Major Depressive Disorder
Diagnosis: 5+ symptoms for ≥2 weeks (SIG-E-CAPS: Sleep changes, Interest loss, Guilt/worthlessness, Energy loss, Concentration difficulty, Appetite changes, Psychomotor changes, Suicidality). Must include depressed mood or anhedonia. Prevalence: 7% adults; women 2× more likely. Biopsychosocial model: serotonin, norepinephrine, dopamine involvement.
Bipolar Disorder
Bipolar I: full manic episodes ± depressive episodes. Bipolar II: hypomanic + major depressive episodes (no full mania). Cyclothymia: hypomanic + depressive symptoms <2 years, not meeting full criteria. Mania: elevated/expansive/irritable mood, DIGFAST (Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity increase, Sleep decrease, Talkativeness) for ≥1 week.
Pharmacological Treatment
Depression: SSRIs first-line (fluoxetine, sertraline, escitalopram). SNRIs (venlafaxine, duloxetine). Monitor for serotonin syndrome (hyperthermia, agitation, tremors, diaphoresis). Bipolar stabilizers: Lithium (narrow TI — monitor levels 0.6–1.2 mEq/L, renal/thyroid function), Valproate (liver function, CBC), Lamotrigine (Stevens-Johnson syndrome risk — slow titration), Atypical antipsychotics (olanzapine, quetiapine).
Nursing Interventions
Depression: safe environment, therapeutic communication, consistent routine, activity scheduling, medication education, monitor for suicidality. Mania: low-stimulation environment, firm but non-confrontational limits, ensure nutrition/hydration (patients too busy to eat), monitor for aggression, monitor lithium levels and toxicity signs.
Suicide Risk Assessment
Use Columbia Suicide Severity Rating Scale (C-SSRS) or SAD PERSONS (Sex, Age, Depression, Previous attempt, Ethanol/substance, Rational thinking loss, Social support lacking, Organized plan, No significant other, Sickness). Always ask about: ideation, intent, plan, means (access to weapons/medications). Document and escalate as indicated.
Important Notes
- Lithium toxicity: signs include tremors (early), ataxia, confusion, seizures, cardiac arrhythmias — check levels before each dose.
- SSRIs have a "black box" warning: increased suicidality in children, adolescents, and young adults — monitor closely during first 4–8 weeks.
Clinical Tips
- Lithium is renally cleared — dehydration, NSAIDs, and low-sodium diet all increase lithium levels and risk toxicity.
- Antidepressants can trigger mania in undiagnosed bipolar patients — screen for bipolar before prescribing.
Summary
Mood disorders require accurate diagnosis, evidence-based pharmacotherapy, nursing interventions, and ongoing suicide risk assessment. A therapeutic nurse-patient relationship is foundational to all psychiatric nursing care.
