Major Depressive Disorder is a mood disorder characterized by symptoms like depressed mood, feelings of hopelessness, decreased interest in activities, and social withdrawal. It often occurs concurrently with other psychiatric diagnoses and is influenced by biological, genetic, environmental, and psychological risk factors. Signs include loss of pleasure or interest, changes in appetite, sleep, and energy, feelings of worthlessness, difficulty concentrating, and suicidal thoughts. Nursing diagnoses for those with Major Depressive Disorder focus on safety, communication, decision making, roles, and mood. Treatment involves medication, psychotherapy, social support, and ensuring a safe environment.

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Major Depressive Disorder
Description
A mood disorder may include symptoms of depressed mood, feelings or hopelessness and
helplessness, decreased interest in usual activities, disinterest in relationship with others
or cycles of depression and mania.
Depression is often concurrent with other psychiatric diagnoses. Almost have of clients
with major depressive disorders have histories of non-mood psychiatric disorders.
A high incidence exists for persons with chronic illness or prolonges hospitalization or
institutional care.
Risk Factors
1. Biological factors – brainchemicals
2. Family genetics – parent with depression, child 10-13% risk of depression.
3. Gender – higher rate for women
4. Age – often less than 40 when begins
5. Marital status – more frequently single, widowed
6. Season of year – Seasonal Affective Disorder (SAD) occurs when client experiences
recurrent depression that occurs annually at the same time.
7. Psychological influences – low self-esteem, unresolved grief.
8. Environmental factors – lack of social support, stressful life events.
9. Medical co-morbidity – clients with chronic or terminal illness, postpartum, and current
substance abuse are especially prone to becoming depresses.
Signs and Symptoms
1. Sexual disinterest
2. Suicidal and homicidal ideations
3. Decrease in personal hygiene
4. Tearfulness, crying, and melancholy
5. Altered thought process; difficulty concentrating, self-destructive behavior.
6. Loss of energy or restlessness
7. Anhedonia or loss of pleasure
8. Gain or loss of weight
9. Anger, self-directed
10. Psychomotor retardation or agitation
11. Insomnia or hypersomnia
12. Feelings of hopelessness, worthlessness, and helplessness.
Nursing Diagnoses

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Risk for violence, self-directed or directed at others
Impaired verbal communication
Decisional conflict
Altered role performance
Hopelessness
Deficit in diversional activity
Fatigue
Sel-care deficit
Altered thought processes
Self-esteem
Anxiety
Therapeutic Nursing Management
1. Safe environment
2. Psychological treatment
o Individual psychotherapy – long –term therapeutic approach or short term
solution-oriented, may focus on in-depth exploration, specific stress situations, or
problem solving.
o Behavioral therapy – modifying behavior to assist in reducing depressive
symptoms and increasing coping skills.
o Behavioral contacts – focus on specific client problems and need to help the client
resolve them.
3. Social treatment
o Milieu therapy – incorporates day to day living experiences in a therapeutic
environment to expect changes in perception and behavior.
o Family therapy – aimed at assisting the family cope with the client’s illness and
supporting the client in therapeutic ways.
o Group therapy – focuses on assisting clients with interpersonal communication,
coping, and problem-solving skills.
4. Psychopharmacologic and Somatic treatments
o Administer antidepressant medications
o Continued assessment by monitoring client’s mental health status is critical,
particularly interms of agitation and suicidal ideation.
o Electroconvulsive therapy
Nursing Interventions
1. Priority for care is always the client’s safety.
2. Use of behavioral contacts. Use this technique to meet outcomes relating to “no self-
harm” or no suicidal ideation or plan.
3. Assess regularly for suicidal ideation or plan.
4. Observe client for distorted, negative thinking.
5. Assist client to learn and use problem solving and stress management skills.
6. Avoid doing too much for the client, as this will only increase client’s dependence and
decrease self-esteem.

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7. The nurse’s role in the physical care of the client experiencing major depressive disorder
is to provide assessment and interventions related to appropriate nutrition, fluids, sleep,
exercise, and hygieme, and to provide health education.
8. Explore meaningful losses in the client’s life.
9. Help the client and family to identify the internal and external indicators of major
depressive disorder.