of your discription

"a person doesn't have to play football to be allright."

I suspect some parental pressure to participate in "manly" sports etc. If the kid is getting into trouble at school, with the law or at home the additional dx of "oppositional defiant d/o" might be made. If the issue is more that parent is dissatified with child the additional dx of "parent /child d/o" might be made.

In the absence of suicidality the dx of "major depressive d/o" is problematic, but it might be made if many of the other signs were strongly positive. (A person with deep religious convictions might be seriously depressed but not suicidal) I would probably call this kid "Depressive d/o NOS" as an admission dx.

If there were any evidence of mood swings the addition of a "rule out Bipolar D/O" would be prudent.

This pt should also be assessed for pyschotic symptoms, inorder to rule out the possiblity that we might be seeing a first psychotic break in a schizophrenic. Incidence of schizophrenia is about one in a hundred for males with first psychotic break mostly between 15 and 25 yr of age. It often presents as isolation and withdrawal from social activity.

I hope that helps. I know I'm coming at the problem from more of a "doctor" than "Nurse " angle. Sorry, but that's what I do. I'm a night admission Nurse for a psych hospital. I gather the data, put together a probable dx and present the case, over the phone, to the on call psychiatrist, for admission orders.

eko · Sep 27, 2005

hey there... thank you very much for your info, it was very useful, and am i thankful you're working at a psych hospital... anywayz please do hope that i pass this semester.. im a 3rd year here at chinese general hospital in manila...

having some troubles with ncm... very nice chatting... till next tym... :)

deb18 · Sep 27, 2005

Very often bipolar depression or cyclothymia is often missed. often with bipolar depression there is hypersomnia so make sure what is asked about is not only hx. of elated s&s but irritability, which is the way it often manifests in adolescents. also ask about if there has been repeated cycles of this or first episode. don't forget the dx. of dysthymia and adjustment disorder with disturbance of emotions as well. good luck Tym in manila. deb

mwbeah · Sep 29, 2005

hey there, ineed help with my case press next week, i was wondering if you could helpme with the patho of depression, if there is one... many thanks...

http://www.nimh.nih.gov/publicat/depresfact.cfm

Excerpt from above linked NIH article

Evidence from neuroscience, genetics, and clinical investigation demonstrate that depression is a disorder of the brain. Modern brain imaging technologies are revealing that in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and that critical neurotransmitters--chemicals used by nerve cells to communicate--are out of balance. Genetics research indicates that vulnerability to depression results from the influence of multiple genes acting together with environmental factors. Studies of brain chemistry and of mechanisms of action of antidepressant medications continue to inform the development of new and better treatments.