Major Depressive Disorder: NCLEX Priorities
Depression: SSRI first-line, suicidality assessment, ECT for refractory.
Depression is common and tested heavily. NCLEX focuses on assessment, suicide screening, and meds.
Recognition
5+ symptoms × 2 weeks: depressed mood, anhedonia, sleep changes, appetite/weight changes, fatigue, concentration impairment, worthlessness/guilt, psychomotor changes, suicidal ideation.
Suicide assessment
Ask directly. Plan, means, intent. Means restriction. Safety contract not protective. Hospitalize for active plan with intent.
Treatment
SSRI first-line. 4-6 weeks for full effect. SNRI, atypical (bupropion). Therapy (CBT). ECT for refractory or severe.
Warnings
Early SSRI can increase suicidality in patients <24 (black box). Monitor first 4-6 weeks.
Frequently asked
Patient denies SI but family worried?
Family observations are data. Continue close monitoring.
ECT, anesthesia?
Yes, brief general anesthesia + neuromuscular blockade.
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