Title: Psychiatric Nursing Guide to Managing Depression
and Mood Disorders
Audience
● Psychiatric nurses in inpatient, outpatient, community, school, and home-health settings.
● New graduates to experienced clinicians seeking a comprehensive update.
Learning Objectives
● Accurately screen, assess, and triage depressive and mood disorders across the lifespan.
● Differentiate unipolar depression from bipolar spectrum conditions and other
medical/psychiatric mimics.
● Deliver trauma-informed, recovery-oriented, culturally responsive nursing care.
● Implement evidence-based psychoeducation, brief psychotherapies, medication
adherence support, and safety planning.
● Coordinate multidisciplinary care and leverage digital tools, care pathways, and quality
metrics.
Module 1. Foundations: Epidemiology, Definitions, and Lived Experience
● Scope
o Depression is among the top causes of disability worldwide.
o Lifetime prevalence: Major Depressive Disorder (MDD) ~15–20% (varies by
country).
o Bipolar disorder ~1–3% combined prevalence; cyclothymic disorder less
common.
● Core Definitions
o Major Depressive Episode (MDE): ≥2 weeks depressed mood or anhedonia plus
neurovegetative/cognitive symptoms causing distress/impairment.
o Persistent Depressive Disorder (Dysthymia): chronic depressive symptoms ≥2
years (≥1 year in youth).
o Bipolar I: at least one manic episode (≥1 week or requiring hospitalization).
o Bipolar II: at least one hypomanic episode (≥4 days) and at least one MDE; no
history of mania.
o Cyclothymia: at least 2 years of subthreshold hypomanic and depressive
symptoms.
o Specifiers: melancholic, atypical, psychotic features, peripartum onset, seasonal
pattern, mixed features, anxious distress, rapid cycling (bipolar).
● Lived Experience Perspective
o Emphasize person-first language; avoid labels (“a person living with depression”).
o Validate suffering; assess strengths and resilience.
o Address stigma and barriers (cost, transportation, cultural beliefs).
, ● Social Determinants of Health (SDOH)
o Housing, food security, employment, trauma exposure, discrimination,
o community safety.
o Nurses screen and connect patients to resources.
Module 2. Screening, Case-Finding, and Early Recognition
● Universal and Targeted Screening
o Primary care, ED, inpatient med-surg, perinatal clinics, oncology, neurology, pain
clinics.
● Validated Tools (selection)
o PHQ-2 → PHQ-9 (adults).
o GAD-7 for anxiety often comorbid.
o Columbia-Suicide Severity Rating Scale (C-SSRS) or ASQ for suicide risk.
o MDQ (Mood Disorder Questionnaire) for bipolar screening in depressed patients.
o Edinburgh Postnatal Depression Scale (EPDS) for peripartum.
o Geriatric Depression Scale (GDS).
o Child/Adolescent: PHQ-A; Columbia SSRS; PSC; SMFQ.
● Red Flags
o Psychotic features; catatonia; severe agitation or retardation;
dehydration/malnutrition; peripartum psychosis; high suicide risk;
intoxication/withdrawal; recent initiation or dose change of antidepressants in
young people.
● Nursing Workflow
o Step 1: Warm introduction, confidentiality, and limits.
o Step 2: Screen with PHQ-2; if positive, complete PHQ-9.
o Step 3: If PHQ-9 ≥10 or any item 9 > 0, perform suicide risk assessment
(C-SSRS).
o Step 4: If positive bipolar screen (MDQ), consult prescriber before starting
antidepressant monotherapy.
o Step 5: Document, notify prescriber, build monitoring plan.
and Mood Disorders
Audience
● Psychiatric nurses in inpatient, outpatient, community, school, and home-health settings.
● New graduates to experienced clinicians seeking a comprehensive update.
Learning Objectives
● Accurately screen, assess, and triage depressive and mood disorders across the lifespan.
● Differentiate unipolar depression from bipolar spectrum conditions and other
medical/psychiatric mimics.
● Deliver trauma-informed, recovery-oriented, culturally responsive nursing care.
● Implement evidence-based psychoeducation, brief psychotherapies, medication
adherence support, and safety planning.
● Coordinate multidisciplinary care and leverage digital tools, care pathways, and quality
metrics.
Module 1. Foundations: Epidemiology, Definitions, and Lived Experience
● Scope
o Depression is among the top causes of disability worldwide.
o Lifetime prevalence: Major Depressive Disorder (MDD) ~15–20% (varies by
country).
o Bipolar disorder ~1–3% combined prevalence; cyclothymic disorder less
common.
● Core Definitions
o Major Depressive Episode (MDE): ≥2 weeks depressed mood or anhedonia plus
neurovegetative/cognitive symptoms causing distress/impairment.
o Persistent Depressive Disorder (Dysthymia): chronic depressive symptoms ≥2
years (≥1 year in youth).
o Bipolar I: at least one manic episode (≥1 week or requiring hospitalization).
o Bipolar II: at least one hypomanic episode (≥4 days) and at least one MDE; no
history of mania.
o Cyclothymia: at least 2 years of subthreshold hypomanic and depressive
symptoms.
o Specifiers: melancholic, atypical, psychotic features, peripartum onset, seasonal
pattern, mixed features, anxious distress, rapid cycling (bipolar).
● Lived Experience Perspective
o Emphasize person-first language; avoid labels (“a person living with depression”).
o Validate suffering; assess strengths and resilience.
o Address stigma and barriers (cost, transportation, cultural beliefs).
, ● Social Determinants of Health (SDOH)
o Housing, food security, employment, trauma exposure, discrimination,
o community safety.
o Nurses screen and connect patients to resources.
Module 2. Screening, Case-Finding, and Early Recognition
● Universal and Targeted Screening
o Primary care, ED, inpatient med-surg, perinatal clinics, oncology, neurology, pain
clinics.
● Validated Tools (selection)
o PHQ-2 → PHQ-9 (adults).
o GAD-7 for anxiety often comorbid.
o Columbia-Suicide Severity Rating Scale (C-SSRS) or ASQ for suicide risk.
o MDQ (Mood Disorder Questionnaire) for bipolar screening in depressed patients.
o Edinburgh Postnatal Depression Scale (EPDS) for peripartum.
o Geriatric Depression Scale (GDS).
o Child/Adolescent: PHQ-A; Columbia SSRS; PSC; SMFQ.
● Red Flags
o Psychotic features; catatonia; severe agitation or retardation;
dehydration/malnutrition; peripartum psychosis; high suicide risk;
intoxication/withdrawal; recent initiation or dose change of antidepressants in
young people.
● Nursing Workflow
o Step 1: Warm introduction, confidentiality, and limits.
o Step 2: Screen with PHQ-2; if positive, complete PHQ-9.
o Step 3: If PHQ-9 ≥10 or any item 9 > 0, perform suicide risk assessment
(C-SSRS).
o Step 4: If positive bipolar screen (MDQ), consult prescriber before starting
antidepressant monotherapy.
o Step 5: Document, notify prescriber, build monitoring plan.
