The term depression is used to define the state of a bad mood. In order to diagnose depression, the symptoms of the condition must persist for a period of at least two weeks. Generally, depression is defined as a mental state or a chronic mental disorder that is characterized by a feeling of despair, loneliness, sadness, anhedonia and reduced self-esteem. Depressive disorders are more common for women than men. There are certain hypotheses that indicate the fact that hereditary factors contribute significantly to the development of depression. Needless to say, depressive disorders have been one of the major causes of involuntary admission to the mental hospital. It is estimated by the WHO that about 120 million people in the world suffer from some form of depression yearly. 10% of these are adult citizens of the US above 18 years of age.
The current paper explores the pharmacological effects of anti-depressants in the treatment of depressive and related disorders, including ADHD, OCD, anti-social disorders, eating/sleeping disorders, and clinical depression. The constructivism of this paper lies in its substantial literature review, discussion section, and nursing implication section where the author reveals both the effectiveness and side effects of psychiatric drugs that are used to cure depression. Practical advice of nurses is given for those who work in mental hospitals to reduce side effects and prevent worsening of the patients’ condition.
Depression and related disorders have been treated with the help of a wide variety of medications that are used to salvage the reuptake of neurotransmitters. These neurotransmitters play a key role in stabilizing the excitatory and inhibitory activities at the presynaptic junctions. More importantly, they are all involved in activating neuronal circuits in the human brain and help to transport serotonin and dopamine neurotransmitters between different brain centers. For this reason, it is recommended to use anti-depressants as stimulators of brain activity. Care should be taken during treatment to avoid adverse effects that arise as a result of drug overdose or interaction with other drugs administered concurrently.
Chemically, anti-depressants may differ by the structure of compounds in their atomic nature. For example, there are tricyclic anti-depressants consisting of three atoms and there are also tetracyclic compounds with the four-based compound structure. By effectiveness, selective and serotonin-norepinephrine reuptake inhibitors can be used without the risk of major side effects, when regulated by other medications, and should be used with caution together with other psychic drugs. Noradrenergic and monoamine oxidase inhibitors belong to the new type of psychic drugs that are used in the treatment of depressive disorders. There are specific criteria that have been put in place to diagnose depression. For instance, the ICD 10 stipulates the following:
- Persistence of bad mood and/or loss of interest or pleasure (anhedonia)
- Fatigue or low energy level (anergia)
- Reduced concentration and attention
- Reduced self-esteem and self-confidence
- The feeling of guilt and worthlessness
- Hopelessness about the future
- Intention to commit suicide
- Sleeping disorder
- Reduced appetite
Depressive disorder can be described as mild, moderate or severe depending on the number of symptoms observed. Depressive episodes are also characterized by other symptoms such as amenorrhea, reduced sexual drive/ libido, constipation, and psychomotor retardation. The etiology of depressions is affected by genetic structure, socio-economic factors, health conditions, and cultural background. Genetics: severe forms of depression tend to follow a genetic course more than the less severe forms. As for severe forms, depression is more common for females than males.
Socioeconomic factors such as loss of property, bereavement, and loss of elections can also cause depressive episodes. Health conditions such as HIV and chronic malignancies cause up to 49.27% of depression in the US. Psychiatrists maintain that the patient’s marital status contributes significantly to the development of depression. Single and divorced individuals tend to be more susceptible to depression than those in a stable marriage. Married, divorced and then widowed individuals show a higher incidence of depressive episodes than any other category.
Non-psychiatric conditions such as Addison’s disease, hypogonadism, and Lyme disease tend to cause depressive episodes. Pharmacological treatment of certain conditions such as ischemic heart disease, convulsions, and hypertension contribute significantly to the development of depression.
The aim of the current paper is to identify the drugs used in the management of various forms of depression, their mechanism of action including pharmacodynamics and side effects as well as contraindications, nursing implications and the role of a nurse in the treatment care of patients with depressive disorders. In conjunction with the report made by the Centers for Disease Control in 2007, anti-depressant drugs were noted to be the most commonly prescribed drugs according to the survey. The increased use of these drugs is not fully known. However, some specialists have proven that anti-depressants are effective in the treatment of a wide range of conditions such as the Conversion Disorders where psychological stress manifests in physical condition.
The main implications for the use of anti-depressants remain to be major depressive disorders. Major depressive episodes from bipolar disorders to affective/mood disorders have been widely spread in the developed nations. In addition, some chronic illnesses such as heart failure are known to have a strong association with depressive episodes. Treatment of depression is highlighted if it coexists with other medical conditions. This helps to narrow down the prevalence and incidence rates of mortality in chronically ill patients.
Pathophysiology of Depression
The physiology of mood disorders is complicated and inferences are based on brain imaging of the present neurotransmitters in relation to the normal amou