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Running head: THE COMMON EFFECTS OF DEPRESSION

The common effects of Depression

Alyssa Crump

Teresa Peck

Youngstown University State

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THE COMMON EFFECTS OF DEPRESSION

Abstract

Depression is one of the most common mental health illnesses that affect individuals throughout

the nation. Psychiatric mental health is commonly seen in the nursing field.

Throughout the paper the patient is identified as BP or the use of gender pronouns. This paper

conducts a case study about a patient that was cared for at Trumbull memorial psychiatric

hospital. The case study covers depression and numerous other mental illness.
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The psychiatric patient cared for at Trumbull memorial on February 4th, 2020 presented to

the unit due to multiple problems resulting from her depression. Patient was diagnosed with

depression and also had other diagnoses such as bipolar disorder. Patient was admitted January

29th to a medical unit and was transferred onto the psych unit February 1st. Upon Admission

patient presented to the emergency department for medical reasoning and that included the

effects of alcohol withdrawal which the patient attempted on her own. Behaviors observed upon

admission were as charted as patient had shakiness, nausea and vomiting, stomach cramps, and

increased anxiety. The patient’s lab results were not too abnormal, but these labs were reviewed

due to patient going through alcohol withdrawal. Red blood cells were 4.37, hemoglobin and

hematocrit were 10.7 L and 34.6 L. Patient blood pressure was 117/91 and this was important

vital sign because the patient had chronic hypertension. The patient ALT and AST were

important labs to review, in order to indicate any liver disfunction and the results presented as

both 24. Iron deficiency anemia and hypertension presented in this patient also and the patient

had prescribed medication for both conditions. Safety and security measures for this patient was

to not think about alcohol and it was put into place by distracting the patient with other coping

skills for her depression. The main focus for this patient was to relieve her depression which

caused her to drink and to identify coping skills that did not lead to drinking. The psychiatric

medications this patient was on included Trileptal, a mood stabilizer because this patient had

bipolar disorder. Also, included three antidepressants, Abilify, Wellbutrin XL, and Trazodone

these medications were very important in this patient’s treatment being that the reason for her

alcohol dependence was her depression. This patient was also on an antianxiety medication,

Atarax because the patient has anxiety. The last psychiatric medication was Haldol ordered PRN

for need of psychotic behavioral acts. The medical conditions mentioned previously caused this
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patient to be on antihypertensive medication as well as an iron supplement and multivitamins

including B vitamin for her alcohol dependence.

An article titled, “Depression is a risk factor for noncompliance medical treatment” it

talks about how patients who have depression and anxiety and medical conditions are more

likely not to complain with their medical treatments. The article states, “Compared with

nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant

with medical treatment recommendations” (DiMatteo et al., 2000). BP presented to the ED with

a high blood pressure not just because she was going through withdrawal, but also because she

was not compliant with her antihypertensive medication because of her depression and alcohol

dependency state.

The definition of Depression is defined as a common and serious medical illness that

negatively affects how you feel, the way you think and how you act. Depression causes feelings

of sadness and/ or a loss of interest in activities once enjoyed. Depression can lead to a variety of

emotional and physical problems and can decrease a person’s ability to function at work and at

home (American Psychiatric Association, 2017). The expected behaviors you see with

depression may include changes in sleep, appetite, energy level, concentration and daily

behavior. While in the care of this patient she showed signs of depression. When brought up

certain topic’s patient had a difficult talking about, she began to get emotional and cry. This

patient also expressed her past of being a registered nurse and she was unable to continue

working and continuing her daily life because of her depression and substance abuse. This

patient also was diagnosed with Bipolar disorder which she has had for a lot of her life. The

proper definition of this disorder states, Bipolar disorder, formerly called maniac depression, Is a

mental health condition that causes extreme mood swings that include emotional highs (mania or
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hypomania) and lows (depression), (Mayo Clinic, 2018). The signs expected to see with bipolar

disorder may include mood swings, anger, hopelessness, self- harm, agitation, weight gain or

weight loss, and many other signs. Most of the signs this patient displayed was mainly

depression while in the presence of this patient I did not witness any mania stage of her bipolar

disorder, but just her low stage which was her depression.

BP was drinking 1-2 liters of rum daily due to recent death of her mother 3 months ago,

which whom she was a caretaker for and the reason she moved to Niles, Ohio from Cincinnati,

Ohio. This patient is also experiencing going through a separation with her husband of 24 years

and also dealing with not seeing her 2 adult sons who are away at college. She stated fears of

being alone and this feeling triggered patient’s depression which lead to her alcohol dependency.

Patient tried to stop drinking on her own after 3 months of consistent drinking and presented to

the emergency department with alcohol withdrawal symptoms. This also triggered her anxiety

and BP was at a desperate means for help. This patient has a history of psychiatric

hospitalization and using substances as a coping mechanism. Back 10-15 years before this

hospitalization patient admitted to falling into a substance abuse and it cause her to surrender her

license as a registered nurse. Therefore, the patient having a psychiatric history it shows she is

more at risk to a continuing effect of mental illness and negative coping skills towards it.

Studies have shown that people who drink and abuse alcohol tend to experience more

depressive symptoms. An article titled, “Alcohol Use Among Depressed Patients: The Need for

Assessment and Intervention” explains multiple research that proves this to be true. A statement

from the article exclaimed, “in addition, men drinking 14 to 27 drinks per week and women

drinking 7 to 13 drinks per week endorsed significantly more symptoms of depression than those
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who drank at lower levels” (Ramsey et al., 2005). BP indulged in 1-2 litters of alcohol a day and

she slip into depression significantly.

While interacting with the patient and retaining information from the chart this patient

had a good childhood, raised by both parents, and she currently has a supportive sister. There

was no found evidence of the patient having come from a family with mental illness or growing

up around mental illness or even trauma. This shows proof that not all situations are influenced

by a person’s childhood, although most situations that is the case, but not all. This patient

experienced some unfortunate trauma with her separating from her husband and the death of her

mother.

A study was done on how alcohol intake is increased in people who have had losses

within 3 years. The article titled, “Alcohol use in the first three years of bereavement: a national

representative survey” gives great statics proving this factor. The article explains, “The results of

our study, carried out on a national representative sample from Hungary, confirm the results of

previous smaller sample studies, which indicated an elevated risk of alcohol related problems

among bereaved persons” (Pilling et al., 2012). BP recently loss her mother who she was caring

for and that is when she stated the alcohol dependency began. This proves that a lot of people

who experience trauma such as a loss of a loved one can cause triggers. BP already had a history

of mental illness and she found herself mourning her mother by running to alcohol. Alcohol is

used to cope with emotional pain, so the person doesn’t have to deal with these feelings. A very

negative coping strategy but is seen very often worldwide.

During the time of the shift the patient I was assigned attended 3 group therapies and 2

groups that I attended alongside with her. The first activity was a more for social purposes and to

get to know each patient. The group coordinator did a game called 2 truths and 1 lie. The purpose
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of this was to the patient to interact with each other and just to have a bit of fun. BP participated

really well with this activity and enjoyed hearing the other patients’ thoughts. Another group BP

attended was an activity that involved sharing of their coping skills and goals. Bp was willing to

share and shared how she was excited to go home, and her family supported her alcoholism and

was already removing alcohol form her home. The patients were talked to daily throughout the

shift and was giving antidepressant medication daily. Interactions with BP and other patients was

very pleasant and looked enjoyable to her.

While speaking with the patient she never expressed any spiritual beliefs or cultural

influences. The patient never expressed not believing in any cultural beliefs, but it was never

discussed in our conversation. Evaluation of the patient’s outcome from that day seems to be she

was not experiencing physical alcohol withdrawal symptoms anymore. BP was also very

interactive and pleasant during group activities and in the milieu environment. BP was still

showing signs of depression, but it was not shown consistently, but more so when a specific

topic was brought up. The care BP received while at Trumbull memorial seemed to be effective

and responding positively with the patient.

The patient plan for discharge was focused on this same day. The patient was to go to a

rehab facility based on her alcoholism and continue treatment there. BP was not very excited

about going to another facility, but she recognized she needed help and was compliant with the

decision. BP also talked about how she would stay with her supportive sister for a while until she

was ready to move back to Cincinnati closer to her sons.

A list of actual nursing diagnoses for this patient would be, Risk- prone health behavior/t

lack of motivation to change behaviors and addiction, disabled family coping r/t codependency

issues due to alcoholism, ineffective coping r/t use of alcohol to cope with life events, these are
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related to BP alcoholism. Also, a list for bipolar disorder is necessary for this patient as in,

fatigue r/t psychosocial demands, ineffective health management r/t lack of ability to make good

judgments regarding ways to obtain help. The next disordered that would need a nursing

diagnosis would be the patient’s depression. Adult failure to thrive r/t depression, self-neglect r/t

depression, cognitive therapy, insomnia r/t inactivity. The 3 potential nursing diagnosis for this

patient would be sleep deprivation r/t prolonged psychological discomfort, ineffective coping r/t

mobility to express feeling appropriately, and adult failure to thrive r/t to depression. This patient

did not get a lot of sleep prior to hospitalization, and she experienced ineffective coping by

alcohol consumption. BP also lacked ability to care for herself properly due to her depression

and alcohol dependency.

Inconclusion, BP was 48-year-old women who just loss her mother 3 months ago and

was going through a separation with her husband. She has a history of mental illness and these

unforeseen ladders of events triggered her depression and alcohol dependency. BP responded to

treated well as of what was noted on the day of care and was approved for discharge later that

day. This patient resulted in a lot of great information to learn from and a patient who was

willing to talk about her history and get help for it, because she did present to the psych unit as a

voluntary admission. Depression affects people worldwide and can lead to a lot of negative

coping skills as alcohol abuse or any substance abuse. BP was in a better state of mind on this

day of care and was excited about discharge later on that evening.
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References

Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: an evidence-based

guide to planning care. Tenth edition. Maryland Heights, Missouri: Mosby

Elsevier.

Bipolar disorder. (2018, January 31). Retrieved from

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-

causes/syc 20355955

DiMatteo MR, Lepper HS, Croghan TW. Depression Is a Risk Factor for Noncompliance

With Medical Treatment: Meta-analysis of the Effects of Anxiety and Depression

on Patient Adherence. Arch Intern Med.2000;160(14):2101–2107.

doi:10.1001/archinte.160.14.2101

Pilling et al. Substance Abuse Treatment, Prevention, and Policy 2012, 7:3

http://www.substanceabusepolicy.com/content/7/1/3

Ramsey, S. E., Engler, P. A., & Stein, M. D. (2005). Alcohol Use Among Depressed

Patients: The Need for Assessment and Intervention. Professional psychology, research

and practice, 36(2), 203–207. https://doi.org/10.1037/0735-7028.36.2.203

What is Depression? . (n.d.). Retrieved from https://www.psychiatry.org/patients-

families/depression/what-is-depression
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