MH | Mood Disorders

1. Major Depressive Disorder (MDD)

• Core Concept: Requires ≥2 weeks of sad mood or anhedonia + ≥4 symptoms (weight/sleep changes, fatigue, guilt, poor concentration, suicidal thoughts).
• Priority Nursing: Directly assess suicide risk (plan, lethality, access). Promote ADLs by breaking tasks into small, concrete steps. Avoid being overly cheerful; use silence and active listening to build trust.
• Medications:
  • SSRIs (Fluoxetine, Sertraline): First-line. Side effects: sexual dysfunction, weight changes.
  • TCAs (Amitriptyline): High risk of lethality in overdose. Watch for anticholinergic side effects and orthostatic hypotension.
  • MAOIs (Phenelzine): Risk of fatal hypertensive crisis with tyramine. Requires 5-6 week washout before starting SSRIs to prevent Serotonin Syndrome.
  • Serotonin Syndrome: Life-threatening emergency causing confusion, hyperthermia, tachycardia, and muscle rigidity.

2. Bipolar Disorder (Mania)

• Core Concept: Mania involves ≥1 week of elevated/irritable mood, decreased sleep, pressured speech, flight of ideas, grandiosity, and high-risk behaviors.
• Priority Nursing: Set firm, nonjudgmental limits on intrusive behaviors to protect boundaries. Decrease environmental stimuli. Provide high-calorie, high-protein finger foods because manic patients will not sit down to eat.
• Medications:
  • Lithium: Narrow therapeutic index (maintenance 0.5-1.0 mEq/L, toxic >1.5 mEq/L). Early toxicity: N/V, diarrhea, weakness. Severe toxicity: ataxia, confusion, seizures. Patients must maintain consistent dietary salt and fluid (2L/day) intake.
  • Anticonvulsants: Valproic acid (monitor liver), Carbamazepine (monitor WBCs for agranulocytosis), Lamotrigine (monitor for rashes).

3. Suicide Risk & Emergencies

• Warning Signs: Giving away prized possessions, indirect statements ("I can't take it anymore"), or sudden calmness (indicating a decision to die has been made).
• Priority Nursing: Assume an authoritative role to keep the patient safe. Implement 1-to-1 constant observation for high-lethality risk. Remove hazardous items like belts and shoelaces.
• Critical Red Flag: Suicide risk significantly increases during the first few weeks of starting antidepressants. The drug provides the physical energy to carry out a suicide plan before the depressed mood actually improves.

4. Clinical Judgment & Exam Logic

• Safety First: Always assess suicidal ideation directly; do not ignore subtle hints.
• Communication: Avoid clichés ("things will get better"). Acknowledge and validate feelings. For mania, use short, simple sentences.
• ECT: Induces a therapeutic seizure. Safe for pregnant women/elderly. Post-ECT, expect mild confusion and short-term memory impairment.