Depression and Mood Disorders

Definition: Depression is characterized by a sad or despondent mood and a loss of interest in usual activities. Common symptoms include:
- Lack of energy
- Psychomotor retardation or agitation
- Sleep disturbances (insomnia, hypersomnia)
- Abnormal eating patterns
- Feelings of despair, guilt, hopelessness
Risk Factors:
- History of abuse, neglect, or loss
- Dysfunctional family relationships
- Personal or family history of mental illness and substance abuse

No definitive prevention methods:
- Regular exercise and a proper diet
- Sufficient rest
- Avoiding drugs and illicit substances
- Client education on recognizing symptoms and seeking help

Major Depressive Disorder (MDD):
- Affects the individual’s emotional state, with feelings of sadness, discouragement, hopelessness.
- Somatic complaints such as fatigue, decreased energy.
- Symptoms can include anhedonia, changes in appetite, sleep disturbances, feelings of guilt and worthlessness.
Persistent Depressive Disorder (Dysthymic Disorder):
- Chronic depression lasting most days over at least 2 years with no more than 2 months symptom-free.
- Symptoms are generally less severe than MDD.
Seasonal Affective Disorder (SAD):
- Related to seasonal changes, particularly in winter.
- Treatment includes light therapy and medications such as Buproprion.

Diagnosis:
- No definitive diagnostic test; relies on medical history and physical exam.
- Diagnosis by a licensed mental health provider.
Pharmacologic Therapy:
- Antidepressants may involve trial and error.
- Medications should be maintained until the client is symptom-free, with slow discontinuation.
- Psychotherapy is often recommended alongside medication, especially for mild depression. Cognitive-behavioral therapy (CBT) is shown to be particularly effective.

SSRIs (Selective Serotonin Reuptake Inhibitors):
- 1st line treatment for depression with fewer side effects. Common side effects include:
- GI distress (nausea, vomiting)
- CNS effects (headaches, nervousness)
- Sexual dysfunctions
- Risk of serotonin syndrome if combined with other serotonin-acting medications.
Tricyclic Antidepressants (TCAs):
- Block reuptake of norepinephrine and serotonin. Side effects include sedation, orthostatic hypotension, and risks for toxicity.
Monoamine Oxidase Inhibitors (MAOIs):
- Less commonly used, MAOIs can treat atypical depression but require dietary restrictions due to the risk of hypertensive crisis when tyramine is ingested.
Atypical Antidepressants:
- Alternatives like Bupropion. Despite being second-line, they have fewer side effects and cater to multiple issues (depression, smoking cessation).

Systematic evaluation focusing on:
- Mental status, psychological functioning, physiological status
- Signs of depression including somatic complaints, suicidal ideation, and comorbidities.

Goals for clients may include:
- Remaining free from self-injury
- Engaging in recreational activities
- Complying with the treatment regimen.

Maintain a neutral and supportive approach to foster self-esteem, encourage recreational activities, and help clients set achievable goals.
Begin discharge planning with the first contact to ensure continuity of care.

Expected outcomes include:
- Clients meeting daily needs
- Absence of suicidal ideation
- Description of hopefulness and engagement in normal activities such as work or school.

Implementing strategies to ensure client safety, such as:
- Removal of harmful objects
- Close monitoring and written contracts regarding behaviors.

At Risk Groups:
- Adolescents, elderly, those with chronic or painful illnesses, and previous suicide attempts.

A nurse monitors for urinary retention and constipation in a client with major depression knowing they may arise from psychomotor retardation and medication effects (Option B).