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Depression: Definition, Overview, and Symptoms�Fifth chapter

By: Dr. Pegah A.M. Seidi

Email: Pegah.am.seidi@kti.edu.iq

2025 -2026

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Definition and Overview

Depression—classified in DSM-5 as a Major Depressive Disorder (MDD)—is a mood disturbance characterized by persistent sadness, loss of interest or pleasure, and impairment in daily functioning. It represents a pervasive alteration in affect and cognition rather than a transient emotional reaction.�In clinical nursing, depression is regarded as a maladaptive response to stress producing significant distress or functional impairment.

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According to DSM-5, diagnosis of Major Depressive Disorder requires the presence of five (or more) symptoms during the same two-week period, representing a change from previous functioning, with at least one of the symptoms being either depressed mood or loss of interest/pleasure.�The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning and must not be attributable to substances or another medical condition.

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�Clinical Features and Symptoms�

1. Affective (Emotional) Symptoms

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  • Depressed mood: pervasive sadness, tearfulness, emptiness, or irritability.
  • Anhedonia: marked loss of pleasure in almost all activities.
  • Hopelessness and helplessness: pessimistic outlook, belief that improvement is impossible.
  • Worthlessness and guilt: excessive self-blame or feelings of inadequacy

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�Clinical Features and Symptoms�

2. Cognitive Symptoms

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  • Impaired concentration and decision-making.
  • Preoccupation with death or suicidal ideation.
  • Negative thinking patterns and cognitive distortions (“I’m useless,” “Nothing will change”).

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�Clinical Features and Symptoms�

3. Behavioral and Psychomotor Symptoms

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  • Psychomotor retardation: slowed speech, thought, and movement.
  • Agitation or restlessness (especially in older adults).
  • Decreased productivity, withdrawal from social interaction, neglect of self-care

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�Clinical Features and Symptoms�

  • 4. Somatic (Biological) Symptoms

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  • Sleep disturbances—insomnia or hypersomnia.
  • Appetite and weight changes (loss or gain).
  • Fatigue, reduced libido, constipation, or vague bodily pains.
  • Early-morning awakening and diurnal variation (worse in mornings).
  • Menstrual irregularities or sexual dysfunction in some cases

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�Clinical Features and Symptoms�

  1. Psychotic Features (Severe Depression)

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  • Delusions and hallucinations may occur—commonly mood-congruent (delusions of guilt, nihilism, or poverty). Prognosis is poorer when psychotic content is mood-incongruent

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Causes and Risk Factors

1. Biological Factors

  • Genetic predisposition: increased risk among first-degree relatives.
  • Neurochemical imbalance: deficiency of serotonin (5-HT), norepinephrine (NE), and dopamine; altered receptor sensitivity
  • Endocrine abnormalities: hypercortisolemia (demonstrated by dexamethasone-suppression-test failure).
  • Sleep and circadian rhythm disruption.
  • Chronic illnesses: hypothyroidism, diabetes, cardiovascular disease.

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Causes and Risk Factors

2. Psychological Factors

  • Negative self-concept, low self-esteem, maladaptive coping.
  • Learned helplessness and cognitive distortions (Beck’s triad).
  • Unresolved grief, early loss, or trauma.
  • Personality traits—dependent, obsessive, or avoidant patterns increase vulnerability.

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Causes and Risk Factors

3. Social and Environmental Factors

  • Stressful life events: bereavement, job loss, relationship breakdown.
  • Lack of social support and isolation.
  • Socio-economic hardship or chronic exposure to violence/conflict.
  • Substance abuse or certain medications (e.g., steroids, reserpine).

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Nursing Interventions and Management

DSM-5–Guided

  • Comprehensive assessment should include biological, psychological, and social dimensions, covering:
  • Mood, affect, and thought content (suicidal ideation, delusions).
  • Level of functioning, sleep and appetite patterns.
  • Risk of self-harm or harm to others.
  • Standardized scales such as the Hamilton Depression Rating Scale (HAM-D) and Beck Depression Inventory (BDI)

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Causes and Risk Factors

Nursing Diagnoses

  • Risk for Suicide related to hopelessness and helplessness.
  • Ineffective Coping related to cognitive distortions.
  • Self-care Deficit related to psychomotor retardation.
  • Disturbed Sleep Pattern related to biological rhythm disruption.
  • Social Isolation related to withdrawal and low energy.

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Causes and Risk Factors

Planning and Goals

  • Promote safety and prevent self-injury.
  • Restore normal biological rhythms (sleep, appetite).
  • Encourage expression of feelings in a supportive environment.
  • Rebuild self-esteem and adaptive coping skills.
  • Facilitate medication adherence and psychoeducation for patient/family.

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Interventions

  • 1. Biological/Physical Interventions
  • Pharmacotherapy: administer and monitor antidepressants safely.
    • SSRIs: fluoxetine, sertraline, citalopram—first-line due to tolerability.
    • TCAs: amitriptyline, imipramine—effective but with anticholinergic side effects.
    • MAOIs: phenelzine, isocarboxazid—reserved for resistant cases.
    • Atypical agents: bupropion, mirtazapine.
    • Monitor for side effects (e.g., serotonin syndrome, orthostatic hypotension).
  • Electroconvulsive Therapy (ECT): indicated for severe or suicidal depression; ensure informed consent, airway safety, and post-ECT orientation
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  • Light Therapy: beneficial in seasonal affective disorder.
  • Encourage adequate rest, nutrition, and exercise to improve energy levels.

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Interventions

2. Psychological Interventions

  • Use therapeutic communication: active listening, empathy, and nonjudgmental attitude.
  • Facilitate cognitive-behavioral techniques: help patient identify and replace negative thoughts.
  • Encourage participation in structured daily activities to prevent withdrawal.
  • Support expression of feelings through writing, art, or discussion.

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Interventions

3. Social and Educational Interventions

  • Involve family in psychoeducation: symptom recognition, medication adherence, relapse prevention.
  • Refer to support groups or community mental-health resources.
  • Teach stress-management strategies and problem-solving skills.
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Evaluation

  • Progress is evident when the patient:
  • Expresses hope and reduced suicidal ideation.
  • Demonstrates improved sleep, appetite, and energy.
  • Engages in self-care and social interaction.
  • Verbalizes adaptive coping and positive self-evaluation.

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Summary

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Domain

Nursing Focus

Expected Outcome

Biological

Administer antidepressants, monitor side effects, ensure nutrition/sleep hygiene

Stabilized mood, improved biological rhythms

Psychological

Therapeutic communication, CBT support, emotion expression

Increased self-esteem, realistic thinking

Social

Family education, community referrals

Reintegration into work/family roles

Safety

Suicide prevention, observation levels, remove harmful objects

No self-harm or harm to others

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References

  • Sreevani, R. A Guide to Mental Health and Psychiatric Nursing. 4th ed. New Delhi: Jaypee Brothers Medical Publishers; 2015.
  • Varcarolis, E.M. Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care. 5th ed. St. Louis: Elsevier; 2022.
  • American Psychiatric Association. DSM-5 Handbook of Differential Diagnosis. Washington, DC: American Psychiatric Publishing; 2013.
  • World Health Organization (WHO). Mental health action plan 2013–2030. Geneva: WHO; 2021. Available from: https://www.who.int
  • Jahoda, M. Current Concepts of Positive Mental Health. New York: Basic Books; 1958.
  • Shorter, E. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: Wiley; 1997.
  • Kurdistan Technical Institute – Nursing Department. Coursebook: Psychiatric and Mental Health Nursing (NU230). Sulaimaniyah: KTI; 2025.

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How to use website

  • Kticc.kti.edu.iq
  • Staff administrative staff
  • Pegah seidi Link Lectures

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