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Psychiatric-Mental Health Nursing

16.2 The Spectrum of Mood Disorders

Psychiatric-Mental Health Nursing16.2 The Spectrum of Mood Disorders

Learning Objectives

By the end of this section, you will be able to:

  • Outline the diagnosis, types, incidence, and possible causes of depression
  • Describe the clinical symptoms of depression
  • Recall the approaches used in the treatment of depression

Mental health conditions characterized by persistent feelings of sadness, loss of interest in activities, and difficulties in carrying out daily activities are called depressive disorders. These conditions can significantly impair a person’s quality of life, social relationships, and physical health, and they often require medical intervention for management and recovery. Treatments typically include psychotherapy, medications, or a combination of both. The exact cause of depressive disorders is unknown but is thought to involve a combination of genetic, biological, environmental, and psychological factors. Despite their serious nature, with appropriate treatment, individuals with depressive disorders can lead fulfilling lives (American Psychiatric Association, 2022).

Diagnosis, Types, Incidence, and Cause

Depression, clinically referred to as major depressive disorder, is a common and serious medical illness that negatively affects how a person feels, thinks, and acts. It is characterized by persistent feelings of sadness and a lack of interest or pleasure in activities. It can lead to various emotional and physical problems and decrease a person’s ability to function at work and at home.

The exact causes of depression are not fully understood, but current research suggests that it is caused by genetic, biological, environmental, and psychological factors. Depression can run in families, suggesting a genetic link. Changes in the brain’s neurotransmitter levels, particularly serotonin, norepinephrine, and dopamine, also play a role. Environmental factors, such as early childhood trauma, stress, or exposure to certain medications or drugs can trigger the onset of the disease. Additionally, certain personality traits, such as low self-esteem or being overly dependent, can make an individual more susceptible to depression (American Psychiatric Association, 2022).

DSM-5 Definition of Depression

Major depressive disorder (MDD) is not just a bout of the blues; it is a mood disorder that affects one’s quality of life. Individuals with MDD may experience significant changes in appetite or weight, sleep disturbances (either insomnia or hypersomnia), fatigue, feelings of worthlessness or excessive guilt, difficulty concentrating or making decisions, and recurrent thoughts of death or suicidal ideation. Physical symptoms, such as aches or pains without a clear physical cause, can also be present. These symptoms can lead to significant impairments in daily functioning and quality of life, making early identification and intervention crucial (American Psychiatric Association, 2022).

For a diagnosis of depression, at least five of these symptoms must be present most of the day, nearly every day for at least two weeks, and they must cause significant distress or impairment in social, occupational, or other important areas of functioning. It is important to note that these symptoms can be related to a number of medical conditions or can be caused by certain substances, so it is always important to rule out other causes before confirming a diagnosis (American Psychiatric Association, 2022).

Types of Depression

Depression exists as a variety of related disorders. The DSM-5 identifies several types of depressive disorders. MDD is what most people think of when they hear “depression.” MDD is characterized by one or more major depressive episodes, during which an individual experiences a depressed mood or a loss of interest or pleasure in activities, along with other symptoms, such as changes in weight or sleep, fatigue, feelings of worthlessness or guilt, and thoughts of death or suicide (American Psychiatric Association, 2022).

Persistent depressive disorder (PDD), formerly known as dysthymia, is a chronic form of depression. Unlike MDD where individuals might experience severe depressive episodes, PDD is characterized by a steady, low-grade depressive mood that lasts for at least two years. While the symptoms might not be as intense as those of MDD, they can still pose a significant challenge in daily functioning and well-being of the affected individual (American Psychiatric Association 2022).

Premenstrual dysphoric disorder (PMDD) is a type of depression that occurs the week before the onset of menstruation, and is marked by mood swings, irritability, and anxiety, among other symptoms. Perinatal depression is a mood disorder that can affect women during pregnancy and after childbirth. The term perinatal encompasses both the prenatal (occurring during pregnancy) and postpartum (occurring after childbirth) periods. It involves a significant depressive episode with symptoms, such as feelings of sadness, issues bonding with the baby, appetite and sleep pattern alterations, and thoughts of self-harm or harming the baby (National Institute of Mental Health [NIMH], 2021).

Depressive disorder due to another medical condition is distinguished from MDD by the direct causative relationship between a separate medical condition and the onset of depressive symptoms. Rather than being a primary mental health disorder, the depression in these cases arises as a physiological consequence of a different medical condition or its treatment. Such conditions might include neurological disorders (e.g., Parkinson disease, multiple sclerosis, or traumatic brain injuries), endocrine disorders (e.g., hypothyroidism), or autoimmune diseases, among others. The clinical presentation can include symptoms similar to MDD, such as persistent sadness, loss of interest in activities, fatigue, and feelings of worthlessness (American Psychiatric Association, 2022).

Seasonal affective disorder (SAD) is a specific type of depression that corresponds with the seasons. This disorder is seen more frequently during the fall and winter months when there is less sunlight. People with SAD may experience symptoms, such as low mood, lack of energy, increased sleep, and weight gain, which subside during the spring and summer.

Other specified depressive disorder and unspecified depressive disorder are categories of depression used when depressive symptoms cause significant distress or impairment but do not meet the full criteria for any of the specific disorders (American Psychiatric Association, 2022). Other types of depression may be related to specific circumstances or events. For example, adjustment disorder with depressed mood occurs in response to a stressful life event, such as the loss of a loved one or a major life change. Substance/medication-induced depressive disorder is characterized by depressive symptoms arising from the use or withdrawal of certain substances or medications (American Psychiatric Association, 2022). Depression encompasses a range of distinct conditions, each with unique features and characteristics. The DSM-5 outlines several types of depression based on specific diagnostic criteria (Table 16.2).

Type Definition
Major depressive disorder (MDD) Persistent feelings of sadness or a lack of interest in previously enjoyed activities
Symptoms must last at least two weeks
Persistent depressive disorder (dysthymia) Less severe than MDD but chronic, lasting for at least two years; there may be periods of improvement involved, but these periods last no longer than two months
Seasonal affective disorder (SAD) Occurs at a specific time of year, usually in the winter months
Perinatal depression Affects some women before or after giving birth; symptoms include extreme sadness, anxiety, and exhaustion, making it difficult for the new mothers to complete daily care activities for themselves or for others
Table 16.2 Types of Depression

Incidence of Depression

According to the World Health Organization (WHO), as of 2023, almost 280 million people of all ages suffer from depression worldwide (World Health Organization, 2023). This pervasive condition is more prevalent in women than men, with studies indicating that approximately one in three women will experience a major depressive episode in their lifetime compared to one in five men (American Psychiatric Association, 2022). In the United States, the incidence of depression is particularly striking. According to the National Institute of Mental Health (NIMH), in 2020, approximately twenty-one million adults in the United States, or roughly 8.4 percent of the adult population, had at least one major depressive episode in the past year (NIMH, 2020a).

Despite the high incidence of depression, many people suffering from the condition do not receive appropriate treatment. For example, the WHO reports that less than 75 percent of those affected receive adequate treatment (World Health Organization, 2023). This lack of treatment may be due to various barriers, including the stigma associated with mental health disorders, a lack of available resources, and insufficient training of health-care professionals in mental health.

The COVID-19 pandemic brought about unprecedented challenges to the global population, and its effects on mental health have been profound. Children and teenagers, a demographic historically resilient to many stressors, have been noticeably affected. They faced disruptions in their daily routines, including school closures, limited social interactions, and changes in familial dynamics due to economic hardships or health concerns. Studies have indicated an increase in symptoms of anxiety and depression among this group. For instance, Loades et al. (2020) found that young people who were already at risk of anxiety were particularly vulnerable to the effects of social isolation, leading to heightened symptoms. Furthermore, there have been concerns about the long-term effects on academic progress, social skills, and emotional development (Loades et al., 2020).

Unfolding Case Study

Depression: Part 2

See Depression: Part 1 for a review of the client data.

Nursing Notes 1940: Ongoing Assessment
The client is in bed and does not come out for dinner. He is awake and is not sleeping. When the PCT rounds and reminds him of dinner, he states, “I am not hungry.” He reports to the nurse that he has no energy, but is unable to sleep and has been having disrupted sleep for the past several days. Prior to that he was sleeping fourteen hours a day.
1255: Intervention
Assess for suicide
Promote nutrition
Promote sleep
2330: Ongoing Assessment
The client remains awake in bed, and on rounding the nurse notices he is tearful. He states that he just wants to die.
Provider’s Orders 1:1 observation
Meal supplement
Trazodone 50 mg HS PRN

Based on the recognized cues, the nurse determines the client has symptoms that could indicate suicide risk, insomnia, and poor nutrition. The nurse anticipates that this is due to depression, anxiety, or insomnia. Designate which condition the cue is associated with.

Cue Depression Anxiety Insomnia
Poor sleep
Low appetite
Low mood
Suicidal ideation
What cue would the nurse give priority to in the planning of care for this client?
  1. risk of suicide
  2. insomnia
  3. poor nutrition
  4. lack of energy

Possible Causes of Depression

Depression is a complex condition arising from various interrelated genetic, biological, environmental, and psychological factors. Genetic factors play a significant role in the development of depression. Research indicates that individuals with a family history of depression have a higher likelihood of experiencing the condition themselves, suggesting a hereditary component.

Alterations in brain structure and function, along with imbalances in neurotransmitters, such as serotonin, norepinephrine, and dopamine, are known to be associated with depression. The neuroendocrine system has also been implicated in depression; chronic stress can lead to dysregulation in the system, leading to increased production of cortisol, which has been linked to depression.

Environmental factors, including exposure to trauma, abuse, neglect, or stressful life events, can also trigger the onset of depression. Such circumstances can lead to an emotional response that overwhelms an individual’s capacity to cope, leading to depression.

Lastly, psychological factors, such as personality traits, are significant contributors. For example, individuals with a tendency toward negative thinking or low self-esteem are more susceptible to depression (American Psychiatric Association, 2022).

Symptoms of Depression

Depression is characterized by a collection of symptoms that affect an individual’s mood, physical health, and cognitive functioning. According to the DSM-5, the primary symptoms of major depressive disorder include a persistent feeling of sadness or a lack of interest or pleasure in almost all activities. These core symptoms must be present most of the day, nearly every day, for at least two weeks for a diagnosis (American Psychiatric Association, 2022). For diagnosis, the person has to experience five or more symptoms outlined in the DSM-5 during a two-week period. These include:

  • depressed mood for most days
  • decreased interest in pleasure in all or most activities
  • significant weight gain or loss
  • insomnia or hypersomnia
  • psychomotor agitation or retardation nearly every day
  • fatigue or loss of energy
  • feelings of worthlessness
  • diminished ability to concentrate
  • recurrent thoughts of death or recurrent suicidal ideation (MDCalc, 2024)

Depression often manifests through emotional, cognitive, and physical symptoms. Therefore, individuals experiencing depression typically report persistent feelings of sadness, emptiness, or hopelessness and may display anhedonia, which is a marked disinterest or lack of pleasure in activities they once enjoyed. Additionally, significant changes in weight or appetite (either increase or decrease), sleep disturbances (including insomnia or hypersomnia), anergia, which is a pervasive sense of fatigue or loss of energy, and feelings of worthlessness or disproportionate guilt are common. Cognitive impairments, such as difficulties with concentration, decision-making, and recurrent thoughts of death or suicidal ideation, may also be present. In some cases, individuals might endure somatic complaints without clear medical origins, further highlighting the comprehensive impact of depression on one’s well-being (American Psychiatric Association, 2022).

The severity and frequency of these symptoms can vary widely among individuals. Some clients experience most or all of these symptoms, while others only experience a few. Additionally, the manifestation of these symptoms can be influenced by the individual’s cultural context and may present differently across different cultures (American Psychiatric Association, 2022). Culture plays a pivotal role in shaping how depression is experienced, expressed, and understood in different populations. Cultures differ in their norms and values regarding emotional expression, coping mechanisms, familial roles, and perceptions of mental health (Mental Health First Aid, 2019). For instance, in some cultures, depression might not be articulated in terms of sadness but rather in terms of physical symptoms or spiritual afflictions. Additionally, certain cultures may value stoicism or suppress emotional displays, which can influence the presentation and diagnosis of depressive symptoms. In other cultural settings, mental health challenges might be stigmatized, deterring individuals from seeking appropriate help or disclosing their feelings. Consequently, understanding the cultural nuances and putting the client’s symptoms in the context of their own culture are paramount for clinicians to ensure accurate diagnosis, culturally sensitive interventions, and effective therapeutic outcomes (Salchi, 2022). Furthermore, in older adults, depression may present with somatic complaints, such as fatigue, sleep disturbances, or unexplained physical ailments, rather than the classic mood disturbances seen in younger populations.

Clinical Judgment Measurement Model

Recognizing and Analyzing Cues: CJMM Clients with Depression

The National Council of State Boards of Nursing (NCSBN) Clinical Judgment Measurement Model (CJMM) offers a structured approach to developing clinical judgment in nursing students, encompassing five layered aspects: recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, and taking action, followed by evaluating outcomes (National Council of State Boards of Nursing, 2019). When applied to a client experiencing depression, this model can serve as a useful guide for nursing students.

In the “recognizing cues” phase, nursing students should be alert to both overt and subtle signs of depression, including mood changes, social withdrawal, or shifts in daily routines. Physical symptoms, such as fatigue or changes in appetite, can also be indicative of an underlying depressive disorder (World Health Organization, 2023).

The “analyzing cues” phase involves assessing the significance of these cues. Students should consider whether the observed signs are isolated or persistent, as well as their severity and impact on the client’s well-being. At this stage, it is important to differentiate symptoms of depression from those of other possible conditions, like anxiety disorders or medical illnesses (American Psychiatric Association, 2022).

Treatment of Depression

Depression is a multifaceted condition that requires a comprehensive, multimodal treatment approach. According to the American Psychiatric Association (2022), first-line treatment options for major depressive disorder generally include pharmacotherapy, psychotherapy, or a combination of the two.

Pharmacotherapy, primarily involving antidepressant medications, is an essential component of treatment. Psychotherapy, including CBT and IPT, has been shown to be effective in treating depression (Cuijpers et al., 2014). Lifestyle modifications, including regular exercise, a balanced diet, adequate sleep, and social support, also help to manage depression and improve overall well-being. For clients with severe or treatment-resistant depression, additional interventions, such as ECT, transcranial magnetic stimulation (TMS), or ketamine infusion may be indicated (Pradhan et al., 2015).

ECT is a procedure where controlled electric currents are passed through the brain, intentionally triggering a brief seizure, which is thought to cause a rapid increase in neurotransmitters, alleviating depressive symptoms (Mayo Clinic, 2018). TMS, on the other hand, uses magnetic fields to stimulate nerve cells in the brain in the motor cortex and improve symptoms of depression. It is a noninvasive procedure that targets specific areas of the brain associated with mood (NIMH, 2016). Lastly, ketamine infusion, a dissociative anesthetic, has shown rapid antidepressant effects, even in clients suffering from treatment-resistant depression. The mechanism behind its antidepressant effect is believed to be related to its ability to restore synaptic connections in the brain (Sanacora et al., 2017). While these treatments can be effective, they come with specific risks and considerations, requiring careful assessment and monitoring by health-care professionals (NIMH, 2016).


Pharmacotherapy is a critical component in managing major depressive disorder, often used as first-line treatment or in combination with psychotherapy. SSRIs and SNRIs are both classes of antidepressant medications found to be effective in the treatment of depression (Cipriani et al., 2018). SSRIs work by selectively inhibiting the reuptake of serotonin, a neurotransmitter associated with mood, sleep, and appetite (Chu & Wadhwa, 2021). Commonly prescribed SSRIs include fluoxetine, paroxetine, and citalopram. SNRIs, on the other hand, inhibit the reuptake of both serotonin and norepinephrine, another neurotransmitter linked to mood and alertness. Examples of SNRIs include venlafaxine, duloxetine, and desvenlafaxine (Fanelli et al., 2021). SSRIs and SNRIs are frequently used due to their effectiveness and tolerable side effects (Cipriani et al., 2018). The decision to use an SSRI over an SNRI, or vice versa, depends on the client’s specific symptoms, the side effect profile that is acceptable to the client, and any other comorbid conditions. For instance, SNRIs might be preferred for clients with chronic pain conditions because of the role of norepinephrine in pain modulation (Robinson et al., 2022). Additionally, for clients who do not respond adequately to SSRIs, switching to an SNRI might be beneficial (Tundo et al., 2015).

These medications typically take several weeks to reach their full effect, and individual responses may vary. Combining an SSRI with another serotonergic agent can cause a rare but potentially life-threatening condition called serotonin syndrome, characterized by agitation, fever, rapid heartbeat, muscle stiffness, and hallucinations (Scotton et al., 2019). Serotonin syndrome is a medical emergency.

For clients who do not respond to or cannot tolerate SSRIs or SNRIs, other options include atypical antidepressants, like bupropion or mirtazapine, and older classes of medications, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs). One of the major concerns with TCAs is their potential for toxicity in overdose. Even a small overdose can be fatal due to cardiac toxicity and central nervous system depression (Moraczewski & Aedma, 2020). MAOIs are one of the oldest classes of antidepressant medications, initially introduced in the 1950s for the treatment of depression. While effective, they are generally used as a last resort due to their more significant side effect profiles and potential for severe drug and food interactions (Cleare et al., 2015). Hypertensive crisis can occur when foods high in tyramine (e.g., aged cheeses, cured meats, fermented foods) are consumed while taking an MAOI. This results from the inhibition of intestinal and liver MAO-A, which normally metabolizes dietary tyramine. Accumulated tyramine can then induce excessive norepinephrine release, leading to a sharp rise in blood pressure (Gillman, 2018).

Antipsychotics may be utilized as an adjunctive treatment in cases of treatment-resistant depression (Rybakowski, 2023). The choice of medication depends on the individual’s specific symptoms, the side effect profile of the medication, the presence of any other psychiatric or medical conditions, and the individual’s response to medication (Stroup & Gray, 2018). More recently, ketamine and esketamine have shown promise for treatment-resistant depression, although this treatment requires more research (Popova et al., 2019). These medications affect the primary excitatory pathway within the CNS that is responsible for cognition, memory, learning, emotion, and mood (Halaris & Cook, 2023). Table 16.3 lists the common medications used to treat depression.

Class Examples Mode of Action Side Effects
Selective serotonin reuptake inhibitors Fluoxetine (Prozac)
Sertraline (Zoloft)
Citalopram (Celexa)
Inhibit uptake of serotonin, thus increasing levels of serotonin in the brain Agitation, anxiety, nausea, dizziness, blurred vision, lowered libido
Serotonin and norepinephrine reuptake inhibitors Venlafaxine (Effexor)
Duloxetine (Cymbalta)
Inhibit uptake of serotonin and norepinephrine, increasing the levels of serotonin and norepinephrine in the brain Nausea, diarrhea, decreased libido, erectile dysfunction, weight gain, dizziness, drowsiness, headache, insomnia, serotonin syndrome
Tricyclic antidepressants (TCAs) Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Affect several neurotransmitters in the brain, including serotonin and norepinephrine Dry mouth, blurred vision, constipation, orthostatic hypotension, weight gain, sexual dysfunction, increased risk of seizures, toxicity in overdose
Monoamine oxidase inhibitors (MAOIs) Phenelzine (Nardil)
Tranylcypromine (Parnate)
Inhibit the breakdown of norepinephrine, serotonin, dopamine, and tyramine, thus increasing their levels and allowing them to continue to influence the cells that have been affected by depression Orthostatic hypotension, dizziness, drowsiness, insomnia, sexual dysfunction, weight gain, hypertensive crisis
Atypical antidepressants Bupropion (Wellbutrin) Shifts the levels of dopamine and norepinephrine in the brain Gastrointestinal issues, orthostatic hypotension, sedation, weight loss, sexual dysfunction, increased risk of seizures
Mirtazapine (Remeron) Increases the levels of serotonin and norepinephrine in the brain Drowsiness, sexual dysfunction, weight gain
Antipsychotics Aripiprazole (Abilify)
Quetiapine (Seroquel)
Olanzapine (Zyprexa)
Augment the therapeutic effects of antidepressants when they alone have proven insufficient in treating depressive symptoms Weight gain, elevated blood sugar levels, metabolic syndrome, increased lipid profiles, tremors, akathisia, dystonia, sedation
Table 16.3 Medications Used to Treat Depression (Moraczewski & Aedma, 2020; Rush, 2024; Sub Laban & Saadabadi, 2019)

Psychosocial Considerations

Psychosocial Factors Affecting Depression

It is essential to remember that psychosocial factors play a significant role in the onset, course, and recovery from depression. These factors include the individual’s social environment (such as relationships with family, friends, and coworkers), their psychological resources (such as coping skills and resilience), and the cultural context within which they live.

Depression often impacts and is impacted by these psychosocial factors. For example, a person with depression may withdraw from their social network, leading to feelings of isolation that can exacerbate their depressive symptoms. Additionally, ongoing stressors, such as financial difficulty or relationship problems, can contribute to the development and persistence of depression. Understanding and addressing these psychosocial factors is crucial to the treatment of depression (Remes et al., 2021).

Psychotherapeutic Approaches to Treating Depression

There are several psychotherapeutic approaches that are effective in treating depression, such as CBT and IPT (American Psychological Association, 2019). CBT works by helping individuals identify and change negative thought patterns and behaviors that may contribute to their depression. At the same time, IPT focuses on improving interpersonal relationships and social functioning, both of which are often impaired in individuals with depression. In addition, research has shown that mindfulness-based cognitive therapy (MBCT) can help prevent relapse in individuals with recurrent depression by teaching them mindfulness skills to disengage from habitual depressive thoughts (White, 2015). Group therapy, family therapy, and other supportive therapies can also be beneficial, particularly in cases where social support and relationship issues play a role in the onset or maintenance of depression (American Psychological Association, 2019).

Clinical Safety and Procedures (QSEN)

Client-Centered Care for Clients with Depression

Quality and Safety Education for Nurses (QSEN) underscores the importance of applying the six competencies in delivering client-centered care, particularly when treating conditions such as depression. Client-centered care demands that health professionals acknowledge clients as individuals with unique needs and respect their values and choices about their care (QSEN Institute, 2020).

Provide client-centered care for depression in a respectful, nonjudgmental, empathic manner to ensure dignity, decrease the stigma associated with depression, and promote better health outcomes. This care involves actively involving clients in their care plans and decision-making processes. The nurse should conduct a thorough assessment, considering the client’s emotional, mental, and physical health, lifestyle, social factors, and personal beliefs about health and treatment. Then, the care team should establish a personalized care plan that reflects the client’s preferences and respects their autonomy. This care plan might include a variety of interventions like psychotherapy, pharmacotherapy, self-management strategies, and complementary therapies, if suitable (American Psychological Association, 2019).

Communication is also a vital part of client-centered care. Nurses should provide clear, jargon-free explanations about the nature of depression, available treatments, possible side effects, and the expected course of recovery. Encourage clients to voice their concerns, ask questions, and express their views about their disorder and course of treatment. Moreover, recognize that families and caregivers are crucial members of the care team. They should be involved in care decisions and given proper education and support to understand and cope with the client’s condition.

Planning Nursing Care for a Client with Depression

A comprehensive care plan for a client with depression begins with a holistic assessment of the client, including physical, emotional, and mental health, along with psychosocial factors, such as support systems and lifestyle factors. It is important to assess the client’s risk of self-harm or suicide and take appropriate safety precautions.

The management of a depressed client with self-harm potential presents significant safety challenges that must be carefully addressed. A depressed client may exhibit various forms of self-harm behaviors, such as cutting, burning, or ingesting harmful substances, often as a maladaptive coping strategy for emotional pain or distress (SAMHSA, 2023b). In these cases, a comprehensive safety plan is essential and should include thorough risk assessment, close monitoring, and environmental modifications. This may involve removing items that could be used for self-harm, such as sharp objects, from the client’s vicinity (SAMHSA, 2020a). Medications prescribed should be carefully selected, ideally opting for those with a lower risk of lethality in case of overdose (Carpenter et al., 2021). Clients should be closely monitored for the warning signs of self-harm or increasing emotional distress (SAMHSA, 2020a).

Establish specific, measurable, achievable, realistic, and timely (SMART) goals in collaboration with the client. For example, these goals could involve managing symptoms, enhancing coping strategies, improving function in daily activities, or engaging in social interactions (Smith, 2018). Tailor interventions to the individual’s needs and preferences. These might include facilitating therapeutic communication, promoting self-care activities, assisting with symptom management, advocating for treatment adherence, educating about depression and its management, and coordinating care with other health-care professionals. Evaluate the care plan regularly to monitor the client’s progress and adjust the plan as necessary. The ultimate goal is to support the client in managing depression, improving their quality of life, and preventing relapse.

Clinical Safety and Procedures (QSEN)

Applying Client-Centered Care to a Client with Depression

Client: John, a thirty-five-year-old male

Presenting issue: John has been feeling persistently sad, tired, and disinterested in activities that he usually enjoys for the past two months. In addition, he reports significant difficulty sleeping and a loss of appetite, which resulted in a ten-pound weight loss over the last month. John was admitted to an inpatient psychiatric unit after expressing feelings of worthlessness and reports that he has had recurrent thoughts of suicide, though he denies any specific plan or intent.

Past medical history: No significant past medical history.

Family and social history: John is single and lives alone. His father committed suicide at forty-two when John was a teenager. John has a stable job but admits that he has been missing work because he “just can’t get out of bed.” He has no significant history of substance use.

Diagnosis, risk factors, nursing interventions, evaluation: John’s symptoms align with the criteria for MDD as defined by DSM-5. Persistent sadness, loss of interest or pleasure, significant weight loss, insomnia, fatigue, feelings of worthlessness, and recurrent thoughts of death or suicide are indicative of this condition (American Psychiatric Association, 2022).

John’s risk factors include a family history of depression and suicide (his father), living alone (potential social isolation), and possibly work-related stress.

Nursing interventions for John may include regular safety assessments given his suicidal ideation; facilitating therapeutic communication to provide emotional support and encouragement; promoting self-care activities, such as regular physical activity, a healthy diet, and adequate sleep; educating John about depression and its management; supporting medication adherence, if prescribed; and coordinating care with other health-care professionals, such as a psychiatrist or psychologist (Cleare et al., 2015).

The overarching goal of John’s treatment is to alleviate his depressive symptoms, reduce suicidal ideation, and equip him with coping skills for his reintegration into the community. Evaluating the success of John’s care in an inpatient psychiatric unit necessitates a multifaceted approach and may include the following measures:

  • Clinical assessment: Repeated use of standardized clinical scales like the Hamilton Depression Rating Scale (HDRS). A significant reduction in scores could indicate treatment efficacy (Rush et al., 2021).
  • Behavioral indicators: Observe for behavioral changes, such as increased engagement in activities, improved sleep, better appetite, and increased social interaction, which can be positive signs of treatment efficacy (Rost et al., 2023).
  • Medication review: Ensure that John’s medication regimen has been effective in treating his symptoms without causing intolerable side effects. Adjustments in medication may demonstrate attentive care, but may also suggest that they have not yet found the optimal treatment (Informed Health, 2020).

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