NCLIP

Depressive Disorders

3 min read

Depressive Disorders

Key Points

  • Depressive disorders include persistent sadness and/or loss of interest with functional impairment.
  • Presentations vary by age group, culture, and comorbidity patterns.
  • Diagnosis is enhanced by specifier use (for example anxious distress, mixed features, melancholic, atypical).
  • Nursing care combines safety assessment, pharmacologic support, psychotherapy linkage, and self-management coaching.

Pathophysiology

Depressive disorders arise from interacting biologic, psychological, and social contributors. Neurotransmitter dysregulation, stress-system effects, cognitive distortions, and social isolation can reinforce persistent low mood and anhedonia.

Untreated depression increases risk for disability, chronic medical burden, and suicide.

Classification

  • Major depressive disorder: Episodic major depressive symptoms with significant impairment.
  • Persistent depressive disorder: Longer-term, often less intense but chronic depressive symptoms.
  • Specifier framework: Anxious distress, mixed features, melancholic, atypical, psychotic, catatonic, and rapid-cycling contexts.

Nursing Assessment

NCLEX Focus

Prioritize suicide-risk cues and functional decline before symptom-label refinement.

  • Assess mood, anhedonia, sleep/appetite, concentration, and guilt/worthlessness burden.
  • Assess active/passive suicidality, intent, means, and protective factors.
  • Assess age-related presentation differences (for example irritability in youth, somatic/cognitive focus in older adults).
  • Assess medical and medication contributors that can mimic or worsen depression.
  • Assess support systems, treatment barriers, and adherence readiness.

Nursing Interventions

  • Implement safety precautions and escalation when suicide risk is present.
  • Use empathic therapeutic communication and collaborative goal setting.
  • Support medication adherence, side-effect management, and psychoeducation.
  • Link clients to evidence-based psychotherapies (CBT, IPT, MBCT, DBT as indicated).
  • Promote sleep, activity, nutrition, and social-connection routines that support recovery.

Energy-Rebound Risk

Early treatment may improve energy before suicidal ideation resolves, increasing attempt risk if monitoring is weak.

Pharmacology

Common medication groups include SSRIs, SNRIs, atypical antidepressants, and adjunctive agents. Nursing monitoring should track efficacy, activation, side effects, adherence, and emergent suicidality during early treatment windows.

Clinical Judgment Application

Clinical Scenario

A client reports persistent sadness, insomnia, poor appetite, fatigue, and escalating passive death wishes after social withdrawal.

Recognize Cues: Core depressive cluster with suicide-risk warning features. Analyze Cues: Functional decline and hopelessness elevate near-term risk. Prioritize Hypotheses: Priority is safety stabilization and initiation of integrated depression treatment. Generate Solutions: Implement suicide precautions, medication/therapy plan, and support activation. Take Action: Start structured monitoring and client-centered treatment education. Evaluate Outcomes: Reassess suicidality, function, and symptom burden frequently.

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