Depression Nursing Management
On this page
Direct answer
Major depression is diagnosed when five or more symptoms — depressed mood, anhedonia, sleep and appetite change, guilt or worthlessness, fatigue, poor concentration, psychomotor change, and thoughts of death — persist for at least two weeks, with low mood or anhedonia mandatory. In Indian practice somatic complaints of body pain, weakness and burning sensations often mask the mood symptoms, so the nurse screens directly. The priority nursing action in every depressed patient is suicide risk assessment: asking about ideation, plan, means and past attempts does not plant the idea and is the single most protective step. Selective serotonin reuptake inhibitors are first line, take two to four weeks to act, and adherence teaching plus observation for self-harm frames most of the ward care.
What you must remember
- SIGECAPS: sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicidality — five for two weeks, one being mood or anhedonia.
- Suicide risk is highest in patients with a previous attempt, a concrete plan, access to means, substance use, social isolation, males over 45 and recent bereavement or loss; asking directly is protective and expected.
- Ward safety: remove cords, sharps and hoarded medicines; observe swallowing (cheeking of tablets is common before an attempt) and check the mouth afterwards; never leave a patient expressing intent alone.
- Vegetative care is treatment: small frequent favoured foods, hydration, sleep hygiene, assisted hygiene and grooming — depressed patients do not "snap out" of these by encouragement.
- SSRIs such as fluoxetine and sertraline are first line; therapeutic effect takes 2 to 4 weeks, so early dropout is the main cause of "drug failure" that nurses must counsel against.
- Serotonin syndrome: agitation, tremor, clonus, sweating and hyperthermia — stop the drug and support; milder discontinuation symptoms follow abrupt SSRI stop except with fluoxetine, whose long half-life tapers itself.
- Tricyclic antidepressants are lethal in overdose (widened QRS, arrhythmia) and monoamine oxidase inhibitors cause hypertensive crisis with tyramine foods — aged cheese, cured meat, beer, overripe bananas.
- Electroconvulsive therapy is used in severe, psychotic, or suicidal depression and in refusal of food: the nurse prepares like for anaesthesia — fasting, consent, empty bladder, dentures out, and after the procedure monitors airway, orientation and transient memory difficulty.
A typical exam case
A 48-year-old widow admitted after an overdose of sedatives keeps saying "everyone would be fine without me". The nursing sequence the examiners want: first, one-to-one observation and means restriction because a recent attempt is the strongest predictor of a completed one; second, a direct, calm risk interview — "do you have thoughts of harming yourself, have you thought how" — documented in the notes; third, medication administration with a mouth check since hoarding preceded the attempt. Only then do communication strategies appear: sitting with her through silence, scheduling small achievable activities, and involving the daughter in a no-lecture safety plan. When fluoxetine is started on day 2, teaching covers the two-to-four week lag, transient nausea, and the instruction not to stop when energy returns before mood does — the dangerous window in which energy to act on suicidal thoughts arrives first. If the stem escalates to refusal of food and fluids with psychotic guilt, the answer shifts to ECT, and the tested details are written informed consent, pre-procedure fasting with dentures and prostheses removed, and post-procedure orientation checks with reassurance about short-term memory blurring.
Where students slip
The commonest wrong answer is hesitation about asking directly about suicide, on the belief that it introduces the idea; the tested position is the opposite — direct questioning is the standard of care. Second slip: reassuring statements like "look at all you have to live for", which invalidate and shut down disclosure; correct options acknowledge feeling and stay with the patient. Third: assuming antidepressant effect should be immediate, which undermines adherence counselling on both patient and family fronts. Finally, the "energy returns before mood lifts" window in week two of SSRI treatment is the specific period MCQs flag for intensified observation.
Frequently asked questions
What is the first priority in nursing care of a depressed patient?
Safety: assessing suicide risk directly, restricting means, ensuring observed medication swallowing and one-to-one observation for active ideation.
When do SSRIs begin to show therapeutic effect?
Two to four weeks after starting, which is why early counselling about delayed benefit and continuation during apparent non-response is essential.
Which foods must a patient on monoamine oxidase inhibitors avoid?
Tyramine-rich foods — aged cheese, cured and fermented meats, beer, yeast extracts and overripe bananas — which can trigger hypertensive crisis.
Why is the second week of recovery considered high risk?
Energy and motivation often improve before mood does, giving a still-hopeless patient the capacity to act on suicidal thoughts.
How is the nurse prepared before electroconvulsive therapy?
Written informed consent, fasting as for anaesthesia, empty bladder, removal of dentures and prostheses, and a bite block and anaesthetist at the session.
What is serotonin syndrome?
Clonus, hyperreflexia, agitation, diaphoresis and hyperthermia from serotonergic excess; the drug is stopped and supportive care given.