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NSG 221 Mood Disorders Summary

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This is a comprehensive and detailed summary on;Mood Disorders and Treatment Approaches: A Nursing Perspective. An Essential Study Resource just for YOU!!

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  • February 20, 2025
  • 6
  • 2023/2024
  • Summary

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Summary
Mood disorders interfere with a person’s life, plaguing the individual with drastic
and long-term sadness, agitation, or elation. Accompanying self-doubt, guilt, and
anger alter life activities, especially those that involve self-esteem, occupation, and
relationships. The primary mood disorders are major depressive disorder and bipolar
disorder (formerly called manic-depressive illness). A major depressive episode lasts
at least 2 weeks, during which the person experiences a depressed mood or loss of
pleasure in nearly all activities.
Several related mood disorders exist;&one example is&Premenstrual dysphoric
disorder is a severe form of premenstrual syndrome and is defined as recurrent,
moderate psychological and physical symptoms that occur during the week before
menses and resolving with menstruation. Psychosocial stressors and interpersonal
events appear to trigger certain physiological and chemical changes in the brain,
which significantly alter the balance of neurotransmitters. Genetic studies implicate
the transmission of major depression in first-degree relatives who are at twice the
risk for developing depression compared with the general
population. Neurochemical influences of neurotransmitters (chemical messengers)
focus on serotonin and norepinephrine as the two major biogenic amines implicated
in mood disorders. Elevated glucocorticoid activity is associated with the stress
response, and evidence of increased cortisol secretion is apparent in about 40% of
clients with depression, with the highest rates found among older clients. One
psychodynamic theory example is: Children raised by rejecting or unloving parents
are prone to feelings of insecurity and loneliness, making them susceptible to
depression and helplessness.

Major depression is twice as common in women and has a one-and-a-half to three
times greater incidence in first-degree relatives than in the general population. An
untreated episode of depression can last from a few weeks to months or even years,
though most episodes clear in about 6 months. Some people have a single episode
of depression, while 50% to 60% will have a recurrence of depression.
Approximately 20% will develop a chronic form of depression.
Electroconvulsive Therapy (ECT) involves application of electrodes to the head of
the client to deliver an electrical impulse to the brain; this causes a seizure. It is
believed that the shock stimulates brain chemistry to correct the chemical
imbalance of depression. Generally, a minimum of six treatments are needed to see
sustained improvement in depressive symptoms. Maximum benefit is achieved in
12 to 15 treatments. The goals of combined therapy are symptom remission,
psychosocial restoration, prevention of relapse or recurrence, reduced secondary
consequences such as marital discord or occupational difficulties, and increasing
treatment compliance.
The Hamilton Rating Scale for Depression is a clinician-rated depression scale used
like a clinical interview. The clinician rates the range of the client’s behaviors, such
as depressed mood, guilt, suicide, and insomnia. There is also a section to score
diurnal variations, depersonalization (sense of unreality about the self), paranoid
symptoms, and obsessions. Some nursing interventions for clients suffering from

, depression include: Provide for the safety of the client and others, institute suicide
precautions if indicated, begin a therapeutic relationship by spending non-
demanding time with the client, and/or promote completion of activities of daily
living by assisting the client only as necessary.
 Major depression is a mood disorder that robs the person of joy, self-esteem,
and energy. It interferes with relationships and occupational productivity.
 Symptoms of depression include sadness, disinterest in previously
pleasurable activities, crying, lack of motivation, asocial behavior, and
psychomotor retardation (slow thinking, talking, and movement).
 Sleep disturbances, somatic complaints, loss of energy, change in weight,
and a sense of worthlessness are other common features.

Medications are the primary therapy for major depression.& These drugs fall into five
major classes: selective serotonin reuptake inhibitors (SSRIs),
serotonin/norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants
(TCAs), monoamine oxidase inhibitors (MAOIs), and atypical antidepressants. All of
these classes are equally effective, as are the individual drugs within each class.
Thus, differences among these drugs relate mainly to side effects and drug
interactions. The risk for suicide may increase as clients begin taking
antidepressants. Although suicidal thoughts are still present, the medication may
increase the client’s energy, which may allow the client to carry out a suicide plan.
 SSRIs are considered to be first-line medications in the treatment of
depression because they have a more favorable side effect profile (e.g., GI
symptoms, sexual dysfunction, CNS stimulation, and increased risk of GI
bleeding).
 SNRIs are similar to SSRIs in terms of therapeutic effects but exhibit more
anticholinergic, CNS sedation, and cardiac conduction abnormalities.
 TCAs, second-line medications in the treatment of depression, produce a high
incidence of adverse effects (e.g., sedation, orthostatic hypotension, cardiac
dysrhythmias, anticholinergic effects, and weight gain).

 MAO inhibitors are used in the treatment of depression only if other
antidepressants are not effective; there is a high incidence of food and drug
interactions that potentially lead to hypertensive crisis.
 The nurse must carefully instruct clients receiving MAOIs to avoid foods
containing tyramine because the combination produces a hypertensive crisis
that can become life-threatening.
 Serotonin syndrome, a serious and sometimes fatal reaction characterized by
hypertensive crisis, hyperpyrexia, extreme agitation progressing to delirium
and coma, muscle rigidity, and seizures, may occur due to combined therapy
with an SSRI or SNRI and an MAO inhibitor or other drug that potentiates
serotonin neurotransmission. An SSRI or SNRI and an MAO inhibitor should
not be given concurrently or within 2 weeks of each other. Fluoxetine,

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