Depression is one of the most common and disabling psychiatric conditions worldwide, affecting millions of people across all age groups. Its impact is not just emotional but also physical, social, and economic. Effective psychiatric care for depression goes beyond medications and counseling—it often requires advanced interventions like Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), and Vagus Nerve Stimulation (VNS).
This article provides a comprehensive review of psychiatric nursing care for depression, focusing on nutritional support, therapeutic procedures, and evidence-based clinical practices. The discussion is framed with insights from HESI, NCLEX, ATI, Kaplan, and Saunder’s exam perspectives, making it highly useful for nursing students, medical aspirants, and healthcare professionals preparing for board exams.
Depression and Nutritional Care
Why Diet Matters in Depression
One of the hallmark symptoms of depression is rapid weight loss or weight gain, often due to poor appetite, refusal to eat, or binge eating. Malnutrition worsens fatigue, cognitive decline, and treatment response. Hence, nutritional interventions play a critical role in psychiatric care.
Key Nursing Interventions for Diet in Depression
- Encourage small, frequent meals instead of large portions.
- Provide high-calorie, high-protein foods and fluids to maintain weight and strength.
- Stay with the client during meals to encourage eating and reduce isolation.
- Monitor weekly weight for accurate evaluation of nutritional progress.
Clinical Example:
A depressed patient refusing meals may benefit from being offered a milkshake, protein-rich snacks, or smoothies throughout the day instead of three large meals.
Exam Insight
HESI and Saunder’s exam questions often test the most reliable evaluation of nutritional outcomes, which is weekly weighing rather than appetite reporting.
Psychiatric Procedures in Depression
1. Electroconvulsive Therapy (ECT)
ECT is one of the most effective treatments for severe depression, particularly when patients are unresponsive to medications or at risk of suicide.
Mechanism:
ECT induces controlled generalized seizures by applying electrical stimulation to the scalp. This resets brain chemistry, similar to jumpstarting a car battery or hard resetting an iPhone.
Treatment Course:
- Duration: 6–12 treatments
- Frequency: 2–3 sessions per week
- Each seizure: lasts 15–20 seconds
2. Transcranial Magnetic Stimulation (TMS)
TMS uses magnetic fields to stimulate brain neurons without inducing seizures. It is non-invasive, outpatient-based, and associated with fewer cognitive side effects compared to ECT.
Indication:
- Moderate depression unresponsive to first-line antidepressants.
- Patients who cannot tolerate ECT or medications.
3. Vagus Nerve Stimulation (VNS)
VNS involves implanting a device that stimulates the vagus nerve, which influences mood-regulating brain areas. It is primarily used for treatment-resistant depression.
Nursing Care for ECT
Before ECT
1. Screen Medical History and report risks such as:
- Recent myocardial infarction
- Cerebral neoplasm
During ECT – Equipment Checklist
- Cardiac monitor
- Oxygen
- Suction machine
- Crash cart
After ECT
- No driving during the treatment course.
- Monitor for temporary confusion and short-term memory loss (most common side effect).
- Provide reassurance that memory loss is temporary.
Exam Tip:
NCLEX often tests on remembering that memory loss is a common side effect of ECT.
Side Effects of ECT
| Side Effect | Frequency | Notes |
|---|---|---|
| Memory loss | Common | Usually temporary |
| Confusion | Less common | Resolves post-treatment |
| Headache | Occasional | Managed with analgesics |
| Muscle soreness | Occasional | Due to induced seizure |
| Cardiovascular risks | Rare | Contraindicated in recent MI |
Integrating ECT, TMS, and VNS in Depression Care
Each of these therapies plays a unique role depending on the severity, patient history, and treatment resistance.
ECT: Gold standard for severe, suicidal, or medication-resistant depression.Depression Care: A Holistic Approach
Beyond procedures, psychiatric care requires a multidimensional approach that includes:
Dietary interventions (to correct malnutrition).FAQs on Depression Psychiatric Care
Q1. What is the most common side effect of ECT?
The most common side effect is temporary memory loss, which usually improves after treatment completion.
Q2. Why are anticonvulsants withheld before ECT?
Because anticonvulsants prevent seizures, which defeats the purpose of ECT.
Q3. How does TMS differ from ECT?
TMS is non-invasive and does not induce seizures, whereas ECT involves controlled seizures.
Q4. Can patients drive during ECT therapy?
No, patients should avoid driving during the course of ECT due to risks of confusion and impaired memory.
Q5. What is the best way to monitor nutrition in a depressed patient?
Weekly weighing is the most reliable method.
