Core features are depressed mood and anhedonia lasting at least two weeks, most of the day nearly every day.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with major depressive disorder is scheduled for electroconvulsive therapy (ECT). After ECT, the nurse expects the client to have:
Answer: B. After ECT, expect transient confusion and short-term memory loss that resolve. Reorient the client, ensure safety, and reassure that memory effects are usually temporary.
Question 2 of 5
A client in the depressive phase of bipolar disorder remains in bed, avoids interaction, and shows poor hygiene. Which nursing intervention is appropriate?
Answer: B. For a severely depressed client, the nurse should spend time with the client and provide structured, simple activities and assistance with hygiene, building a trusting relationship without overwhelming demands. Forcing immediate cheerful socializing or withholding attention is non-therapeutic.
Question 3 of 5
A client experiencing a major depressive episode is unable to make even simple decisions, such as what to wear or eat. Which nursing approach is most appropriate?
Answer: B. Severe depression impairs concentration and decision-making. Offering simple, structured choices or making minor decisions for the client reduces overwhelming stress while maintaining dignity. Demanding independent decisions or presenting many options increases distress.
Question 4 of 5
A client newly admitted for substance use disorder says, "I can quit any time I want, I just choose not to." Which defense mechanism is the client demonstrating?
Answer: A. Minimizing the problem and insisting one can stop at will reflects denial, a common defense in substance use disorder in which the person refuses to acknowledge the reality or severity of the problem. Projection blames others, rationalization makes excuses with logical-sounding reasons, and regression is reverting to earlier behavior. The therapeutic approach is nonjudgmental and reality-based.
Question 5 of 5
A client recovering from substance use disorder says, 'I had one drink, so I've failed completely.' The nurse recognizes this as:
Answer: B. This all-or-nothing thinking is a cognitive distortion and a lapse, not total failure; relapse can be part of recovery. Support the client to re-engage with the plan rather than confirming hopelessness.
Keep the streak going with more questions like these, each with a full rationale.
What is major depressive disorder?
It involves dysregulation of serotonin, norepinephrine, and dopamine. Memory aid SIG E CAPS: Sleep changes, loss of Interest, Guilt/worthlessness, low Energy, poor Concentration, Appetite changes, Psychomotor changes, Suicidality.
Key points to remember
- Core features are depressed mood and anhedonia lasting at least two weeks, most of the day nearly every day.
- Vegetative signs include insomnia or hypersomnia, appetite/weight change, fatigue, and psychomotor agitation or retardation.
- Feelings of worthlessness, excessive guilt, hopelessness, and difficulty concentrating are common.
- Suicidal ideation is a hallmark concern and must be directly assessed.
- Risk of suicide can paradoxically rise as energy returns early in treatment before mood fully lifts.
- Antidepressants (SSRIs first-line) take 2 to 6 weeks for full therapeutic effect.
Signs & symptoms
- SIG E CAPS mnemonic
- Anhedonia, ↓ mood, hopeless
- Sleep/appetite change, fatigue
Nursing priorities
- Assess directly for suicidal ideation, plan, means, and intent at every contact and ensure safety first.
- Establish a trusting relationship and spend time with the client even when they are withdrawn or silent.
- Promote basic needs: nutrition, hydration, sleep hygiene, and personal hygiene/ADLs.
- Set small achievable goals and gradually increase activity to counter psychomotor slowing.
- Monitor for the lag period of antidepressants and watch closely as energy returns.
Labs & values
Patient teaching
- Take antidepressants consistently and do not stop abruptly; full effect takes several weeks.
- Avoid alcohol and report any worsening mood or suicidal thoughts immediately.
- Report symptoms of serotonin syndrome and avoid combining with other serotonergic drugs without provider approval.
Red flags: report now
- A client who suddenly becomes calm, gives away possessions, or has increased energy after starting antidepressants may have decided on suicide.
- Verbalized plan, intent, or access to lethal means requires immediate one-to-one observation and provider notification.
- Serotonin syndrome (hyperthermia, agitation, hyperreflexia, diaphoresis) from SSRI use must be reported immediately.
References
Clinical references for this topic
