Depression is a complex mental health disorder that goes beyond persistent sadness. While initial understanding emphasizes symptoms and neurotransmitter imbalances, advanced psychiatric care involves recognizing treatment phases, specialized depression types, suicide risk assessment, and nursing interventions.
This comprehensive guide expands on Depression II, focusing on care priorities such as suicide prevention, ongoing treatment phases, and practical nursing approaches that improve patient outcomes.
Phases of Treatment for Depression
Depression management is typically divided into three key phases:
1. Acute Phase
- Aim: Reduce depressive symptoms and stabilize mood.
- Duration: 6–12 weeks.
- Interventions: Antidepressants, psychotherapy (CBT, IPT), and crisis management.
- Priority: Ensure patient safety, especially suicide risk monitoring.
2. Continuation Phase
- Aim: Prevent relapse after initial improvement.
- Duration: 4–9 months.
- Interventions: Maintain medication adherence, ongoing therapy, support groups.
- Priority: Reinforce coping skills and stabilize progress.
- Aim: Prevent recurrence of depressive episodes.
- Duration: 1 year or longer.
- Interventions: Long-term psychotherapy, regular follow-up, and structured lifestyle changes.
- Priority: Encourage resilience, long-term goal setting, and reintegration into daily life.
Types of Depression
1. Dysthymia (Persistent Depressive Disorder)
- Characterized by mild but long-term depressive symptoms (≥2 years).
- Patients often function daily but with chronic low mood and fatigue.
2. Seasonal Affective Disorder (SAD)
- Linked to reduced sunlight exposure in winter months.
- Symptoms: Fatigue, oversleeping, carbohydrate cravings, withdrawal.
- Treatment: Light therapy (exposure to a bright light source for 30–45 minutes daily).
3. Perinatal and Postpartum Depression
- Occurs during pregnancy or after childbirth.
- Risk factors: Hormonal changes, lack of support, history of depression.
- Requires early detection and therapy to ensure maternal and infant well-being.
Nursing Care: Suicide Risk as a Priority
One of the greatest concerns in depression is the risk of suicide. Nursing care emphasizes constant vigilance and therapeutic engagement.
Warning Signs of Suicide Risk:
- Sudden calmness after severe depression (increased risk period).
- Giving away prized possessions.
- Statements like “I can’t go on” or “It will all be over soon.”
- Rapid improvement in mood after prolonged sadness (may indicate decision to act).
Suicide Risk Assessment Questions:
- “Have you had any thoughts of hurting yourself?”
- “Do you have a plan to kill yourself?”
- “Do you want to die?”
Nursing Interventions (NCLEX Tips):
- Continuous one-to-one observation for high-risk patients.
- Semi-private room near nurses’ station.
- Remove harmful objects (sharp items, belts, medications).
- Supervise meals (utensils and medication checks).
- Reassess suicidal thoughts regularly.
- Encourage patients to set future-oriented goals involving family and friends.
Interventions in Depression Care
Effective interventions focus on therapeutic communication, daily living support, and structured activities.
Key Nursing Interventions:
- Encourage participation in activities and group therapy.
- Assist with ADLs (Activities of Daily Living): Help patients bathe, eat, and dress if needed.
- Spend time with the client: Sitting quietly can reduce feelings of isolation.
- Communicate directly and simply: Avoid vague reassurances; be honest and supportive.
- Frequent reevaluation: Track mood changes, medication effects, and risk levels.
Examples of Therapeutic Nursing Approaches:
- “I’d like to spend some time with you.” (direct, supportive communication).
- “I talked with my family about how we can celebrate holidays together.” (shows improvement in depression).
The Link Between Sudden Energy and Suicide
Paradoxically, a depressed patient who suddenly becomes more energetic may be at higher risk of suicide. This occurs because:
- Initially, severe depression limits energy and motivation.
- As treatment begins or mood suddenly shifts, the patient may now have the energy to act on suicidal thoughts.
Nurses must increase suicide precautions during this period.
Structured Programs and Long-Term Care
Saunders and Kaplan nursing frameworks emphasize that depression care must be structured, consistent, and interactive:
- Group activities promote socialization.
- Structured routines reduce decision-making stress.
- Long-term follow-ups prevent relapse.
- Family involvement strengthens support systems.
Quick Reference Table: Depression II in Psychiatric Care
| Category | Key Points |
|---|---|
| Phases of Treatment | Acute, Continuation, Maintenance |
| Types of Depression | Dysthymia, Seasonal Affective Disorder, Perinatal/Postpartum |
| Suicide Risk Signs | Sudden calmness, giving possessions, “I don’t want to live” statements |
| Nursing Priorities | One-to-one observation, remove harmful objects, constant reassessment |
| Therapeutic Interventions | Sit with client, simple communication, encourage ADLs, group therapy |
FAQs on Depression II
Q1: Why is suicide risk higher when a depressed patient suddenly becomes calm?
Because the patient may now have the energy to carry out suicidal plans.
Q2: What is the first nursing action when a patient admits to suicidal thoughts?
Provide direct one-to-one observation and remove harmful objects.
Q3: How is Seasonal Affective Disorder treated?
Through light therapy (30–45 minutes daily), along with psychotherapy or medications if necessary.
Q4: What role do nurses play in continuation and maintenance phases?
They reinforce adherence to therapy, encourage coping strategies, and monitor for relapse.
Q5: Can postpartum depression resolve on its own?
Mild "baby blues" may pass, but postpartum depression requires intervention to protect both mother and child.
