Mood Disorders Overview
Mood disorders involve disturbances in emotional state that affect daily functioning.
Mood disorders are a major category of psychiatric illness involving sustained changes in emotional state. They affect thinking, behavior, sleep, energy, and physical health. Mood disorders are among the most commonly tested psychiatric topics on the NCLEX-PN.
Two Main Categories
- Depressive Disorders
- Persistent low mood, loss of interest, and impaired functioning. Key examples: major depressive disorder (MDD), persistent depressive disorder (dysthymia), postpartum depression.
- Bipolar & Related Disorders
- Episodes of both depression and elevated mood (mania or hypomania). Key examples: bipolar I, bipolar II, cyclothymic disorder.
Neurotransmitters Involved
- Serotonin — low levels linked to depression; SSRIs increase serotonin availability
- Norepinephrine — low levels in depression, dysregulated in mania
- Dopamine — reduced in depression, elevated in mania
- GABA — the brain's main inhibitory neurotransmitter, involved in anxiety and mood
Mental health is a state of well-being where a person can cope with normal stresses, work productively, and contribute to community. Mental illness involves clinically significant disturbances in cognition, emotion, or behavior that impair functioning. Mental and physical health are connected — every psychological problem has physical effects, and every physical illness has psychological effects.
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Major Depressive Disorder (MDD)
Persistent low mood lasting at least 2 weeks with functional impairment.
Diagnostic Criteria
MDD requires 5 or more of the following symptoms present for at least 2 weeks, with at least one being depressed mood or loss of interest:
- Depressed mood most of the day, nearly every day
- Anhedonia — loss of interest or pleasure in activities
- Significant weight change (loss or gain) or appetite change
- Sleep disturbance — insomnia or hypersomnia
- Psychomotor agitation or retardation — observable by others
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Diminished concentration or indecisiveness
- Recurrent thoughts of death or suicidal ideation
Sleep changes · Interest loss (anhedonia) · Guilt · Energy loss · Concentration problems · Appetite changes · Psychomotor changes · Suicidal ideation. Need 5 of these PLUS depressed mood OR loss of interest, lasting 2+ weeks.
Risk Factors
- Family history of depression or other mood disorders
- Female sex (twice as common as in males)
- Chronic medical illness (heart disease, diabetes, cancer)
- Substance use
- Major life stressors (loss, trauma, divorce)
- Postpartum period
- Older adults (especially with isolation or chronic illness)
Nursing Interventions
- Safety
- Assess suicide risk on admission and every shift. Suicide is the most serious complication of depression.
- Basic Needs
- Monitor intake, output, weight, and sleep. Depression causes neglect of self-care, eating, and sleep.
- Activity
- Encourage simple, structured activities — one-step at a time. Complex tasks are overwhelming; small successes build self-esteem.
- Communication
- Sit with the client in silence; use open-ended questions. Demonstrates care without pressure to perform.
- Hygiene
- Assist with ADLs gently, increase independence as tolerated. Severely depressed clients may need full assistance initially.
- Medications
- Administer antidepressants, monitor for side effects. SSRIs are first-line; take 4-6 weeks for full effect.
Suicide risk increases when antidepressants start working — the client regains energy and motivation BEFORE depressive thoughts lift. They now have the energy to act on suicidal thoughts. Assess suicide risk frequently during this period. The black box warning on SSRIs in young adults specifically addresses this risk.
Bipolar Disorder I vs II
The presence and severity of mania is what separates them.
- Required Episode
- Bipolar I: At least one full manic episode (7+ days, or any duration requiring hospitalization). Bipolar II: At least one hypomanic episode (4+ days) PLUS at least one major depressive episode.
- Depression
- Bipolar I: May or may not have depressive episodes. Bipolar II: Major depressive episode is REQUIRED for diagnosis.
- Severity
- Bipolar I: More severe — may include psychotic features. Bipolar II: Less severe than mania; does NOT include psychosis.
- Hospitalization
- Bipolar I: Often required during manic episodes. Bipolar II: Usually not required for hypomania.
- Functional Impairment
- Bipolar I: Severe — cannot function normally during mania. Bipolar II: Hypomania may actually improve functioning temporarily.
- Risk
- Bipolar I: Risky behaviors with major consequences (financial, legal, sexual). Bipolar II: Periods of elevated mood without major impairment.
Distractibility · Irresponsibility (risky behaviors, spending sprees) · Grandiosity · Flight of ideas · Activity increase (psychomotor agitation) · Sleep decreased (without feeling tired) · Talkativeness (pressured speech). Need 3+ symptoms for mania.
Cyclothymic Disorder
- Numerous periods of hypomanic symptoms and depressive symptoms for 2+ years (1 year in children/adolescents)
- Symptoms do NOT meet full criteria for hypomania or major depression
- Considered a milder, chronic form of bipolar disorder
Nursing Care During Acute Mania
Safety, structure, and limit-setting are the foundation.
Priority Nursing Interventions
- Reduce environmental stimulation — private room if possible, dim lighting, quiet area, limit visitors
- Provide structure — consistent staff, simple schedule, clear expectations
- Set firm, consistent limits — brief and clear, without lengthy explanations or arguing
- Channel excess energy — allow pacing, walks, simple physical activities (NOT competitive games)
- Offer finger foods and high-calorie liquids — client is too restless to sit and eat full meals
- Encourage rest — quiet area, dim lighting; client may not realize they need sleep
- Protect the client from poor judgment — intervene with risky behaviors (financial, sexual, legal)
- Administer medications — mood stabilizers (lithium, valproate), antipsychotics for acute mania
Communication During Mania
- Use a calm, low voice — do not match the client's energy
- Keep statements short and concrete
- Avoid lengthy discussions — client cannot focus and is easily distracted
- Redirect the client from inappropriate or risky topics to safer activities
- Do NOT argue with grandiose statements; redirect instead
Do NOT engage in lengthy conversations — client cannot focus. Do NOT place in group therapy or stimulating activities. Do NOT play competitive games (escalates agitation). Do NOT argue, threaten, or punish. Do NOT take grandiose or insulting comments personally.
Suicide Assessment & Prevention
The most important psychiatric assessment a nurse performs.
Sex (male) · Age (older or adolescent) · Depression · Previous attempt · Ethanol/substance use · Rational thinking loss · Support lacking · Organized plan · No spouse · Sickness (chronic illness).
Assessment Questions (Most Important to Least)
Warning Signs That Suicide May Be Imminent
- Sudden calm after a period of severe depression — the client has decided and feels relieved
- Giving away possessions or saying goodbye to people
- Making a will or putting affairs in order
- Increased energy after starting antidepressants (weeks 1-4)
- Verbal cues — "Things will be better when I'm gone," "I won't be a burden much longer"
Priority Nursing Interventions for Suicidal Clients
- Active plan + means
- 1:1 constant observation, remove all means, do NOT leave alone, notify provider immediately
- Suicidal ideation
- Frequent checks (every 15 minutes), no-harm contract, restrict to unit, no sharps, monitor closely
- All clients with depression
- Assess suicide risk each shift; document specifically
Safety Environment
- Remove all potential means: sharps, cords, belts, shoelaces, plastic bags, medications
- Suicide-resistant rooms: no exposed pipes, breakaway shower bars, no looped fixtures
- Check belongings for contraband on admission
- Monitor when alone, especially in the bathroom (where most inpatient suicides occur)
- Watch for cheeking medications — clients may hoard pills to use later
One of the most persistent myths is that asking about suicide will plant the idea or make it more likely. Research clearly shows this is FALSE. Direct, compassionate questioning gives the client permission to talk about their feelings and often provides relief. Always ask directly: "Are you thinking about hurting or killing yourself?"
? A depressed client who has been withdrawn for weeks suddenly appears calm and says "I've figured everything out." What does this suggest?
Postpartum Mood Disorders
A spectrum from baby blues to psychosis — know the differences.
- Postpartum BluesBaby Blues
- Onset: day 2-3 after delivery. Resolves within 2 weeks. Mild tearfulness, mood swings, anxiety, fatigue. Mother CAN care for baby. Treatment: reassurance, rest, social support. NO medications needed.
- Postpartum Depression
- Onset: within 4-6 weeks (can occur up to 1 year). Lasts > 2 weeks. Hopelessness, severe fatigue, difficulty bonding, intrusive thoughts about baby, possible suicidal ideation. Treatment: antidepressants (sertraline preferred if breastfeeding), psychotherapy, EPDS screening.
- Postpartum Psychosis
- Onset: within 2 weeks of delivery. Psychiatric emergency. Hallucinations, delusions (often about the baby), disorganized thinking, risk of harm to baby or self. Treatment: hospitalization REQUIRED, antipsychotics, mood stabilizers. NEVER leave mother alone with baby.
Edinburgh Postnatal Depression Scale (EPDS)
- 10-item self-report screening tool given at postpartum visits
- Score of 10 or higher warrants further assessment
- Item 10 specifically asks about self-harm — any positive answer requires immediate evaluation
Unlike the blues or even depression, postpartum psychosis includes a loss of touch with reality, often featuring delusions involving the baby. The risk of infanticide and suicide is real. The mother must be hospitalized, and she should NEVER be left alone with the baby until the psychosis resolves. This typically begins suddenly within 2 weeks of delivery.
Grief & Loss
Normal grief follows a process — know the stages and how to support clients.
Kubler-Ross Five Stages of Grief
- 1. Denial
- "This can't be happening." Refusal to accept reality. Protective initially. Nursing: Do not force acceptance. Allow time. Provide truthful information gently when client is ready.
- 2. Anger
- "Why me?" Directed at family, providers, God, or the deceased. Often the most uncomfortable for staff. Nursing: Allow expression. Do NOT take personally. Recognize anger as healthy progress, not failure.
- 3. Bargaining
- "If only I had..." Negotiation, often with a higher power. Nursing: Listen without judgment. Avoid offering false hope or quick reassurance.
- 4. Depression
- Sadness, withdrawal, regret. Realizing the full reality of the loss. Nursing: Sit in silence with the client. Do not rush them. Assess for suicide risk.
- 5. Acceptance
- Coming to terms with reality. Calmer state. Nursing: Support reintegration. Acknowledge the work the client has done.
Anger is a NORMAL and necessary stage. It allows release of painful emotional energy. The nurse should not take it personally and should not try to reason the client out of their anger. Anger is a sign the client is moving through grief, not stuck in it. Skipping anger often leads to longer, more complicated grief later.
Normal vs Complicated Grief
- Normal grief: intense feelings improve over months; client gradually returns to functioning
- Complicated grief: persistent intense longing, inability to accept the loss, dysfunction lasting beyond 6-12 months
- Anniversary reactions: temporary return of grief symptoms around the anniversary of the loss is normal
Key Medications for Mood Disorders
High-yield medication content commonly tested on the NCLEX-PN.
Antidepressants
- SSRIs1st line
- Sertraline (Zoloft), fluoxetine (Prozac), escitalopram (Lexapro), paroxetine (Paxil), citalopram (Celexa). Onset: 4-6 weeks. Side effects: GI upset, sexual dysfunction, insomnia. Do NOT stop abruptly — discontinuation syndrome.
- SNRIs
- Duloxetine (Cymbalta), venlafaxine (Effexor). Also treats anxiety and neuropathic pain. Similar side effects to SSRIs. Can raise BP.
- TCAs
- Amitriptyline, nortriptyline, imipramine. Older class. Strong anticholinergic effects (dry mouth, urinary retention, constipation, drowsiness). Risk of fatal overdose. Cardiac effects.
- MAOIs
- Phenelzine, tranylcypromine, isocarboxazid. Tyramine-restricted diet required. Risk of hypertensive crisis with aged cheese, cured meats, wine, beer. Drug interactions are extensive.
- Atypical
- Bupropion (Wellbutrin), mirtazapine (Remeron), trazodone. Bupropion: no sexual side effects, helps smoking cessation, contraindicated in seizure disorders. Mirtazapine: causes weight gain and sedation (helpful in depression with weight loss/insomnia).
Mood Stabilizers
Ranges vary by lab, facility, and textbook — for exams, use the range given in the question. See the full NCLEX-PN lab-value reference & sources →
- Lithium
- Therapeutic range: 0.6-1.2 mEq/L (acute mania: up to 1.5). Maintain consistent sodium and fluid intake. Toxicity signs: tremor, GI upset, ataxia, confusion. Hold and notify provider if level > 1.5. Monitor thyroid and renal function.
- Valproate (Depakote)
- Therapeutic range: 50-100 mcg/mL (up to ~125 for acute mania). Monitor liver function, platelets. Contraindicated in pregnancy (teratogenic — neural tube defects).
- Carbamazepine (Tegretol)
- Therapeutic range: 4-12 mcg/mL. Risk of agranulocytosis (low WBC). Monitor CBC. Avoid grapefruit juice (CYP3A4 inhibitor).
- Lamotrigine (Lamictal)
- Not routinely monitored. Risk of Stevens-Johnson syndrome — rash requires immediate discontinuation. Titrate slowly.
Serotonin Syndrome
Caused by too much serotonin (combining SSRIs with MAOIs, St. John's Wort, tramadol, triptans). Signs: hyperthermia, agitation, tremor, hyperreflexia, diaphoresis, tachycardia, confusion. Treatment: stop all serotonergic agents, supportive care, cyproheptadine. Wash-out period of 2-5 weeks required when switching between SSRIs and MAOIs.
? A patient on lithium presents with tremor, nausea, and confusion. Lithium level is 1.8 mEq/L. What is the priority action?
Frequently Asked Questions
Common student questions on this topic.
What is the difference between major depression and bipolar disorder?
What are the priority assessments for a suicidal patient?
What are the signs of a manic episode?
How is depression treated and how long does it take to work?
What is the difference between dysthymia and major depressive disorder?
What is the difference between baby blues, postpartum depression, and postpartum psychosis?
Quick-Reference Cheatsheet
Every key point from this guide on a single printable page.
Mood Disorders Cheatsheet
One-page PDF — free download.