According to the American Psychiatric Association (2018), depression is a critical health condition that severely impairs how people feel, thinks and acts. It is responsible for causing feelings of prolonged sadness as well as loss of interest in the things one used to enjoy doing. Aziz and Steffens, (2013, pp. 497-516) observe that late-life depression is caused by different biopsychosocial factors which often combine to exacerbate the condition. To this end, elderly patients diagnosed with depression need to be subjected to treatment and management approaches that promise to suppress symptoms rapidly to prevent emergence or curtail other old age complications such as hypertension and diabetes. In doing so and for purposes of administering comprehensive patient-centered care, nurses ought to take into consideration the ethical implications of managing such patients. Drawing from the case study of Amy (75-year old woman suffering from depression), the focus of this paper will be on identifying and discussing the biopsychosocial factors contributing to the development of depression and nursing management approaches used in the treatment of same under the guidance of ethical implications.
Biopsychosocial Factors Related To Depression
Like is the case for Amy, patients suffering from depression exhibit symptoms such as depressed mood, sadness, loss of appetite leading loss of weight, sleep disturbance, restlessness, increased fatigue, feelings of guilt and worthlessness, having difficulties in thinking and having constant thoughts of death. These symptoms come by patients undergo through touching incidences and painful moments in their life subjecting them to stressful and grieving situations that by extension exacerbate to more serious mental disorders such as depression. While there is no single known cause of depression, factors leading to depression are quite numerous and interact to lead to complex relationships that work to compound the condition. The biopsychosocial model is one model that can be used by mental health professionals to easily identify and diagnose a patient as suffering from depression (Beck & Alford, 2009).
First, advanced by cardiologist Dr. George Engel, the biopsychosocial model is widely used in the management of individuals with mental health illnesses. The model advances that biological, psychological and social factors are interlinked contributors in the development of ill health of patients and especially for those suffering from mental disorders. The model promotes that idea that the mind and the body are connected and interdependent and that what affects the body also affects the mind and vice versa. Health is not only a matter of the physical body status but it is also greatly influenced by a patient’s psychological and social status too (Bruce, 2008, pp.175-184).
In using the biopsychosocial model to identify and describe mental health phenomena such as depression, psychiatric nurses are obliged to examine critical biological, psychological, and social factors. Concerning biological factors and drawing from Amy’s case, some patients’ depressed condition may emanate from family lineage gene s implications leading to such individuals inheriting their depressed conditions from their fore parents. Amy is reported to be a quiet but caring person who likes her own company. These same traits were exhibited by her mother who also had been diagnosed with depression and died some fifteen long ago. This implies that possibly Amy’s depressed condition could have been partly instigated by genes transmission that contributes to depression. Moreover, being an elderly woman, Amy could be suffering from hormonal imbalances or having an impaired neurotransmitter system. Women have a higher likelihood developing depression than men given that they have a greater likelihood of “internalizing stress”. Amy is also suffering from diabetes and hypertension which are health conditions that play a critical role in exacerbating depression in older persons (Katon et al., 2010, pp. 423-429).
The psychological factors contributing to depression include possession of negative personality behaviors such as perfectionism, low self-esteem and self-criticism. Amy has been labeled as having low-self-esteem and is quick to self-criticize herself. Despite being a caring person, she keeps to herself which could have triggered feelings of worthlessness, hopelessness, and helplessness. At one point in time she is heard saying “If I were gone, things would be easier for my daughters”. Such negative thought patterns and judgments coupled with the absence of coping mechanisms helps promote depression. Furthermore, Williams and Tappen (2008, pp.72-80) assert that long-term stress emanating from ongoing issues is another factor that may dearly contribute to depression over time. It is reported that Amy started to feel depressed some ten years ago after being diagnosed with diabetes and hypertension. These chronic health conditions are not only a constant source of worry for Amy but also important triggers of the same.
Lastly, social factors contributing to depression include being severely affected by recent negative events such as losing a loved one. In this case, after the death of Amy’ husband some three years ago, Amy was unable to eat and sleep and since she felt she had no one to talk to since her children lived in another city, she relocated to a retirement village. Moreover, after lacking social support, Amy decided to relocate to a retirement village. Amy’s children would only visit her only once a month. Social stressors such as traumatic situations like losing a loved one can trigger other physical causes of depression (Mitchell, Vaze & Rao, 2009, pp.609-619).
Scientific evidence has confirmed that biopsychosocial factors are by and large interdependent and work to influence each other in promoting depression. Depression can emanate from being triggered by varied factors which are independent but indeed interrelated (Miller & Massie, 2010, pp. 311-318). To this end, the manner in which different causes of depression impact and affect one another is paramount in the formulation and implementation of treatment mechanisms and nursing management interventions for depressed people.
Depression Nursing Management or Treatment Interventions
Treatment interventions for depression are dependent on the type of depression a patient suffers from and it usually involves an amalgamation of pharmacotherapy, self-help and talking therapies. For mild depression, health care professionals may apply a “wait and see” approach in which a patient is subjected to a “watchful waiting” to determine whether symptoms will improve by themselves. Moreover, Knapen, Vancampfort, Moriën, and Marchal, (2015, pp. 1490-1495) advice that patients may be subjected to exercises and self-help group therapies to assist them relieve stressful emotions. Blake, Mo, Malik and Thomas (2009, pp. 873-887) contend that physical activity is critical in assisting older persons to forget what contributes to their depressed conditions such as traumatic conditions. In the case of mild to moderate depression, health practitioners recommend talking therapies which can be critical in improving symptoms. Talking therapies include counseling and cognitive behavioral therapy (CBT). All this intervention mechanisms are appropriate in the management of Amy’ depressed condition.
Patients with moderate to severe depression may be subjected to a combination of interventions that are instrumental in tackling the condition from different dimensions. Pharmacotherapy which is the administration of antidepressants is critical for this category of patients. Antidepressant act by suppressing depression symptoms. In addition to antidepressants, nurses can subject patients to talking therapies such as CBT especially if the depression is quite severe. The two actually works much well than when one treatment intervention id adopted (Weeks, Kalucy, & Hill, 2009, pp. 27-34). In this case, Amy’s doctor has prescribed her antidepressants as well as being scheduled for cognitive behavioral therapy and art and craft support group activities.
Psychotherapy interventions such as CBT are aimed to assist patients to come to terms with their thoughts and behaviors and how they affect them. The therapy is cognizant that a patient’s past history may have had critical contributions to their current depressed condition but it gives more emphasis on changing how patients think, feel and behave in the current times. This relates to helping patients realize their potential in overcoming negative thought patterns and instilling hopefulness. Nurses usually manage CBT in 6 to8 sessions in a time span of 10 to 12 weeks in which patients are expected to have significantly improved their depression symptoms. Interpersonal therapy (IPT) is critical in helping depressed patients improve their relationships with others by eliminating communication difficulties as well as coping with bereavement. This therapy can be helpful for Amy given that she likes keeping to herself. Counseling and psychodynamic psychotherapy are instrumental in helping patients think through what is troubling them and finding ways of dealing with those troubling issues.
On the other hand, antidepressants are instrumental in treating symptoms of depression. Roughly 30 different types of antidepressants have been developed so far to act on different neurotransmitters. While managing depression through the use of antidepressants, nurses need to try out different types of antidepressants on their patients until they realize which ones work best with their patients. After realizing that the antidepressants Amy had been prescribed before were not working, Amy’s doctor decided to prescribe her another group of antidepressants. Patients need to be closely monitored for purposes of identifying different reactions, side effects, and improved outcomes. Examples of antidepressants types include selective serotonin reuptake inhibitor (SSRI) which assists patients to elevate the levels of serotonin; a chemical claimed to elevate “good mood”. Nonetheless, Rabins et al., (2009, pp.931-937) observe that depression and its medical treatment complexity bring up numerous critical ethical concerns.
Ethical Implications in the Treatment of Depression
The domination of pharmacotherapy in the treatment of depression across the globe has been seen as an ethical indictment of evidence-based psychotherapy interventions which have abilities to produce equally similar outcomes in the contemporary management of depression. Patients like Amy are more likely to be prescribed medication than being subjected to other means of managing depression such as CBT, social support, and exercises. This ethical indictment of psychotherapy denies patients a chance to receive insights of understanding what depression really is and how they can avoid or cope with symptoms. In total contrast, antidepressants only act to elevate the mood of the patients independent of the need to provide insights into the nature and significance of depression. In a retirement home setting like the one Amy resides in currently, for instance, Choi, Ransom, and Wyllie (2008, pp.536-547) assert that patients are supposed to be provided with opportunities that are supposed to assist them to cope with nursing home environmental stressors such as support group as well as individual therapy as opposed to being subjected to medications only.
While antidepressants are okay in the management of depression, many are the times that patients have been prescribed medication while only undergoing normal levels of melancholy. Trying to realize healthy feelings of happiness from conditions of sadness through medication prescription only acts to alter the normal human experience. While medication is more or less successful in freeing patients from moody conditions, Sheehan and McGee (2013, p. 4) contend that they object the patient’s ability to face the realities of life and the actual causal factors of depression. Antidepressants interfere with the adaptive mechanisms embodied by human capabilities in dealing with especially normal levels of stress.
The differences between these two types of treatments are a critical cause of ethical concerns in the treatment of depression. Psychotherapy has the capacity of promoting the personal autonomy of patients to contribute to their recovery process, a characteristic absent when only antidepressants are administered. Medication alone denies patients the material understanding of what actually causes depression and making decisions on how best they would wish to be treated. Psychotherapy has so far been treated as an option in the treatment of depression but indeed acknowledging that self-knowledge actually empowers patients to make informed life choices can go a long way in managing the condition. Psychotherapy, support systems, and physical activity posit a moral sense that supersedes its clinical effects (Hsin, & Torous, 2016, pp.214-218). As such, Amy is best suited to receive a combination of intervention mechanisms from her doctor. In doing so, in addition to being prescribed a different group of antidepressants, she is supposed to attend CBT besides engaging in social activities such as art and craft.
Conclusion
Arguably, regardless of the biopsychosocial factors combination contributing to the development of depression, depression itself is by and large not only manageable but also treatable (Chapman & Perry, 2008). Depression patients like Amy can be subjected to treatment therapies involving psychotherapy and pharmacotherapy besides being provided with opportunities that encourage support systems and physical activities for the same. However, it is critical for healthcare professionals to realize the ethical implications of prescribing medications only and should instead employ a number of intervention mechanisms in the treatment of such patients. Medications have been realized to deny patients their autonomy besides creating false realities which are devoid of human emotional experience.
References
American Psychiatric Association (2018). What Is Depression? [Retrieved from] https://www.psychiatry.org/patients-families/depression/what-is-depression. Accessed 30/8/2018
Aziz, R., & Steffens, D. C. (2013). What are the causes of late-life depression?. Psychiatric Clinics, 36(4), 497-516.
Beck, A. T., & Alford, B. A. (2009). Depression: Causes and treatment. University of Pennsylvania Press.
Blake, H., Mo, P., Malik, S., & Thomas, S. (2009). How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review. Clinical rehabilitation, 23(10), 873-887. Bruce, M. L. (2008). Psychosocial risk factors for depressive disorders in late life. Biological psychiatry, 52(3), 175-184.
Choi, N. G., Ransom, S., & Wyllie, R. J. (2008). Depression in older nursing home residents:
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Chapman, D. P., & Perry, G. S. (2008). Peer reviewed: depression as a major component of public health for older adults. Preventing chronic disease, 5(1). Hsin, H., & Torous, J. (2016). Ethical Issues in the Treatment of Depression. FOCUS, 14(2), 214-218.
Knapen, J., Vancampfort, D., Moriën, Y., & Marchal, Y. (2015). Exercise therapy improves both mental and physical health in patients with major depression. Disability and rehabilitation, 37(16), 1490-1495.
Katon, W. J., Lin, E. H., Williams, L. H., Ciechanowski, P., Heckbert, S. R., Ludman, E., … &
Von Korff, M. (2010). Comorbid depression is associated with an increased risk of dementia diagnosis in patients with diabetes: a prospective cohort study. Journal of general internal medicine, 25(5), 423-429.
Miller, K., & Massie, M. J. (2010). Depressive disorders. Psycho-oncology, 2, 311-318.
Mitchell, A. J., Vaze, A., & Rao, S. (2009). Clinical diagnosis of depression in primary care: a meta-analysis. The Lancet, 374(9690), 609-619. Rabins, P., Appleby, B. S., Brandt, J., DeLong, M. R., Dunn, L. B., Gabriëls, L., … & Mayberg,
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