Depression: Recognition and Management of Mild Depression

All living creatures, great and small, go through periods of depression and elation. Depression is often identified by individuals as a “feeling of sadness”. Feelings of sadness are associated with lower levels of thinking, activity, and functioning. The end result of depression is that the patient lacks the energy to do things and consequently achieves less. Sometimes the reasons for the sadness are known but at other times they are unknown. Many-a-times there are no comprehensible reasons for the depression. It is a state of the mind which cannot be explained or understood in reference terms which are known to human beings. In the not too distant future this mind mystery may be resolved but for the time being we will have to deal with this phenomenon in terms of feelings – a phenomenon which many of us understand.

Depression and feeling low prevent individuals from achieving their full potentials. Further, depression makes the individual prone to accidents, illnesses and reduced productivity. The aims of this article are to help patients recognise the early signs and symptoms of depression and to deal with them before they become medical, surgical or psychiatric problems which need to be treated and managed professionally. Therefore this article is not suitable reading for patients who are suffering from depression.

Healthy individuals have a high level of functioning and they are emotionally comfortable with what they achieve or do not achieve. Depression is a serious illness and affects everything a person does and how he relates with the challenges of life. By learning to recognise feelings, signs, and symptoms of depression in the early stages patients can alter their life styles significantly, above all positively. Knowing, recognising and acting on early depression can bring about positive changes at no cost or negative consequence. Once the patient recognises that he is not feeling right or is not working at his optimal level then he ought to act on the “feeling down” phenomenon. This is the first stage of pending depression. The definition of depression in this article includes feeling down, sleeping a lot, not feeling positive about one’s work and not having energy to get up each morning.
Recognising Depression Early is most productive. If a patient displays any of the following signs, symptoms or behaviours then he is depressed. Recognising the very early signs of depression will require the nurse to be sensitive to emotions, feelings and the spoken language. When a nurse can recognise early depression she can give appropriate feedback to the patient for early interventions.

Behavioural signs of depression are:

• a. Patient goes out less frequently.
• b. Patient finds it difficult to get things done both at home and at work.
• c. Patient begins to withdraw from social circle and family.
• d. Patient consumes more alcohol, sedatives and other drugs.
• e. Patient is unable to stay focussed on tasks he is trying to do.

Verbal Cues of Depression:

The words an individual utters reflect the person’s internal mental state. Patients who are depressed will often make some of the following statements or approximations of these statements.

• a. I am a total failure.
• b. This is all my entire fault; I’m the one to blame.
• c. I never have positive experiences.
• d. I am worthless.
• e. Life is boring, it is not worth living.

Feelings associated with depression:

The following feelings are often displayed by depressed persons.

• a. Easily overwhelmed by simple tasks.
• b. Feel downcast, and sad.
• c. Become angry for no apparent reason.
• d. Easily frustrated by events
• e. Feel guilty for no apparent reason
• f. Find it difficult to decide on simple things like what to have for dinner etc.
• g. Generally feel miserable most of the time.

Physical states associated with depression:

Depressed individuals lack the necessary energy to do household tasks. The following
signs will be apparent in depressed individuals.

• a. Lack of energy, patient looks tired all the time.
• b. Patient looks sick and run down.
• c. Patient may have headaches and muscle pains
• d. Patient may complain of churning in the stomach.
• e. Patient may suffer from insomnia.
• f. Patient may have lost appetite.
• g. Patient may have progressive weight loss.

Management of pre-depression states:

These interventions are not suitable for true depression. When an individual is depressed psychological and medical interventions should be sought through the NHS or private medical providers.

• a. Talking with a close trusted friend about personal difficulties can reduce mental stress thereby making an individual feel better.
• b. If the “feeling down” is due to excessive work then it may be helpful to access employee support services. Sometimes talking with a supportive colleague can help raise the mood.
• c. Going on a holiday can be beneficial after a long stint of hard work. It allows the decks to be cleared of outstanding work.
• d. In the early stages of feeling down a strong cup of tea or coffee can be energizing. Caffeine, Coke and ginseng have “charging up” effects. It is not a good idea to consume these in the latter part of the day because they will interfere with sleep.
• e. Quiet walks in the country which allow time for reflection may help the individual get charged up. For the younger person it may be helpful to go jogging or swimming.
• f. A nice movie can take the focus off depressive feelings.
• g. Eating light meals can be energizing but eating big heavy meals can make one feel more tired.
• h. Positive mind talk can be helpful but it does not work in the later stages because the mind talk becomes negative.
• i. Indulging in activities which one enjoys can be therapeutic. It is a good idea to have a hobby to keep oneself busy.
• j. Pet therapy has been shown to be helpful in the very early stages of “feeling down”.
• k. Rewarding one with a pleasurable item has a motivating effect. However, one must avoid excessive oral gratification.
• l. Becoming a member in a self help group can be mutually helpful. Joint activities help one take the mind off the depressive feelings and help focus on group objectives and achievements.
• m. Religious persons can seek to participate in church activities as volunteers. They can also benefit from quiet prayer.

Classification of Depression:

• a. Mild depression
• b. Moderate depression
• c. Severe depression.

Each category is treated differently. Generally, treatment involves a combination of medications and psychological interventions.

Treatments for Mild depression

Mild depression may only require monitoring by the General Practitioner. This is usually done when the initial assessment indicates that the patient will improve without intervention.

There should be a medical reassessment after two weeks. Light exercise regimens have been shown to be helpful in the management of early depression.

In early depression the usage of antidepressants and other medications is not indicated.
The patient should try talking through his feelings with a friend or relative. The physician may refer a mildly depressed patient to a self-help group.

In some countries self-help reading materials and computerised cognitive behaviour therapy is also available.

Patients with a family history of depression may be started on antidepressants even if they have a mild form of this disease.

Chronic mild depression is called dysthymia if it lasts for two years or more. Such patients also benefit from antidepressants.

Dysthymia usually affects individuals who are fifty-five years or more.
Treatment and management of Moderate depression.

Mild depression which is not improving and moderate depression are most frequently treated with antidepressants and psychological counselling. Psychological interventions are discussed under severe depression.

Treatment and management of severe depression

Severe depression is best managed with antidepressant medications along with psychological counselling. Cognitive behaviour therapy (CBT) in combination with medications works better than having just one of these treatments.

Patients suffering from severe depression may be referred to the mental health team. These professional teams are made up of psychologists, psychiatrists, and specialist nurses. They provide intensive and highly specializes counselling sessions including cognitive therapy and psychotherapy.

Types of Psychological Treatments

Cognitive behavioural therapy (CBT)

Cognitive behaviour therapy (CBT) focuses on problem-solving and coaching. Each patient is usually subjected to six to eight counselling sessions over a period of twelve weeks. Some General Practitioners have counsellors who specialize in helping patients with severe depression.

Cognitive behaviour therapy (CBT) is based on the principle that the way we feel is dependent upon the way we think in our minds i.e. mind talk. CBT teaches the patient to behave in ways which challenge negative thoughts. It encourages the patient to be active and to challenge the feelings of hopelessness.

Interpersonal therapy (IPT)

Interpersonal therapy (IPT) modulates interpersonal relationships and focuses on problems which the patient perceives as difficult e.g. communications, coping with bereavement etc. There is evidence to show that IPT is as effective as medication or CBT.

Counseling

Counselling helps the patient with problems he is experiencing in his life. It helps the patient find new ways of dealing with difficulties. Counsellors support the patient in finding new solutions to problems. They do not tell the patient what to do.

Studies show that antidepressants and therapies are equally effective in managing and treating mild to moderate depression. When the two types of treatments are combined together there does not seem to be any extra benefits.

In conclusion I must state that early interventions are simpler, and cheaper. Also they can be implemented while the patient continues to work and perform his activities of daily living. The interventions for moderate to severe depression are more costly and the patient is, most often, unable to work or continue with his activities of daily living.