Recognizing Depression in Your Patients

While the holiday season can be a lot of fun, it can also be a time that makes a lot of people become depressed. Whether it’s because they’ve lost family or friends, they’re experiencing rough times, or they are in the hospital and/or are ill, it can make many sad.

There’s a difference between regular sadness and depression, though. And it’s important to be able to recognize if your patients are experiencing depression. According to Sharon R. Kowalchuk, RN, DPN, Director of Nursing at Silver Hill Hospital (an academic affiliate of the Yale University School of Medicine, Department of Psychiatry), nurses can recognize symptoms of depression in their patients. “In any setting, patients may come to our attention with reports of loss of energy, anxiety, aches and pains, headache, insomnia, changes in appetite, or a significant weight loss or gain in a short period of time. These symptoms are not necessarily signs of depression, but they call for further exploration,” says Kowalchuk.

What are the specific signs that you can recognize as being those of depression? “It is easiest to recognize depression when the patient reports feeling sad, empty, hopeless, having difficulty enjoying usually pleasurable activities or sex. The more subtle signs may be irritability, restlessness, becoming more cranky than usual, having difficulty keeping up with everyday routines, or focusing on TV or reading. Expressing feelings of pessimism, guilt about one’s life, thinking a lot about losses or failures, believing things will not get better—these are more concerning symptoms,” explains Kowalchuk. As difficult as it might be, she says, “You will need to ask if they have thought about suicide.”

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If you recognize these signs in patients, it’s important to get more information about any action they may have taken to prepare for suicide. “A key question is whether they have attempted suicide or began a suicide attempt that was interrupted by another person—or they stopped of their own volition,” says Kowalchuk. She adds that these questions are outlined in the Columbia-Suicide Severity Rating Scale (C-SSRS), a protocol that uses simple, plain language questions that anyone can ask to assess risk.

Depending on the level of risk or the particular setting, says Kowalchuk, the nurse caring for this patient may need to refer him or her to a mental health professional.

“Holidays are times that bring up life events, feelings of loss or loneliness, placing all of us at risk. The consequence of undetected depression is death by suicide,” she says. “According to the suicide experts at The Lighthouse Project, ‘Just ask, you can save a life.’”