All of us have felt sad and blue at one time or another in our lives. It can be a normal reaction to the stresses of life. It certainly is an expected reaction to loss, such as the death of a loved one. However, if the condition lasts for a long period and interferes with a person’s well-being and ability to care for him or herself, it is more likely a treatable physical condition: depression.

Nurses rally around a particular patient or coworker who experiences a loss. But what happens when the person’s crying and need for reassurance lasts for longer than two weeks? Or when a person is always negative, low on energy, irritable, and unable to have any fun? In short, how do you treat a downer or a wet blanket? Patients like this may be seen as annoying, demanding, and cranky. No one wants to care for them. Nursing staff members may be slow to answer their call lights. Nursing staff members may become frustrated with the same complaints being made over and over.

Depression has been called the common cold of mental illness. It can be highly contagious, sucking in others in its midst. People can be influenced by depression and not recognize it as depression. Some people live in depressed households and don’t know of any other lifestyle. Negativity, physical illnesses, irritability, pessimism, rudeness, sarcasm, and the silent treatment can all be signs that depression has taken over a person’s life.

The sooner you spot this creature the better, the sooner it is acknowledged as depression the better, and the quicker treatment is started the better.

Diagnosis difficulties

Unfortunately, many healthcare providers are still not savvy when it comes to spotting clinical depression. How many times have you heard statements such as “But of course, anyone would be depressed if they just lost their child” or “Anyone would feel sad and blue under these circumstances”? Or “He is just getting older. People get slower and don’t have as much fun at his age. He is 70 years old. What do you expect?”

It is time to replace these statements with objective data collection and analysis for what the real diagnosis might be: clinical depression.

Spotting the sadness

Look for these signs and symptoms of depression:

• Expressions of sadness, emptiness, hopelessness, worthlessness, pessimism, and/or guilt
• Changes in sleep: either not enough (insomnia) or too much (excessive sleep)
• Changes in appetite: either not enough with weight loss, or too much with weight gain
• Changes in energy level: either too much (restlessness, irritability, and anxiety) or too little (no energy, feeling fatigued, and feeling slowed down)
• Loss of enjoyment from things that were once pleasurable, including sex
• Difficulty concentrating, making decisions, and/or forgetfulness
• Somatic complaints: stomachache, recurrent headaches, body aches and pains
• Thoughts of death or suicide, or attempting suicide

Editor’s note: This excerpt is adapted from Stressed Out About Difficult Patients, the newest addition to the Stressed Out collection. It’s due out early next month. All this week, we’ll be presenting excerpts of the book so you can get a good look at our new title.