Handling a patient with depression from illness.

Abstract

Introduction

Depression is one of the most common and disabling chronic health problems encountered in the primary care setting. In this article, opportunities and strategies to improve care for depression in primary care practice are reviewed and collaborative care, an evidence-based approach to chronic disease management for depression is introduced. In this approach, primary care providers (PCPs) and care managers look after a caseload of depressed patients with systematic support from mental health experts.

Handling a patient with depression from illness.

Handling A Patient With Depression From Illness

Depression is a mental health disorder characterized by extreme sadness and loss of interest and pleasure. It is caused by major life events such as chronic illness, sudden loss of a job, and loss of a beloved relative (Gold, et al, 2020). Depression presents with sleep disturbance, loss of interest, fatigue, impaired concentration, and suicidal ideation.

Handling a patient with depression from illness.

My Encounter With A Patient With Depression

G.M is a 32-year old female who presented at the outpatient department with complaints of generalized body malaise, sleep disturbance, and impaired concentration. Recently, she was diagnosed with coronary heart disease and diabetes mellitus type 1. She is currently on insulin, metformin, atorvastatin, digoxin, and enalapril. She reports of being overwhelmed by taking medicine daily. G.M is a teacher in a local school. She is married and has two children. When doing the mental assessment, I observed that she is neat, oriented to time place, and person, and restless. She seems to be sad, have a low volume and a weak tone. Her thought process is hopeless and she says she might die and leave her family.

Handling a patient with depression from illness.

How I Advocated In The Patient’s Situation

As the primary care provider, I re-assured the patient of the diseases; diabetes and coronary heart disease are chronic long-term diseases whose symptoms are controlled through lifestyle modification and drug compliance. I sent the patient to the clinical psychologist to start psychotherapy sessions. I also initiated antidepressants; citalopram 10mg once daily. According to Zhang, et al, (2019) depression is managed by both pharmacotherapy and psychotherapy. Citalopram is a serotonin selective inhibitor that works at the serotonin and dopamine receptors hence relieving the depressive mood.

Handling a patient with depression from illness.

Legal/Ethical Complications When Handling The Patient

Ethics are the moral principles that guide nursing practice. They are beneficence, non-maleficence, autonomy, and informed consent (Smith, & Sisti, 2020). Before initiating treatment, I assured the patient that the information provided is private and confidential, I ensured got fully informed consent from the patient, and I prioritized the patient’s needs and preferences hence observing the principle of autonomy.

Handling a patient with depression from illness.

Depression – treatment and management

People with depression can find it difficult to take the first step in seeking support. They may need to get help with the support of family members, friends or a health professional.

There is no one proven way that people recover from depression. The good news is that there is a range of treatments, health professionals and services available to help with depression. There are also many things that people with depression can do to help themselves.

Handling a patient with depression from illness.

Depression is common

In any one year, around one million people in Australia experience depression. One in six women and one in eight men experience depression at some time in their life. The good news is that just like a physical illness, depression is treatable and effective treatments are available.

The sooner a person with depression seeks support, the sooner they can recover.

Handling a patient with depression from illness.

Types of depression

There are different types of depression. The symptoms for each can range from relatively minor (but still disabling) through to very severe. The main types of depression are:

• major depression
• dysthymic disorder
• bipolar disorder (which used to be called manic depression)
• cyclothymic disorder
• seasonal affective disorder (SAD).
  

  Handling a patient with depression from illness.

Treatment for depression

Depression is unlikely to simply go away on its own. In fact, if ignored and left untreated, depression can go on for months, sometimes years, and can have many negative effects on a person’s life.

Every person needs to find the treatment that’s right for them. It can take time and patience to find a treatment that works.

Handling a patient with depression from illness.

Different types of depression require different treatment. Mild symptoms may be relieved by:

• learning about the condition
• lifestyle changes (such as regular physical exercise)
• psychological therapy provided by a mental health professional or via online e-therapies.

For moderate to more severe depression, medical treatments are likely to be required, in combination with these other treatments.

Handling a patient with depression from illness.

Treatment for depression should start with seeing your doctor. Book an extended consultation to give you time to discuss your symptoms and treatment options. Your doctor may ask you to fill out a screening questionnaire or conduct some tests to rule out other conditions.

Your doctor may refer you to a psychologist, social worker, counsellor or psychiatrist. You can access a rebate to see most of these professionals through Medicare. This requires that your doctor writes you a GP Mental Health Plan – ask them for more details.

Handling a patient with depression from illness.

Other treatment options include:

• your local community health centre – speak to someone at your local council for contact details
• your local mental health service triage service – they can give you advice about your closest major hospital with a psychiatric department with staff available for mental health assessments.

In an emergency contact 000 or go to your nearest hospital emergency department to obtain a mental health assessment. 

Psychological treatments for depression

Psychological treatments (also known as talking therapies) have been found to be an effective way to treat depression. They can help you change your thinking patterns and improve your coping skills so you’re better equipped to deal with life’s stresses and conflicts.

Handling a patient with depression from illness.

As well as supporting your recovery, psychological therapies can help you stay well by identifying and changing unhelpful thoughts and behaviour.

There are several different types of psychological treatments including:

• cognitive behaviour therapy (CBT)
• interpersonal therapy (IPT)
• behaviour therapy
• mindfulness-based cognitive therapy (MBCT).

CBT is one of the most commonly used psychological therapies. It helps people with depression to monitor and change negative patterns of thinking and improve their coping skills so they are better equipped to deal with life’s stresses and conflicts.

Handling a patient with depression from illness.

Antidepressant medications

The main medical treatment for depression is antidepressant medication. Antidepressant medication may be prescribed, along with psychological treatments, when a person experiences a moderate to severe episode of depression. Sometimes, antidepressants are prescribed when other treatments have not been successful or when psychological treatments are not possible due to the severity of the condition or a lack of access to the treatment.

Handling a patient with depression from illness.

People with more severe forms of depression (bipolar disorder and psychosis) generally need to be treated with medication. This may include one or a combination of mood stabilisers, antipsychotic drugs and antidepressants.

There are many types of antidepressants. Making a decision about which antidepressant is best for a person can be complex. The decision is made in consultation with a doctor, after careful assessment and consideration. Antidepressants take at least two weeks before they start to help, and it may also take some time for the doctor to find the most suitable medication and dosage.

Handling a patient with depression from illness.

Antidepressants can make people feel better, but they won’t change their personality or make them feel happy all the time. As with any other medication, some people will experience some side-effects.

Common side-effects, depending on which medication is taken, include:

• nausea
• headaches
• anxiety
• sweating
• dizziness
• agitation
• weight gain
• dry mouth
• sexual difficulties (for example, difficulty becoming or staying aroused).

Some of these symptoms can be short-lived, but people who experience any of these symptoms should tell their doctor, as there are ways of minimising them. The likelihood of a particular side-effect happening varies between people and medication.

Handling a patient with depression from illness.

The length of time a person needs to take antidepressants for depends on the severity of the condition and how they respond to treatment. Antidepressants are safe, effective and not addictive. Stopping medication should only be done gradually, on a doctor’s recommendation and under supervision.

Handling a patient with depression from illness.

Every person needs to find the treatment that’s right for them. Just because a treatment has been shown to work scientifically doesn’t mean it will work equally well for every person. Some people will have complications, experience side-effects or find that the treatment does not fit in with their lifestyle. It can take time and patience to find a treatment that works.

After seeking appropriate advice, the best approach is to try a treatment you’re comfortable with and one that works for most people. If you do not recover quickly enough, or experience problems with the treatment, discuss this with your health professional and consider trying another option.

Handling a patient with depression from illness.

Depression – coping and recovering

While psychological and medical treatment can help with a person’s recovery, there are many other ways people can help themselves to get better and stay well.

Staying active

When you are depressed, you may not enjoy activities that you once loved. You may also think you won’t enjoy something but, when you do it, you actually enjoy it more than you expected.

Handling a patient with depression from illness.

If you don’t try activities, you reduce the number of things that may help you cope with your depression. To increase the amount of activities you enjoy, you can:

• list activities you used to enjoy – include as many as possible
• plan one of these activities each day
• increase the amount of time available for activities you enjoy
• after an activity, think about or write down what you enjoyed about it
• talk to others about what activities they like.

If you keep going, it will help you get better. You will enjoy activities more as you recover.

Sleeping patterns and depression

Depression can disrupt sleep patterns. It’s essential to try to restore a regular sleep pattern to make a full recovery. Some tips for restoring a regular sleep pattern include:

• Try to go to sleep and get up at about the same time each day.
• If you’re worrying about things during the night, set aside some time for problem solving during the day.
• Avoid drinking caffeine after 4 pm and try not to drink more than two cups of caffeine-type drinks (such as coffee, strong tea, cola or energy drinks) each day.
• Avoid using alcohol to help you sleep. As the alcohol is broken down in your body, it causes you to sleep less deeply and to wake more frequently.
• Allow yourself time to wind down before going to bed. If you are working or studying, stop at least 30 minutes before bedtime and do something relaxing.
• Give your mind a break from online activity such as social media for an hour before bedtime, and consider putting your phone in a separate room from your bedroom at night time.
  

  Handling a patient with depression from illness.

Negative thoughts and depression

Worrying or thinking negatively is common in people with depression. This affects your ability to focus on getting better and makes you more vulnerable to unhealthy emotions.

Tips to help you control worry and reduce negative thinking include:

• Write down what you are worried about. Go through each concern and think about how realistic your negative thoughts are. Explore alternative thoughts and explanations.
• Try not to focus on the things you cannot change.
• Focus on the present. Accept your thoughts without actively engaging with them.
• Write down your problems and brainstorm solutions. Jot down the pros and cons with each option and choose the one that seems the best. Review whether it worked to overcome the problem.
• Avoid making major decisions about your life at this time.
  

  Handling a patient with depression from illness.

Dealing with irritability

Some people with depression may experience irritability. These feelings can become worse because of changes in sleeping patterns and lifestyle.

Help yourself to deal with this by:

• telling your friends, family and colleagues what you are going through and that you may appear to be irritable
• if you feel yourself getting angry, stopping and taking some time out to settle yourself down
• practising regular relaxation to reduce the effects of irritating or frustrating situations
• talking to people who are supportive.

Many people with depression can also simultaneously experience anxiety conditions. In most cases the treatment for anxiety is similar to the treatment for depression, but it is important to tell your doctor or mental health professional about any anxiety symptoms so they tailor the treatment to both conditions.

Handling a patient with depression from illness.

Where to get help

• GP
• Your local community health centre
• beyondblue Support Service Tel. 1300 22 4636
• Lifeline Tel. 13 11 14
• Kids Helpline Tel. 1800 55 1800
• SuicideLine Tel. 1300 651 251
• SANE Australia Helpline Tel. 1800 187 263
•  Australian Psychological Society – Find a psychologist service Tel. 1800 333 497 (outside Melbourne) or (03) 8662 3300 (in Melbourne)
• Mind Australia Tel. 1300 AT MIND (286 463)
  

  Handling a patient with depression from illness.