Conditions › Mental health
Major Depressive Disorder Nursing Care Plan and Interventions
Depression nursing care starts with asking directly about suicide, and risk can rise as energy returns on treatment. Antidepressants take weeks to work; watch for serotonin syndrome and teach MAOI food rules when they apply.
Major depressive disorder nursing care plan
| Nursing problem | Goal | Key interventions |
|---|---|---|
| Risk for suicide | Stays safe; tells staff about suicidal thoughts. | |
| Hopelessness | Joins care and states one goal. | |
| Risk for medication harm | Serotonin syndrome or interactions caught early. |
Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.
What it is
Major depressive disorder
A treatable mood disorder of persistent sadness or lost interest and pleasure. Linked to serotonin, norepinephrine and dopamine changes. 1
Not a bad week or a weakness: it changes how a person feels, thinks and acts.
Diagnosis: the 2-week rule
At least 5 symptoms, most of the day, nearly every day, for 2 weeks or more. One must be low mood or loss of interest (anhedonia). 1,2
Rule out medical and substance causes before calling it depression.
Postpartum depression
Depression after birth lasting over 2 weeks, more severe than baby blues. Blues: tearful, tired days that clear on their own by 2 weeks. 3,4
Hallucinations or delusions after birth point to postpartum psychosis: an emergency.
Assessment: what you will see
Cues
Sleep and appetite changes, weight change, fatigue, worthlessness or guilt, poor concentration, thoughts of death. 1
Older adults may report aches, tiredness or poor sleep more than sadness.
Complications and red flags
Energy returns first
Early in treatment, energy can come back before mood and suicidal thoughts lift. The client may now have the energy to act. 5
More energy and giving belongings away after weeks in bed? Ask directly about suicide now.
Serotonin syndrome
Excess serotonin, usually from combining serotonergic drugs: agitation, fever, fast heart rate, stiff muscles, clonus. An emergency. 1,6,2
Never combine an SSRI with an MAOI.
Priority: what the nurse does first
Safety first: ask about suicide
Assess suicide risk in every client with depression. Ask directly about thoughts, a plan and means. Asking does not plant the idea. 1,5
"Are you thinking about killing yourself?" Plain words, asked calmly.
Nursing interventions and treatment
Nursing care
Small, specific goals set with the client, support for self-care, food and sleep, and a calm, steady presence. 1
"Will dress and eat breakfast in the dining room by day 3" is a measurable goal.
SSRIs and SNRIs first
First-line drugs. SSRIs: fluoxetine, sertraline, citalopram. SNRIs: venlafaxine, duloxetine. Common: nausea, sexual side effects. 1,6
Tricyclics are used less: even a small overdose can be fatal.
Antidepressants take weeks
Benefit builds over several weeks, so the client keeps taking it daily. Never stop suddenly: a taper prevents discontinuation syndrome. 1,6
"Two weeks and I feel the same" is expected. Encourage the client to keep going.
Boxed warning: suicidality
All antidepressants carry a boxed warning: more suicidal thoughts and behavior in children, teens and young adults (24 and younger). 7
Watch every client closely in the first few months and after any dose change.
MAOIs and tyramine
MAOIs (phenelzine, tranylcypromine) plus tyramine foods like aged cheese, cured meats or fermented foods cause hypertensive crisis. 1
A last resort because of these food and drug interactions.
ECT
Electroconvulsive therapy: a brief seizure induced under general anesthesia. For severe or treatment-resistant depression; works fast. 5,8
Expect brief confusion on waking and some memory loss. Helps when suicide risk is acute.
NCLEX traps
Depression vs bipolar
Depression: low mood or lost interest for 2+ weeks, with no history of mania. Bipolar: the same lows plus mania or hypomania. 9,6
Ask about past highs before an antidepressant: given alone, it can trigger mania in bipolar disorder.
Keep studying major depressive disorder in NurseLingo Pro
Everything for major depressive disorder in one place. A free account gets 5 free opens of any condition; Pro opens all 277.
Test yourself: free mental health practice questions with answers and rationales.
Frequently asked questions
What are the priority nursing diagnoses for major depressive disorder?
Common nursing problems for major depressive disorder include risk for suicide; hopelessness; risk for medication harm. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.
What does the nurse do first for major depressive disorder?
Assess suicide risk in every client with depression. Ask directly about thoughts, a plan and means. Asking does not plant the idea.
What are some nursing interventions for patients with major depressive disorder?
Ask directly about suicide and keep the client safe. Build a trusting relationship, encourage small daily goals, nutrition and sleep, and give antidepressants as ordered. Teach that they take weeks to work and watch closely as energy returns, when suicide risk can rise.
More mental health
Sources
- OpenStax Psychiatric-Mental Health Nursing, 16.2
- merckmanuals.com
- OpenStax Maternal-Newborn Nursing, 20.1
- OpenStax Maternal-Newborn Nursing, 21.5
- OpenStax Psychiatric-Mental Health Nursing, 16.3
- OpenStax Psychiatric-Mental Health Nursing, 4.2
- dailymed.nlm.nih.gov
- OpenStax Psychiatric-Mental Health Nursing, 4.3
- OpenStax Psychiatric-Mental Health Nursing, 16.4
For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.