Major Depressive Disorder Nursing Diagnosis and Nursing Care Plan

Major Depressive Disorder Nursing Care Plans Diagnosis and Interventions

Major Depressive Disorder Nursing Care Plans Diagnosis and Interventions

Depression is a mood condition characterized by a constant feeling of sadness and lack of interest. It influences how a person feels, thinks, and behaves and may cause many emotional and physical issues.

It is commonly known as major depressive disorder or clinical depression. The patient could struggle to do routine daily duties and occasionally question the purpose of life.

Causes of Major Depressive Disorder

The pathophysiology of major depressive disorder is not yet clearly identified. However, there is a link between the following possible causes and the development of Major depressive disorder:

  • Neurotransmitters. Clinical and preclinical studies suggest that depletion in the central nervous system’s serotonin activity is a significant factor in Major depressive disorder and is also associated with reduced dopaminergic function.  The possibility of developing Major depressive disorder is common in people with inactive D1 dopamine receptors or with a malfunction in the mesolimbic dopamine pathway based on some theories. Other neurotransmitters related to the development of Major depressive disorder (DA) are glutamate, brain-derived neurotrophic factor, norepinephrine (NE), and dopamine.
  • Brain structures. Depression may occur in certain people due to brain abnormalities that impact mood. Studies on functional neuroimaging supported the theory that there is a connection between depression and decreased metabolic activity from the neocortical to limbic regions.
  • Aging. Depression is a diagnosable and controllable medical disorder, not a natural component of the aging process. However, depression is more likely to occur in older people. According to studies, endocrine changes accompany depression throughout the lifetime, some of which are specific to aging. Additionally, low testosterone contributes to depression in older men. Women with a history of depression are more likely to experience it following menopause, even though estrogen replacement therapy does not alleviate the condition.
  • Hormones. Depression may result from changes in the body’s hormone balance. Pregnancy, the postpartum period (the weeks and months following delivery), thyroid issues, menopause, and several other diseases can all cause changes in hormone levels.
  • Inherited traits. Depression is more common among patients whose biological relatives suffer from it than those who are not. Researchers continuously investigate the link between the development of depression and genes.

Types of Major Depressive Disorder

Healthcare practitioners classify depression based on its symptoms and causes. These occurrences frequently have no evident cause. For no identifiable reason, they can remain far longer in some patients than in others.

  • Bipolar depression. Patients with Bipolar depression experience alternate episodes of depressed mood and excessively high energy (manic). Patients might experience sadness, despair, or lack of energy during the depressed period.
  • Perinatal depression. Perinatal generally means around birth. Perinatal depression can happen throughout pregnancy and until one year after giving birth. Symptoms extend beyond “baby blues,” which produce little sadness, anxiety, or pressure.
  • Persistent depressive disorder. Dysthymia is another term for persistent depressive disorder. The symptoms of persistent depressive disorder are relatively mild than those of major depression. However, some patients might have PDD symptoms for up to two years.
  • Premenstrual dysphoric disorder. Premenstrual dysphoric disorder (PMDD) is premenstrual disorder (PMS). However, the symptoms are more severe than those of PMS and include intense depression, anger, and anxiety. Symptoms primarily affect women in the days or weeks before their menstrual cycle.
  • Psychotic depression. Severe depressive symptoms and hallucinations or delusions characterize psychotic depression. Delusions are unrealistic beliefs in things, whereas hallucinations include seeing, hearing, or being touched by objects that aren’t truly there.
  • Seasonal affective disorder. Seasonal depression, a seasonal affective disorder, typically begins in late fall or early winter. It frequently disappears in the spring and summer.

Signs and Symptoms of Major Depressive Disorder

While each person’s signs and symptoms may differ, the following are the most frequent manifestations of depression:

  • sadness, weeping, loneliness, or despair
  • irrational behavior, irritation, or frustration, even about simple matters
  • loss of enjoyment or enthusiasm in most everyday activities, including sex, hobbies, and sports
  • sleep disorders, such as insomnia or excessive sleeping
  • feeling worn out and feeling tired makes even minor chores more challenging.
  • weight loss and decreased appetite, or weight gain and increased desire for food
  • a feeling of uneasiness, anxiety, or fear
  • sluggish speech, posture, or other body movements
  • thoughts of failures from the past or self-blame, along with feelings of worthlessness or regret
  • having difficulty thinking, concentrating, making judgments, and remembering things
  • suicidal ideation, suicide attempts, or other suicidal behavior frequently or repeatedly
  • undiagnosed physical complaints like headaches or back pain

Complications of Major Depressive Disorder

Depression is a severe condition that can have a damaging effect on the patient and their family. Depression, if left untreated, often worsens, resulting in emotional, behavioral, and physiological issues that affect every aspect of life.

Some examples of depression-related complications are:

  • Obesity or excess weight can result in cardiovascular disease and diabetes. It’s no surprise that patients turn to food for relief during depressive periods. Some refer to this behavior as emotional eating. A major depressive condition can also disrupt appetite hormones, causing a person to consume far more than usual.
  • Physical ailment or pain. Physical discomfort and depression are closely linked. They share some neurotransmitters that serve as communicators between nerves. They also share parts of the same spinal cord and brain nerve pathways. A patient with depression may become more receptive to pain, and ongoing discomfort may exacerbate depression.
  • Abuse of alcohol or drugs. Both alcohol and drugs can influence how the minds and bodies function. A person is more prone to develop other mental health disorders, such as anxiety, when they misuse substances. The likelihood that they will commit suicide is higher if they have suicidal thoughts.
  • Issues on family, marriage, school, and work-related. A person with a major depressive disorder could struggle to concentrate or recall a word or someone’s name, which may occur between episodes of severe depression. Additionally, it may make it more challenging to carry out daily activities like job, study, and maintaining personal connections.
  • Suicidal ideations and attempts. During severe MDD symptoms, the patient may experience suicide ideation. The patient might try to slash or burn their skin, rip out the hair, or pick at scabs to cope with unpleasant emotions. The use of drugs and alcohol concurrently may increase the likelihood of a severe injury.
  • Medical disorders that cause premature mortality. Most people with major depressive disorder also have one or more chronic illnesses. Many of these conditions are manageable, even though no treatment exists. However, depression makes them more challenging to treat and manage.

Diagnosis of Major Depressive Disorder

  • Physical examination. The doctor may perform a physical exam and give health-related questions to the patient. Depression may be associated with an existing physical health condition in some circumstances.
  • Laboratory testing. For instance, the doctor might check the thyroid to see if it’s functioning properly or perform a complete blood count.
  • Psychiatric assessment. The mental health specialist will examine the signs, thoughts, and behavior patterns. The patient may be requested to answer a questionnaire to help the doctor make a proper diagnosis.
  • Imaging. Neuroimaging can shed light on the characteristics of a neurologic condition that may manifest as psychiatric symptoms. The doctor may recommend imaging procedures such as a CT scan and MRI of the brain if the differential diagnosis includes organic brain disease or hypopituitarism.
  • DSM-5. The mental health provider may obtain The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association to determine whether the patient meets the criteria for depression

Treatment for Major Depressive Disorder

There are numerous efficient treatments for major depressive disorder. Here is a closer analysis of the available depression treatments:

  • Medications. There are numerous varieties of antidepressants available, including those listed below. Discuss any potentially severe side effects with the doctor or pharmacist.
    • Selective serotonin reuptake inhibitors (SSRIs) are the commonly prescribed medication for depression. They can lessen the symptoms of moderate to severe depression, are generally safe, and have fewer adverse effects. SSRIs manage depression by elevating serotonin levels in the brain. Serotonin is one of the neurotransmitters, or chemical messengers, that connect brain nerve cells (neurons).
    • Atypical antidepressant. Atypical antidepressants work by changing chemical messengers (neurotransmitters) for brain cells to work and communicate with one another. Atypical antidepressants, like most antidepressants, treat depression by ultimately affecting changes in brain chemistry and interaction in brain circuitry known to control mood and assist in relieving depression.
    • Tricyclic and tetracyclic antidepressants. Commonly known as cyclic antidepressants, they were among the first produced antidepressant. They are practical, although antidepressants have mostly replaced them with lesser adverse effects. Cyclical antidepressants, on the other hand, may be a good alternative for some patients. In some situations, they treat depression when different medications are not effective.
    • Monoamine Oxidase Inhibitors. MAOIs are a potent class of antidepressants that manage depression by blocking the breakdown of the brain neurotransmitters serotonin, dopamine, and norepinephrine and facilitating their ability to control their mood.
  • Psychotherapy. It is a broad term for discussing depression and related difficulties with a mental health practitioner. Cognitive behavioral and interpersonal therapy are two types of psychotherapy that can help with depression. Additionally, the mental health specialist could suggest different kinds of therapies. The following benefits of psychotherapy:
    • Adapt to a crisis or other ongoing difficulties.
    • Find unhealthy, constructive ideas and behaviors and change them with healthy and optimistic thoughts.
    • Examine relationships and interactions, and establish beneficial ties with people.

Major Depressive Disorder Nursing Diagnosis

Nursing Care Plan for Major Depressive Disorder 1

Impaired Social Interaction

Nursing Diagnosis: Impaired Social Interaction related to changes in cognitive processes secondary to major depressive disorder as evidenced by dysfunctional interaction with family, friends, and others, expressed uneasiness in social settings, avoiding interaction with others, and making no eye contact.

Desired Outcomes:

  • The patient will state that they enjoy communicating with others in activities and one-on-one conversations to the same amount as before being depressed.
  • The patient will recognize the emotions that cause unsatisfactory social relationships.
  • The patient will communicate with friends, family, and friends.
  • The patient will take part in certain community social events.
InterventionRationale
Provide basic, low-concentration tasks (e.g., sketching, playing simple board Games).People with depression struggle with focus and memory. Activities with no “correct or wrong” or “winner or loser” lessen the chance that patients may criticize themselves.
Encourage the patient to verbalize their thoughts and the challenges they are experiencing.            The nurse will then be able to recognize and explain any potential causes for the patient’s difficulty in social interaction—for instance, the feelings of being unwanted or unlovable, as well as sexual insecurity.    
Engage the patient in simple motor activities that don’t require much focus (e.g., walking).These activities will help to reduce tension and improve mood.
Participate in one-on-one activities with the client when they are the most depressed.Increases the possibility of interactions while lowering anxiety levels.
Include the patient in team activities (e.g., group discussions, art therapy, dance therapy).Socialization reduces the Feeling of isolation. A sincere regard for others can increase a positive sense of self-worth.
Maximize the patient’s interactions with others throughout time (first one other, then two others, and others).Interaction with others diverts the patient’s attention away from themselves.  
Recommend self-help groups in the community to the client and family.Participants sharing their stories can provide significant support and understanding to the patient and family.

Nursing Care Plan for Major Depressive Disorder 2

Chronic Low Self-Esteem

Nursing Diagnosis: Low Self-Esteem related to neurophysiological imbalances secondary to major depressive disorder as evidenced by the inability to deal with events and hostile response to a positive review.

Desired Outcomes:

  • The patient will have a positive outlook on life and the capacity to enjoy the moment.
  • The patient will list two areas they wish to improve and four positive characteristics honestly and nonjudgmentally.
Major Depressive Disorder Nursing InterventionsRationale
Analyze the patient’s degree of self-esteem.Low self-esteem can show up as a withdrawal from social interactions, a feeling of inferiority, a disregard for personal appearance and grooming, and a rejection of oneself.
Let the patient perform personal care activities.Grooming is an essential first step toward developing a positive self-image
Compliment patients after completing a task.Positive reinforcement plays a vital role in self-esteem development.
Allow the patient to partake in basic recreational activities before moving on to more complex tasks in a group setting.The patient might initially feel overwhelmed when participating in a group activity.
Teach visual representations to help patients replace negative self-images with more positive content and ideas.Encourage the patient to make more realistic decisions about their ideas and behavior.
Motivate the client to participate in a group therapy session where the other participants experience similar circumstances or emotions.To lessen feelings of loneliness and provide an environment where supportive comments and a more accurate assessment of oneself are available.
Engage patients in activities they wish to enhance by employing their problem-solving abilities. Analyze and determine whether more instruction in this area is needed.Feelings of low self-esteem might inhibit problem-solving skills.
Collaborate with the client to discover misconceptions that promote negative self-evaluation.Cognitive biases promote unfavorable, incorrect perceptions of oneself and one’s surroundings.

Nursing Care Plan for Major Depressive Disorder 3

Disturbed Thought Processes

Nursing Diagnosis: Disturbed thought processes related to traumatic life experiences secondary to major depressive disorder as evidenced by incorrect assessment of the surroundings, memory issues/deficits, and reduced problem-solving abilities.

Desired Outcomes:

  • The patient will analyze the facts and make sound decisions.
  • The patient will correctly recall current and distant information.
  • The patient will demonstrate a well-organized thought process.
Major Depressive Disorder Nursing InterventionsRationale
Identify the patient’s prior level of cognitive capacity (from the patient, family members, and past medical records).Creating a baseline data set enables the evaluation of the patient’s development.
Make use of clear, precise terms.Slow thinking and trouble focusing impair the patient’s level of understanding
Give the customer ample time to reflect and organize their responses.Slower thinking requires more time to create a response.
Give the client more time than usual to complete daily routine tasks (ADLs) (e.g., eating, dressing).Typical tasks may take a long time; asking the patient to rush merely increases tension and slows the ability to think effectively.
Assist the patient in recognizing negative ideas and behaviors. Help the client learn how to challenge or reframe their opposing views.Negative thoughts are part of a depressed person’s flawed mental processes and contribute to feelings of helplessness. A healthier and more practical attitude toward life results from getting involved in this process.
Assist the client and family in creating a setting that can support the restoration of regular schedules and routines during severe depression.It is simpler to follow and remember a routine.  
Assist the customer in delaying major life decisions.Making sound life decisions necessitates excellent psychophysiological functioning.
Minimize patient responsibility while they are severely depressed.To reduce the patient’s feelings of guilt, anxiety, and stress.
Never introduce a competitive element in activities. The ideal activities promote one-on-one interaction with the nurse or therapist.Competitive actions pose a potential danger to suspicious patients.

Nursing Care Plan for Major Depressive Disorder 4

Risk for Self-directed Violence related to social isolation secondary to major depressive disorder.

Desired Outcomes:

  • The patient will ask for assistance if they feel the urge to hurt themselves.
  • The patient will exhibit behavioral manifestations of absent depression.
  • The patient will feel content with their current social situation and progress toward their personal goals.
Major Depressive Disorder Nursing InterventionsRationale
Determine the necessary level of suicide prevention measures. Does a hospital stay become required if the risk is high? Will the patient be safe to return home under the monitoring of a family member or friend if there is a low risk?A high-risk patient will demand consistent attention and a secure atmosphere.
Check to see if there is a sufficient supply of the necessary medications.Restrict access to medicine access for a patient with suicidal tendencies for 3-5 days.
Encourage clients to talk about their feelings, such as anger, grief, or guilt, and to think of alternative solutions to deal with negative emotions like anger and impatience.Patients can learn new coping mechanisms for dealing with intense emotions and feel more in control of their decisions.
Call the family and make arrangements for crisis counseling. Establish self-help group links.Patients require a collection of resources to lessen their feelings of worthlessness, isolation, and helplessness.
Hospitalized patients should observe unit protocols.Various measures are available for suicidal patients in the hospital, outpatients, and community.
Put in place a formal no-suicide contract.Reinforces the action the patient may perform if they are suicidal.

Nursing Care Plan for Major Depressive Disorder 5

Grieving related to anticipated loss secondary to major depressive disorder as evidenced by anger, alterations in the activity and immunological function, depression, disassociation, lack of coordination, and sleep disruption.

Desired Outcomes:

  • The patient will perform self-care routines at their or her own pace.
  • The patient will show progress in navigating the stages of grief on their timeline.
  • The patient will verbally express a feeling of improvement toward the resolution of hope and despair the next time.
Major Depressive Disorder Nursing InterventionsRationale
Talk with the patient about any losses that have occurred in their lives. Talk about the patient’s perspective.People frequently fail to comprehend the importance of a loss. They refuse to acknowledge or discuss their suffering, making it appear that everything is well. Denial requires both mental and physical energy. People who experience depression frequently do so when they are both emotionally and physically spent.  
Consider the patient’s cultural and religious practices about coping with their past losses.Religious tradition and cultural practices shape how individuals display and accept grief.
Allow the patient to identify and verbalize feelings and evaluate the relationship between the emotions and the incident.Patients who can express their emotions in a safe setting may find it easier to deal with unresolved issues which may contribute to their depression. It can also help the patient connect the Feeling to the incident.
Offer several approaches to identifying and resolving underlying feelings of rage, hurt, and rejection.It enables patients to consider more options for handling such a circumstance.
Explain to the patient the typical stages of grieving and help them understand the truth of associated emotions like guilt, rage, and helplessness.This approach enables the patient to identify common emotions and lessen some of the guilt that these emotions may have generated.
Help the patient identify the problem, acknowledge the need for an alternative approach, and fully detail every aspect of the problem.People must be clear about the issue before acknowledging needing to change.
Allow the patient to recognize early indicators of depression and ways to lessen these indicators. If the symptoms continue or worsen, recommend seeking other professional help.Actively involving the patient indicates they have options and are not helpless.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna Curran. RN, BSN, PHN

Anna Curran. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse.

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